They’d send checks 6months late and often miss them. They also forced certain prices for him to stay “in-network”
Insurances don’t seem to help anyone.
For example, with my parent’s independent office, people would come in without insurance and unable to pay the high fees for say a filling or a crown.
My parents were technically able to charge much lower prices (more than half off in the case of normal cleanings,) but were unable to because of the contract they had with their insurance network.
Moreover, the listed price mandated by the insurance was not the same as the payout my parents received after filling the claim. (The payout was always less. Sometimes much less than the mandated price)
I don’t see who benefits in this situation besides the insurance company.
Even if my employer pays for my insurance, I still need to meet some premium most of the time. And what I pay is inflated because of the in-network contracts
Consider also that, in the states at least, dental insurance is separate from medical.
Restaurants, yes. But supermarkets and car mechanics? Everyone has to eat, and everyone who has a car has to get it fixed sometimes. In fact, people need to eat much more often than they need health care--yet supermarkets are somehow able to provide a wide selection of food at reasonable prices. The same could be done for health care if it were a competitive free market instead of being regulated so heavily.
I realize this isn't what you meant, but some people have gardens to supplement their food supply and some people repair their own car. I'm not a car owner, but I do repair my own bike and the reason for it is that the required parts and tools are usually much less expensive than a one-time repair (with the biggest expense, tools, being spread across multiple repairs).
As for the regulation of health care, it exists for a reason. Some of those reasons are for the public good. You only need to look at alternative medicine to understand that there are a lot of snake oils salesmen out there. Letting people portray themselves as legitimate doctors would only muddy the water. Then there are factors such as competence. It is difficult enough to deal with in a regulated system, never mind an unregulated one.
One can argue that there are valid reasons to regulate health care. But, as I pointed out elsewhere in this discussion, similar reasons exist to regulate food, and we do regulate food for those reasons, but that doesn't prevent us from having free market competition in food suppliers.
Basically no one in the First World grows enough calories in their garden to make a significant difference, and repairing your own car nowadays generally requires buying lots of expen$ive test equipment. The days of the shade tree mechanic are sadly long over.
You do if you want to get food and don't grow everything yourself?
Everyone has to eat, so everyone except a small number of farmers does have to go to either restaurants or markets.
You don't need to go to college either but prices for that have gone up more than 10x. If anything, I can skip going to the doctor for a very long time because of cost (and people do unfortunately).
> They were talking about the trend of For Profit Health Care, the outcome they came up with was prices will eventually raise up to extortion levels, why, because that is what everyone needs.
Healthcare has always been for profit.
I can only speak for what's happened in the US and have no experience with colleges elsewhere.
It's a case of well-intentioned (in their context) people from each political side that made this mess collectively.
You can get food without going to a restaurant. You cannot get healthcare without going to a doctor.
But further, medicine has extremely low competition at all levels. There are few companies producing penicillin, you likely don't have a lot of options for hospital care (especially if you need a specialist), and your insurance was likely not something you picked.
Compare that to food, where you can get it from multiple grocery stores, gas stations, or even order it online. If you are in a place with 1 restaurant it's highly likely there are 10 competing restaurants. Heck, if you have some land you can even grow your own food in a garden.
Medicine is a necessity with few providers which makes it a particularly bad fit for capitalism. It can't be made cheaper or more available by cutting regulations. They are necessary to keep the industry from killing people.
But not unlike supermarkets, which were also mentioned.
> Medicine is a necessity with few providers which makes it a particularly bad fit for capitalism
Medicine does not have few providers because of "capitalism". It has few providers because of regulation that artificially limits the supply of providers. In a free market, the market would provide whatever supply of providers is needed to meet people's health care needs in the most efficient way. But regulation prevents that from happening.
> They are necessary to keep the industry from killing people.
Yet somehow we manage to have regulations to prevent food from killing people, without restricting the supply of supermarkets, and without impairing competition among them. We could do the same for health care.
The cost of health care is kind of… a×b+c×d, except more complicated, where a is the hourly cost of a physician, b is the number of times you get an hour's care, c is the cost of a pill and d is the number of pills you get. Want the total sum to decrease? Then pick which one of a, b, c and d you want to decrease, and look at whether competition can help. A lot of this thread sounds like just "private equity is evil and therefore guilty", nothing to do with goal-directed efficacy.
We already know the answer to this: competition can help decrease a and c, and even b and d might be fair game since competition in preventive care and preventive information can increase its effectiveness, which in turn reduces people's overall need for health care.
