The vast bulk of health care is by appointment, not a dash in the ambulance.
It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
How did we collectively decide that it's okay for insurance companies to overrule medical professionals?
All of that cost savings makes US healthcare cost double what it does anywhere else in the world.
If we want to hold down costs then we'll have to put a greater focus on preventative care, stop expensive treatments for terminal patients, impose price controls on providers, and stop subsidizing drug development for the rest of the world. None of those measures are politically popular.
Some states have recently passed laws which limit the authority of health plans to conduct medical reviews or deny payment for services that providers deem medically necessary. This will reduce hassles and expenses for some patients, but it will also accelerate the inflation of insurance premiums paid by everyone else.
This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
Is your argument that there is choice involved in public healthcare? Or simply that it's not even a question?
> Nobody chooses healthcare
Yeah, they do. Root canal vs implant vs dentures, for example. Ozempic vs diet+exercise, for another.
a basic heart ultrasound cost me over $1k while my vasectomy cost me a $60 copay. i was expecting those prices to be flipped.
and don’t get me started on labs. i’ve gotten bills for basic screens years later for thousands of dollars.
you can’t shop around if you don’t know what you’ll pay until months after it happens. if you call the insurance company beforehand you wait on a static filled line with a call center in india, and even with the CPT code they can’t give you a straight answer.
All you gotta do is ask.
It works every time I asked.
This is why it's sometimes cheaper to have no insurance than insurance.
if you ask the insurance company you’ll never get an answer. providers are usually more helpful about what “should be covered”, but that’s not guaranteed.
seems like prior authorization is the only way to really make sure charges are covered but takes forever. but even then, if your insurance covers $x and they bill $y, you might get a balance bill in the mail.
point is, the market is heavily skewed against the consumer.
While they do have a competitive market, the government very much does pick and choose winners and loosers here like Huawei, resulting in consolidation into a few large conglomerates like every other country. Their (software) tech scene certainly dosen't like more particularly "capitalist" than Big Tech, nor is the Fed pumping subsidies to Tesla like BYD, if anything they're sidelining Elon Musk.
Right up until the moment that the CCP decides to purge your entire sector, sure. I don't know if it counts as "free" if the government stands ready to nuke the sandbox they so generously let you play in.
https://www.reuters.com/technology/beijings-regulatory-crack...
They proactively forced interconnectivity and limited the ability for companies to make "walled-garden peudo-monopolies", as we have in the US with Apple and Google.
If the same happens here (through act of congress, or legal outcomes), you can expect their market caps to decline as well. A decline in market cap doesn't speak at all to whether it's beneficial to the industry or consumers
WeChat is the inspiration for the idea of the "everything app" that so many US companies want to create but have always failed to. Has it somehow been newly limited in its ability to control an absurd percentage of all Chinese internet-connected activity?
https://asia.nikkei.com/Business/Technology/Beijing-asks-Ten...
"Beijing asks Tencent to lower WeChat's mobile payment market share"
https://www.forbes.com/sites/zennonkapron/2022/11/09/chinas-...
https://www.business-standard.com/world-news/china-may-impos...
"China is planning to introduce a new mobile payment regulation aimed at reducing the market share of Tencent Holdings' WeChat app, similar to efforts made by the National Payments Corporation of India to curb Google Pay and Phone's growing dominance in the market"
China's methods are more authoritarian than are viable in the west. But the general premise of a competitive market being better for society than dominance by a small number of firms is supported well by history
Those are 2 different things.
Monopoly doesn't mean "more powerful than the government". I'm not sure what that means, since the CCP disappears or coerces anyone who might threaten the supremacy of the CCP (or Pooh Bear) in any way.
Capitalism results in a single winner, for many industries. CCP prefers kingmaking in various industries, because it's easier for the government to control a few players than a multitude. This isn't what "fair market" means, in context. It's modern communism. State owned companies that are directed by government, rather than direct investment or day to day management. China learned from Russia's failures, I would say. I would also concede it's less regulated, under a political lens.
>market, maybe, "free" market? I doubt it.
The consumer of healthcare is doubly removed from the price of healthcare. This is the opposite of a free market.
The patient did not pay the doctor, the insurance company does. In most cases the patient does not pay for insurance their employer does.
So the normal pricing forces of a free market are removed.
Then we need to talk about certificate of need laws which restrict the supply...
If you’re poor, you’re fucked. If you’re old you’re ok. If you work for the government or certain companies, you have access to world class care. Everyone else is on a spectrum from high quality PPO to the shittiest Cigna plan.
Ignoring risk and consequences doesn't make them go away.
The entire system only works if healthy 30 year olds are putting in somewhat similarly (it will be cheaper regardless). Insurance is based on the idea of spreading risk. Without it insurance cannot function.
