7 ms·

It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b

It’s not a matter of profit. It’s a matter of costs. From the graphic the insurers take in $371.6b and pay out $241.9b in medical services costs. That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. Healthcare needs to be provided as a matter of course, and “competition” won’t improve it or control it because there is always a supply side shortage of provision. That’s a difficult problem to solve, but solving it by forcing a huge bill on expectant mothers and cancer victims, etc in a futile attempt to control demand is not the way. Which is why the rest of the world charts a different path.

deleted 3mo ago
[deleted]
znnajdla 3mo ago
It’s neither a matter of profits nor costs. It’s a matter of incentives. The basic principle of capitalism can’t work if the buyer doesn’t have a choice, if the buyer is not the one who usually pays, and if the payer has a way of avoiding responsibility to pay. The privatized health insurance system is truly and completely fucked up.
- deleted 3mo ago
  [deleted]
- xenadu02 3mo ago
  By definition a free market in healthcare requires forcing some people to die from a treatable injury or condition to discover the optimal price. That's part of the definition.
  - EvanAnderson 3mo ago
    Because the supply is constrained I feel like that's the case regardless of how the system is financed. (There are only so many providers, facilities, etc.) It seems like the core problems with US "system" come from having a "shadow" socialized system (by way of EMTALA[0]) that offloads costs onto the "free market" (read: patients or insurers who can pay) and a shocking inability to have a mature public conversation about how care will be rationed. (That conversation still happens but it's between providers and insurers and not subject to public scrutiny.) [0] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
  - collingreen 3mo ago
    Only if free means pure or academic here. Free market usefully means both sides can choose to participate in transactions which means price is how they do that. It is a useful concept but it doesn't cover everything, like what you mentioned and things like if emergency patients are shopping around hospitals or if the average consumer is capable of being well informed in such a market.
- Spooky23 3mo ago
  The buyer and sellers are frequently wrong. The buyer isn’t the patient, it’s the employer. The insurer is either charging a premium for risk or servicing work for a self-pay employer. The biggest buyer is the Federal government and by law they are required to get the best deal, the government also restricts the supply of providers. It’s not a capitalist system at all. It’s a weird hybrid command economy with a consolidating cartel of providers and administrators.
zephen 3mo ago
> That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. No, it's much worse than that. How much time and money is spent by medical providers dealing with the billing? Arguably at least twice as much -- the insurers have economy of scale that providers can't match. And that's before you even get to the direct time and stress impacts on the consumer from bullshit denials.
colechristensen 3mo ago
The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss for how your healthcare was going to be for the next four years. People arguing for public health care, are you ready to say you want Donald Trump to be in charge of your health insurance instead of a private provider? (because we're not in a magical fairy land where government is efficient and agrees with everybody's priorities)
- ryandrake 3mo ago
  The fact that a single person is "in charge" of the government, with the other two branches largely deferring all power to that one person, is a recent aberration from the norm in the USA. I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader.
  - colechristensen 3mo ago
    >I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader And I want to win the lottery, marry a princess, and for my childhood dog to come back to life. We all want things. When we're advocating for government changes we need to be realistic and make good choices. Right now throwing an enormous amount of power at a dysfunctional government (public health care) is an insane bid completely disconnected from reality. We need people to care about the basic functionality of government and for it's various pieces to do their duty. They aren't, so maybe let's shelve the idea of handing over control of our healthcare to them until they can deal with their cowardice in front of an aspirational king.
    - ryandrake 3mo ago
eli_gottlieb 3mo ago
> “competition” won’t improve it or control it because there is always a supply side shortage of provision. Why is there always a supply-side shortage?
- anon291 3mo ago
  Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.
  - EvanAnderson 3mo ago
    This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.
    - anon291 3mo ago
      A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the AMA wants it or not. As Americans get richer, many are even just going to foreign countries to get treatment. I know several 'third world' countries have fairly good medical care available for very cheap.
      - Legend2440 3mo ago
        Doctors salaries should be reduced, as should nurses and dentists. We pay them nearly twice as much in the US as in countries with socialized medicine.

deleted 3mo ago

[deleted]

znnajdla 3mo ago

It’s neither a matter of profits nor costs. It’s a matter of incentives. The basic principle of capitalism can’t work if the buyer doesn’t have a choice, if the buyer is not the one who usually pays, and if the payer has a way of avoiding responsibility to pay. The privatized health insurance system is truly and completely fucked up.