I would say medicine has few providers because of -
1. economies of scale for medication - meaning a Bayer selling 10 million motrin/ibuprofen can undercut LocalPharma if they tried to comptete - and 1
2. because of more complex factors for docs/nurses, possibly regulations but also difficult and poorly structured studies/residencies & poor market structure.
> Yet somehow we manage to have regulations to prevent food from killing people, without restricting the supply of supermarkets, and without impairing competition among them. We could do the same for health care.
It is probably possible for a half-competent person to run a mom and pop store with just a few thousand dollars of revenue, and maybe 2-3 months (maybe less if you have your own farm). Even a small medical setup like a dentist's clinic or a doctor's office needs years more of expensive education plus possibly trained staff (technicians/nurses etc).
The entry of barrier to healthcare is extremely high. However unlike how you can just go to a different store if you don't like the prices in one place, in medicine if a drug is made by 1 company and it costs $$$ you don't have many options. You can substitute tomatoes for potatoes but can't with meds.
There are a lot of fields where free markets with minimal/no regulations are very helpful, but medicine is not one of them.
while I can also steal medicine, I don't have the expertise as a doctor or pharmacist, so I'm limited to self-diagnosis and pre-packaged medicines.
Food is an extreme need, and while there are many types of businesses that provide food, we can wrap those up into one larger class of food provider businesses and ask why they aren't being captured and squeezed. Sure, some are to hunt or garden, but that number is far too small when you think of places with the highest concentrations of people. Food even has regulations, but it manages to not lead to monopolies that can charge whatever they want because if the price goes too high, other players can jump through the hoops to enter the market. The regulation on healthcare has reached the point of a stranglehold.
The point is that when you need food, you can go to any number of places to get it. So going to any one specific place is not a requirement.
Compare that to healthcare. I get in an accident or call an ambulance. I don't get a choice where I go or who I see. I just go to wherever is nearest or has availability and hope that it's either not bad enough to justify me needing to go somewhere else or that I have the ability to be transferred to the location of my choice (at great cost).
A more mild example are diseases like cancer. You'll have some more freedom on which place you go to but oncology is extremely diverse and specialised. Unless you get really lucky, odds are there's only a specific handful of doctors within a several hours drive of you that actually have a good idea of how to treat your specific cancer under the specific conditions you have it. So you go to whichever one of them can see you in a reasonable amount of time because otherwise you die. The same goes for many of the complex diseases people spend months or years diagnosing because they are so hard to pin down.
And that's discussing situations where time is of the essence and you get very little choice in your options. And those tend to be the most expensive.
There's plenty of other aspects of healthcare that are far cheaper of course and could be likened to the grocery store examples but drawing the regulatory line between the two is near impossible given the fuzzy nature of healthcare and medical science.
Medical care also often involves crisis situations where you absolutely need care right now so you don't have much leverage. On the other hand, most of the time people have some flexibility in how much they eat, when they eat, and what they eat.
There are about six supermarket chaions in the city where I live. Most people will struggle to guess which ones are owned by private equity (one isn't), but almost everyone can name at least a couple of hospitals that aren't.
It may seem unreal to you, but I can assure you that it actually happened at one point. It was a duopoly.
The history of Central America is essentially the history of these companies. Looking into it will give you more "understanding of the world" than you probably think.
It wouldn't be if the supply of health care were not artificially restricted by regulation.
> Medical care also often involves crisis situations
No, medical care sometimes involves crisis situations. But much more often it doesn't. A sane health care system would treat these two cases very differently. Care for crisis situations would be handled by insurance because that's what insurance is for: unexpected situations that you can't pay for out of pocket. But routine care would not. However, our system is not sane, and insists on bundling these two things together when that makes no sense.
They are. Maybe not by PE, but capitalism finds a way. This isn't the first time either the two big grocery chains in Canada have a long history of exploiting market dominance to screw over people who want to eat.
https://www.ctvnews.ca/business/competition-bureau-probes-al...
Healthcare doesn't really work in a capitalistic marketplace.
No, it isn't. People make all kinds of tradeoffs that place a finite value on their lives.
What skews the health care market is that people do not see the actual cost of what they are getting; they only see a small fraction of that cost. So their demand is way out of proportion to the actual supply of health care. Further, because they can't see the actual costs, patients have no idea whether the health care they are getting is actually worth what they cost. (The lack of transparency about the actual effectiveness of health care doesn't help either.)
> Healthcare doesn't really work in a capitalistic marketplace
No, health care doesn't really work in a regulated marketplace where people are not given the information they need to make accurate judgments about what health care is worth its cost.