To put it into more technical, economic terms: why should the individual tobacco consumer bear the full cost of their externalities while the tobacco company does not?
Because people are well aware that smoking is dangerous and can freely choose to smoke or not.
Actually it's much worse than that. The tobacco company is not just selling tobacco products, it's marketing them and actively encouraging their use!
How would that even work? Any such tax would be priced in into the price of the product. It doesn’t really matter if the government is collecting it directly or through the tobacco companies.
Or if we wanted tobacco companies to pay for all the damage they did retroactively they would just go bankrupt, since they don’t have even remotely enough cash/assets to cover it.
https://www.cms.gov/marketplace/private-health-insurance/mar...
There's a deeper philosophical question here about how we should spread risks and costs across society. Like should some plan members pay more because they have a history of cancer, or because they engage in risky activities like flying light airplanes?
It depends on what your goals are. The reasoning behind why the ACA ("Obamacare") is the way it is:
> Suppose you want to make health coverage available to everyone, including people with pre-existing conditions. Most of the health economists I know would love to see single-payer — Medicare for all. Realistically, however, that’s too heavy a lift for the time being.
> For one thing, the insurance industry would not take kindly to being eliminated, and has a lot of clout. Also, a switch to single-payer would require a large tax increase. Most people would gain more from the elimination of insurance premiums than they would lose from the tax hike, but that would be a hard case to make in an election campaign.
> Beyond that, most Americans under 65 are covered by their employers, and are reasonably happy with that coverage. They would understandably be nervous about any proposal to replace that coverage with something else, no matter how truthfully you assured them that the replacement would be better.
> So the Affordable Care Act went for incrementalism — the so-called three-legged stool.
> It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.
> So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.
> But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.
* https://archive.is/HzS1G / https://www.nytimes.com/2017/07/10/opinion/obamacare-repeal....
* https://thehealthcareblog.com/blog/2023/02/15/all-three-legs...
The goal of the ACA in the US was getting closer to universal coverage, and that means 'subsidizing' bad behaviour to a certain extant.
Certainly smokers and such should practice more (so-called) 'personal responsibility', but there are a lot of situation where the pre-existing condition is not smoking or other lifestyle choice, but something genetic / congenital. So unless we want to get into (social) Darwinism and leave those folks on the sidelines, the lifestyle folks can end up coming along for the ride when society decides to protect other non-lifestyle pre-existing people.
Yes, therefore separating people's lifestyle choices from the plainly obvious risk and consequences involved.
But if you can socialize your losses (banks) or bad decisions (people) and avoid some of the consequences, I get it.
Last year, my wife died from a recurrence of metastatic melanoma. If insurance was rated like general liability insurance, she would have been dropped 8 years ago when the original cancerous lesion was removed.
I would have bankrupted the entire family to fight for the 60% survival rate in a few months, and she would have suffered even more without adequate care at the end.
By your standard, that suffering was her “fault”, because she failed to use sunscreen as a teenager. Fuck that noise.
We have Medicare “socialism” because social security was allowing the elderly to support themselves and live longer. Many were neglected and dying in inhumane ways, or saddling families with the burden of being a full time caretaker. It’s gross that we live in a society drowning in riches, but we take a principled stance to avoid taxation for rich people, at an incalculable human cost.
Those "civilized" countries universally have very long wait lists that make health outcomes worse.
If anything, healthcare and insurance have almost completely perpendicular incentives. No wonder then we have the world's most inefficient system.
Then you get into the wonderful world of getting receipts for every procedure and manually submitting them, only for them to be rejected so you have to call and tell them to provide the service they promised you. The insurance isn't even cheap! My monthly deduction would be close to the same price as an Obamacare plan, and that doesn't include the employer contribution. Healthcare is such a racket.
Not really true, as the employer could otherwise pay that money to the employee who would then shop for his own insurance. So the employee pays, but doesn't have a choice.
and salaries are stagnant. why would they pay extra? at least they're obligated to provide insurance, even if it's terrible and impenetrable
The entire reason health insurance got so mixed up with employment was as a workaround to WW-II era wage freezes. Employers couldn't pay more salary, so they offered other benefits including insurance to attract and retain employees. Now we're stuck with that.
Thankfully you can often get denials reversed after the fact by calling and complaining, but that takes an hour and is another roll of the dice. The only people who like the US system are wall street people who own stock in the companies.
When I am psychotic I cannot exactly choose which psychiatric hospital I want to check into and ponder about the price to put it off for another day.
And this is what the free market did to psychiatric hospitals: https://www.wral.com/holly-hill-hospital/21507953/
market, maybe, "free" market? I doubt it.
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
1. https://en.wikipedia.org/wiki/American_Medical_Association#R...