deleted 3mo ago
[deleted]
xenadu02 3mo ago
By definition a free market in healthcare requires forcing some people to die from a treatable injury or condition to discover the optimal price. That's part of the definition.
- EvanAnderson 3mo ago
  Because the supply is constrained I feel like that's the case regardless of how the system is financed. (There are only so many providers, facilities, etc.) It seems like the core problems with US "system" come from having a "shadow" socialized system (by way of EMTALA[0]) that offloads costs onto the "free market" (read: patients or insurers who can pay) and a shocking inability to have a mature public conversation about how care will be rationed. (That conversation still happens but it's between providers and insurers and not subject to public scrutiny.) [0] https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
- collingreen 3mo ago
  Only if free means pure or academic here. Free market usefully means both sides can choose to participate in transactions which means price is how they do that. It is a useful concept but it doesn't cover everything, like what you mentioned and things like if emergency patients are shopping around hospitals or if the average consumer is capable of being well informed in such a market.
Spooky23 3mo ago
The buyer and sellers are frequently wrong. The buyer isn’t the patient, it’s the employer. The insurer is either charging a premium for risk or servicing work for a self-pay employer. The biggest buyer is the Federal government and by law they are required to get the best deal, the government also restricts the supply of providers. It’s not a capitalist system at all. It’s a weird hybrid command economy with a consolidating cartel of providers and administrators.

zephen 3mo ago

> That’s $130b on a pointless activity that uses up physical resources that would be better deployed elsewhere in the economy. No, it's much worse than that. How much time and money is spent by medical providers dealing with the billing? Arguably at least twice as much -- the insurers have economy of scale that providers can't match. And that's before you even get to the direct time and stress impacts on the consumer from bullshit denials.

colechristensen 3mo ago

The rest of the world has private healthcare on top of the public ones because the public ones are often inadequate. Just go look for the local debate in any country with government healthcare and look for the parties who are pushing for change and their complaints. Then ask yourself if you really would want the current administration in charge of your healthcare... if you'd like every four years to be a coin toss for how your healthcare was going to be for the next four years. People arguing for public health care, are you ready to say you want Donald Trump to be in charge of your health insurance instead of a private provider? (because we're not in a magical fairy land where government is efficient and agrees with everybody's priorities)

ryandrake 3mo ago
The fact that a single person is "in charge" of the government, with the other two branches largely deferring all power to that one person, is a recent aberration from the norm in the USA. I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader.
- colechristensen 3mo ago
  >I'm for a single-payer health system that is administered by a well-checked regulatory apparatus and institutions that are not subject to wild policy swings at the whim of a single king-like leader And I want to win the lottery, marry a princess, and for my childhood dog to come back to life. We all want things. When we're advocating for government changes we need to be realistic and make good choices. Right now throwing an enormous amount of power at a dysfunctional government (public health care) is an insane bid completely disconnected from reality. We need people to care about the basic functionality of government and for it's various pieces to do their duty. They aren't, so maybe let's shelve the idea of handing over control of our healthcare to them until they can deal with their cowardice in front of an aspirational king.
  - ryandrake 3mo ago

eli_gottlieb 3mo ago

> “competition” won’t improve it or control it because there is always a supply side shortage of provision. Why is there always a supply-side shortage?

anon291 3mo ago
Because the American Medical Association artificially restricts residency spots in hospitals. There's really not much more to it. This explains the proliferation of NPs, PA-Cs, etc acting as GPs. In reality, we simply need more doctors, so we should uncap the # of spots.
- EvanAnderson 3mo ago
  This can't be stated enough. I should have my comment w/ citations on standby, but I don't. The AMA was concerned in the 90s re: "oversupply" of doctors and the impact on doctor salaries, lobbied the Republicans (around the "Contract with America" timeframe) and got language limiting NIH-funded residency slots codified. The AMA is backpedaling on that stance now but the damage is already done.
  - anon291 3mo ago
    A reasonable compromise would be a scheduled increase in the number of slots until it is eventually uncapped. Yes, this will reduce doctors salaries in the long-term. You know what else reduces doctor salaries? Importing medical doctors from foreign countries with worse wages and working conditions, and then grinding these individuals to the ground under the threat of immigration. The market finds a way, whether the AMA wants it or not. As Americans get richer, many are even just going to foreign countries to get treatment. I know several 'third world' countries have fairly good medical care available for very cheap.
    - Legend2440 3mo ago
      Doctors salaries should be reduced, as should nurses and dentists. We pay them nearly twice as much in the US as in countries with socialized medicine.