What about the poor people who only have one hospital nearby that might not accept their insurance? What about people who go to a hospital that's in their network, but it turns out one of the many doctors was not? The people who have a time critical illness who can't afford to do the whole Free Market thing right after a accident?
How does anyone know that when they arrive somewhere the exact number of treatments needed to cure their illness? Are you expected to walk out of the hospital and refuse treatment because you've tabulated all of the prices for all of the services needed, then ask the ambulance to take you somewhere else?
The free market solution to health insurance simply does not work and it's insulting to see people suggest it time and time again. It ironically only works in heavily centralized areas where people actually have a choice, and not the more rural areas where hospitals are far more spaced out. There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency.
And that's assuming they didn't decide to go out of network the day before and delayed updating their database.
All of these only apply to time-critical procedures. Otherwise you should be able to use the doctor and hospital which is covered.
Let's assume that emergency medicine should be provided by cities in the same way as other emergency services like fire companies. What's the argument for doing it that way for all medical services, including the ones that are not time sensitive and allow you plenty of time to shop around and choose the provider with the best combination of price, distance, scheduling availability, etc.?
> There's far too many variables at play for even software engineers to manage unless you dedicate a significant amount of your free time to maintaining an excel spreadsheet of every hospital near you and their prices, formulate the exact cheapest plan on the fly according to your personal needs and can pull that out immediately when you have a medical emergency.
This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?
Because for a lot of people, there is no real choice involved. If there's one hospital around for hundreds of miles, they realistically don't have the option to go to one further out when their job expects them to be available for work every single day. Not to mention that requires every hospital to offer every service and to have every type of specialist for every type of disease.
Medical issues don't operate like a grocery store. You can't just walk into a hospital and choose between Name Brand MRI or Store Brand MRI. It requires a level of knowledge that most people don't have. It's knowledge I don't have! And something I'd prefer to never have to think about when I have other shit to deal with in real life.
> This is hardly the only circumstance where there are many variables. Should the government buy everyone the same car because there are so many different choices between prices and safety ratings and fuel economy and performance? How does that even help, since the solution space is the same and government knows less about your priorities than you do?
Your analogy falls apart because the government does make mandates for cars. Things like safety features. And you're trying to compare buying a car which is a fairly small subset of considerations for the average person versus trying to purchase medical assistance which is an incredibly wide field encompassing multiple types of examinations, surgeries, biopsies and more. When you're looking for a car, you have some properties of a car which are easily understandable. When you're searching for medical assistance, most people only vaguely know what's actually wrong.
Federal law requires employers to provide at least unpaid sick leave. That caps the premium a local hospital can charge over competitors at the loss of the day's wages and the travel costs, which are both dwarfed by the amount of money in medical expenses we're comparing them to for these bankruptcy-inducing procedures.
> Not to mention that requires every hospital to offer every service and to have every type of specialist for every type of disease.
Why would it require that? There are thousands of hospitals in the US. You don't need every hospital to do everything as long as there is some competition for any given thing.
And far away hospitals can provide competition even if people don't actually use them in practice. If it costs $1000 in travel and inconvenience to fly to another city for a procedure then people won't use a local hospital that tries to charge $10,000 more, so they charge only $900 more because it's all they can get away with. But that's only if there's price transparency -- if you can't find out ahead of time that it costs $10,000 more for the local hospital then people choose it anyway and there is no incentive for them to lower their prices, which is where we are now.
> You can't just walk into a hospital and choose between Name Brand MRI or Store Brand MRI. It requires a level of knowledge that most people don't have. It's knowledge I don't have! And something I'd prefer to never have to think about when I have other shit to deal with in real life.
And that option exists -- you buy an expansive low deductible insurance plan that covers everything. That necessarily comes at the cost of very high premiums, because it has to cover the cost of making you price-insensitive.
You can also buy a less expensive insurance plan that doesn't cover everything and then consider anything it doesn't cover as unavailable. That's what socialized systems generally do, because they do make people price-insensitive but still have budgetary requirements to meet. But there's no reason you can't get a private plan that does that either; just don't object when it doesn't cover everything. You pay for what you get, one way or another.
> Your analogy falls apart because the government does make mandates for cars. Things like safety features.
They also have mandates for medicine. There is a whole medical licensing system. That's independent from who pays for it.
> When you're looking for a car, you have some properties of a car which are easily understandable. When you're searching for medical assistance, most people only vaguely know what's actually wrong.