If you have to split a dinner bill with a million people no matter if or what you order, people will gravitate to the surf and turff. It's the simple answer to the prisoner's dilemma when you have a million players.
The problem is, you cannot calculate costs for unknowns. You go to a doctor for a small thing, which blows up into a big thing. Those big things are the majority of the cost. Or you go to a hospital for a small issue, which ended up being a critical unknown. No matter how much people wax poetic about healthcare and regulations, it's ultimately a system where you cannot predict costs accurately. People want to treat it like planning a flight, when it's more like your car breaking down or your phone dying suddenly.
anyone who has resources and is rational will use those resources above everything else to stay alive.
it's our biological imperative.
people have addictions and mental disorders but theres very few things someone rational would trade their life for.
that's the Crux of your argument so I don't find the rest of your argument compelling.
especially looking at data comparing healthcare cost and outcomes in first world countries. 79 Now you might be right about regulation because from what I've read most of that increase cost in comparison to other countries is from administration which implies regulation.
but another solution to that is socialized healthcare.
Same with housing. Demand is increasing faster than supply hence price increases.
Price increases make housing a great financial instrument due to ease of getting mortgage loans.
Also why we need to have a sane immigration strategy. Can’t bring in too many people too fast (like Canada)
Private equity is playing cards on the arbitrage that any asset that increases in demand much faster than supply, and can be loan leveraged is a great investment.
But most things people have a price ceiling they're willing to pay.
Health care there is no price people won't pay for their lives, so the demand ceiling is essentially the entire net worth of the entire population
What do you mean? I do absolutely need to go to grocery stores. I would starve otherwise?
Weren’t not talking about insurance networks. We’re talking about how healthcare can’t be free market.
Insurance networks aren’t a requirement of a free market. There are private healthcare systems that don’t have networks.
But insurance networks aren't a requirement of free markets. So your argument that in today's system (only one form of a free market for healthcare) proves free markets don't work is ignoring alternatives.
It sounds like you actually would have plenty of physicians to choose from, just like when you buy food.
You can't get get a second hand operation or medicine.
You can even look at less regulated medication, like pet meds, and see how much cheaper some are. We don't need to go that far, just like how people food is more regulated than pet food, but without being as regulated as our current market for healthcare.
Much of medicine is vastly more complex than something like food safety or clothing safety.
No, because when your tooth hurts now, or you're bleeding now, or you need to get vaccinated to avoid you getting hepatitis, there's very little choice in the matter.
Healthcare is a fundamentally inelastic good. A dangerous one too, because bad quality healthcare can literally kill people. Inaccessibility of healthcare kills people too.
Look, there is no need to reinvent the wheel here. The US can look into any other developed country on the planet for inspiration. Every single one of them has a better, more accessible, cheaper for everyone involved, usually more or at least differently regulated, with better outcomes, model.
> No Way to Prevent This,' Says Only Nation Where This Regularly Happens
The vaccines are also a particular bad example. (The typical Now-lecture example is of emergency room care).
Food (despite recent inflation) is still very cheap in the grand scheme of things, despite it being something ABSOLUTELY NECESSARY for survival.
The health insurance profit margin is around 3.3%. Maybe they're just bad at extortion
There are certain topics people feel very strongly about with no insight or experience, they say things that are demonstrably false and refuse to look at it objectively. Unfortunately US healthcare is one of those
https://content.naic.org/sites/default/files/inline-files/he...
Basically, you mark up the little stuff that everything is built on ($1/page for copies, for example) so the margins look smaller when you get to anything substantial. So 3.3% is a meaningless number until it has been audited all the way down to the smallest purchases.
The question is why can't I provide insurance at the market price and just bring in efficiencies to get my cost down and margin up?
The reason is that it's not a real market through onerous regulations. People are forced to buy it, new entrants aren't allowed and there is an implicit threat that if margins get big politicians will come after you. So were stuck in this crappy system
Because you do not have to go to those places.
Years ago, when I was a kid, I heard my parents, uncles and aunts have a big discussion while I was in bed.
They were talking about the trend of For Profit Health Care, the outcome they came up with was prices will eventually raise up to extortion levels, why, because that is what everyone needs.
So here we are, being extorted by insurance and equity firms. And many Doctors are in the same boat with us, they are being squeezed with insurance costs and bureaucracy. My Dr has to have 3 people working in the office just to deal with health Insurance.
As a kid, it use to be 1 nurse and the nurse would deal wit paper work and help the Dr when needed. Plus their insurance costs were low compared to now.