I don't see how it's different. There are plenty of subtleties when buying anything expensive that aren't readily apparent, like that car insurance can be more than the car payment, or that some models depreciate faster than others so you have to account for future resale value, or that some models have more frequent repairs, or more expensive repairs. Some people buy based on style and only later find out through experience the total cost of ownership is $40,000 higher than they expected.
It's the same thing with healthcare, but it's the same thing with healthcare either way. Regardless of who is paying, which doctor has the best patient outcomes? Which medication is more effective? What clinical trials are there for your condition? You can ask your doctor, but first you have to choose your doctor. And then, in the end, they only advise you what to do. It's still your decision and your life.
Not really. The law you're referring to is the Family and Medical Leave Act (FMLA), which only applies for childbirth and "serious health conditions". Most things you can shop around for also aren't serious enough to qualify, so you're not entitled to such unpaid sick leave.
But also, it's kinda a moot point because laws like that only apply to people that know them or can afford an attourney. Just like the person in the linked article didn't know she couldn't be harassed quarterly by the court system (rather, just yearly) due to being disabled, those who are most in need of that law are unlikely to know about it nor to have an attourney.
> If it costs $1000 in travel and inconvenience to fly to another city for a procedure then people won't use a local hospital that tries to charge $10,000 more
This assumes that people have both perfect knowledge of their procedure and the prices of all hospitals, and that people value money over convenience.
I know for a fact that I can fly to another country with free healthcare and get a procedure for cheaper than I can get it in the US, but hardly anyone does that regardless. It's just too inconvenient.
I also know for a fact that people rarely have even decent knowledge. Plenty of people buy incredibly overpriced cell-phone plans or internet. The free market hasn't been able to get those prices anywhere close what they should be even though people can switch providers, compare prices, and aren't stressed about their health.
But now you're not making an argument for socialized medicine, you're just making an argument for requiring unpaid sick leave for a scheduled medical procedure.
> But also, it's kinda a moot point because laws like that only apply to people that know them or can afford an attourney.
Are there many laws that don't work this way? Would the same people be any better off if the government would pay for their medical procedure but they didn't get it because they didn't know that?
> This assumes that people have both perfect knowledge of their procedure and the prices of all hospitals
Which is the point of requiring price transparency. Your doctor should provide you with a list of all the places that can do the procedure along with their locations and prices and any other information useful to choose between them.
> and that people value money over convenience.
But that is the mechanism by which it operates -- there is a point where the money is worth more than the convenience, and once people actually know the amount of money required, that limits how much providers can overcharge because past that the inconvenience is less than paying the money.
There is nothing wrong with choosing convenience. It's the thing that allows trade offs between price and convenience to exist. Maybe the clinic near the big city will always have the best price because it has the most patients to amortize fixed costs over, so the rural clinic can only stay in business by charging more per patient. If the higher price is worth not having to travel to the city -- and people know that -- then people will choose to patronize it, which is how we know its value exceeds its costs. If everybody chooses to travel to the city for the lower price then we know the rural clinic costs more than it's worth, which is the same mechanism that causes it to fold.
> I know for a fact that I can fly to another country with free healthcare and get a procedure for cheaper than I can get it in the US, but hardly anyone does that regardless. It's just too inconvenient.
Because flying to another country is very inconvenient, and not at all inexpensive on its own. So the limit it places on overcharging is not very strict. Especially when you don't actually know how much you'll be charged, so you don't even realize that it would have been worth it to do that until after it's already done.
The inconvenience is much less to go to another town than another country, so that would provide a much lower limit on how much anyone can overcharge before people would do that. If they were actually provided with the price differences -- so why aren't we doing that?
https://www.menshealth.com/health/a19543406/50-most-overpric...
My state has the highest rate of uninsured residents in the country and also one of the states that did not expand medicaid and take in federal funds to cover 90% of that. I paid for the best health insurance plan I could find on healthcare.gov and went with a doctor that was listed as a preferred provider with my insurance explicitly because my insurance provider claimed that any lab work, referrals, etc from that preferred provider would be covered and that they partnered with them to ensure that there wouldn't be any surprise out of network bills that weren't covered. The best health insurance plan I could buy left me out to dry for ~$600 in bills that were supposed to be covered 100% by my plan.
The notion of the magic of the free market driving down healthcare spending is nothing more than a libertarian fantasy. By any objective measure we spend far more than any other country on the planet for a given medical service. The fact that doctors and hospitals can't even tell you how much a given service will actually cost beforehand should be enough to tell you that the free market clearly isn't working here.
How do prices not help? You at least know how much you'll have to pay, which is certainly relevant information. You still may not know which one is best (no guarantee that it's the one that costs more), but what solution are you proposing to that anyway? Even if the government was paying for your medicine, how would that help you choose which doctor to listen to?
> When you are under, you don't get to consent to the actions of the surgeons ,anesthesiologists or whomever else they decide to bring in to assist.
Which is why it may make sense to have an insurance plan that fully covers emergency services regardless of network. But emergency services aren't the majority of medical costs.
First things first, you probably have little choice in where you are going to get things checked out, as there may only be one place in town or one place your insurance covers or one place that works with the hospital your doctor goes to. It isn't like you can opt out if you suspect things like breast cancer, which might kill you, or if you are getting anything done in an emergency fashion. AT best, knowing the cost might give relief or stress and at worst, it'll cause some folks to die a slow death because they can't afford the cure.
IIRC, they aren't always upfront about this stuff during surgery. You simply don't know or there might not be folks in your network available for a variety of reasons (like your anesthesiologist being sick that day).
No, they don't. When you're out of breath with pain running down your left arm and are about to collapse, you're going to try to get to the nearest hospital, not first shop around to see which one has the most competitive rates like you're buying a new car or something.
A family friend, a very smart guy himself, was recently diagnosed with Parkinson’s Disease. Since I’m a neuroscientist, he asked me for advice. I work on brain stimulation, one of the better treatments for Parkinson’s Disease. My institute is a Parkinson’s Centre of Excellence, and I collaborate with movement disorders specialists. I have easy access to experts and tons of relevant training and literature. Nevertheless, I found it very hard to make a recommendation, even between the options his doctor had laid out—-and I wasn’t even considering price, since he has excellent insurance. This decision was smack in the middle of my wheelhouse too; helping with, say, a decision about kidneys would have been even worse.
There’s no way people, especially people in vulnerable situations, can reasonably be expected to catch up with experts that have a decade of advanced training and then second-guess them.
Sure, you technically have time to shop, but it seems to me that this is just an excuse and makes sick people suffer more.
1. Take 30 mins to find the most affordable option. 2. Ask for a lower price.
You also could just live in a country with a good single payer health service, and know that you'll be treated without any bullshit.
The fact that anyone would seriously suggest shopping around for treatment, as if there is a convincing and credible reason why anyone should even have to consider this, is beyond astonishing to me.
I have heard multiple stories now whete independent practices now just want cash, without insurance, payments for much cheaper, and they get paid more in the end.
We are expecting a baby, and one of the tests we had to get done early in the pregnancy was NIPT. There was 2-3 companies we could go with, and when we asked for the price they responded some number between >2.7K - I don't really recall - it could even be 8K. When asked for the cash price, they said 250$.
Crazy.
We're not talking about the life and death part though. There are already laws requiring emergency rooms to see anyone who shows up. The question is how to pay for it, which is a matter of economics.
Medical providers not being able to provide the total cost for a non-emergency procedure up-front but then expecting people to pay whatever price they make up after the fact is practically fraud. The fact that it leads to outrageous costs is entirely predictable.
I’d like to turn the question around and ask folks who believe that the healthcare problem is one of not enough market freedom: what’s an example of a country that gets a free market in medical care right, from your perspective?
We universal healthcare advocates have a couple of dozen examples lined up to support our perspective, what about from the other side?
But the primary reason you don't see more successes is the lack of attempts. It's not as if there is a long list of countries with failed free market healthcare systems, either.
I don't know in what meaningful sense Israel is a "hybrid" system, it functions almost exactly like a 'Medicare for all' type proposal would.
"Houses keep people warm, they should not cost anything" etc." I'm not sure who is arguing this, but it isn't a stretch for folks to agree that everyone should have access to shelter, even if you cannot afford it. I personally wouldn't mind standard and basic housing being free (Small kitchen/living room, bathroom, and bedroom or bedrooms)
I'd also point out that cross state competition would only help a little. Your laws need to be the same state to state, minimally, and most of the providers wouldn't change. Most insurance is provided through a job anyway, and I'd like to mention that most people's "tech company", besides social media, are ISP's with little to no competition.
So, no, "insurance" will never under any circumstances be the correct model to work from. (And no, I don't know what is.)