7 ms·

How is this surprising? We've completely taken the free-market out of health care. The only way it will ever be solve is if we re-introduce market forces back i

• nawitus 13y ago
  That's not the only way. Government based healthcare works very well in a number of European countries.
  • mseebach 13y ago
    Generally it just works.
  • runn1ng 13y ago
    And, as a consequence, our doctors got paid much less and the state-owned insurance companies are still hemorrhaging money.
  • curt 13y ago
    Where does it work well? A small country with a homogenous population can pull it off but there isn't a single large country where it works. They keep their costs down by rationing coverage with wait-lists. I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called. They also limit the availability to the best medications and procedures to keep costs down. Also the quality is also quite poor, hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water.
    • princess3000 13y ago
      You realize that every single thing you enumerated could easily be applied to for-profit insurance companies in America, right? Just checking.
    • superuser2 13y ago
      >I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called. What about people "the market" doesn't find it profitable to treat? I'd rather be on a waiting list for pain medication than told it costs more than I make in a year.
    • mistercow 13y ago
      > there isn't a single large country where it works The healthcare system in Canada seems to be working a lot better than the one here. Is that large enough?
      • selectiveshift 13y ago
        The population of Canada is approx 35 million, whereas population of the United States is over 300 million. Canada is not a large country population wise.
        • nisse72 13y ago
          And presumably, there are nearly 10 times as many taxpayers in the US to fund such a system. Why do the absolute numbers matter? In fact, shouldn't there be better economies of scale in the larger country?
        • mistercow 13y ago
          OK, Japan then. 125 million people, universal health coverage, ranked 10th in the world by WHO (the US is ranked 38).
          • cmircea 13y ago
            I hate to say it, but: owned
        • maxxxxx 13y ago
          Why is this always used as an excuse why the US is different? The US has ten times more people, hence 10 time more tax payers. If anything I would expect things to be easier for the US because of its scale.
        • AlexandrB 13y ago
          Canada has significant costs associated with delivering health care service to remote areas because of its low population density. A US public system should be more efficient, not less.
      • 13y ago
    • _delirium 13y ago
      Wouldn't a free-market system have to ration coverage in some way as well, unless infinite resources were put into medical treatment? The disagreement seems to be over how to ration it, e.g. do you do it based on wait-lists, or do you do it more auction-style, or some hybrid (like France), or something else entirely?
      • dragonwriter 13y ago
        > Wouldn't a free-market system have to ration coverage in some way as well "Free market" is a rationing system that provides scarce goods/services to those willing and able to pay the most first.
    • cpncrunch 13y ago
      That is certainly not the norm. I lived in the UK for 3 decades, and it's definitely not like that. The level of care is very good, and the vast majority of the population are happy with it.
      • mikeash 13y ago
        There are incredibly powerful vested interests in the US who find it useful to convince as many people as possible that socialized medicine is awful and must be avoided at all costs. As a result, there's a huge amount of propaganda floating about, using techniques ranging from cherry-picking (it's bad because of these specific example cases) to outright lies (socialized medicine is why European states are bankrupt). A sadly large number of Americans believe it. Everyone then gets terribly confused when such a person bumps into a European who never noticed that the health care system they used all their life is actually a communist hellhole.
    • DanBC 13y ago
      > had to wait YEARS for their number to be called. They could have paid and gone privvate at any time. While wait lists were terrible some time ago they have got a lot better. Since year 2000 wait lists have been consistantly targetted for action by a variety of governments. There are some dodgy actions by some hospitals, but these are called out as dodgy and people take action to prevent it. Patients have maximum wait times listed in national documentation. > They also limit the availability to the best medications and procedures to keep costs down. I'm not sure what your point is. Imagine A and B, where A is shown to work effectively and B isn't. Which would you want? In this situation I'm glad that people have a responsibility to evaluate the research to weed out very expensive and inefficient medication and proceedures (and that's really what they're doing. They stop a small number of very expensive and ineffective meds; they don't just allow a small number of cheap meds.) > Also the quality is also quite poor How are you measuring quality? > hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water. Hundreds sounds too high. Do you have a cite for that please? (Note that the Mirror or the Mail will cause much mirth and laughter and people will then ignore anything else you say.) While we're talking about deaths from incompetence: Yes, it happens. Yes, it kills distressing many people. It also happens in the US. Medical error is the 3rd biggest cause of death in the US. About 7,000 people die each year in the US because clinicians make a mistake with the medication. About 12,000 people die from unnecessary surgery. About 20,000 die from other errors. Nosocomial (Hospital aquired) infection kills another 80,000 people in the US. About 100,000 people get the right quantity of the right meds, but die from side-effect complications. There are some things US health care does better. But the UK has better outcomes for some things. We also spend less money on our healthcare than the US. (http://www.nursingtimes.net/a-comparison-of-british-and-us-mortality-outcomes/201501.article http://www.nursingtimes.net/a-comparison-of-british-and-us-m...)
      • paulhauggis 13y ago
        "They could have paid and gone privvate at any time." Once you have government health care in place, private care costs get so high, only the rich can afford them.
        • 13y ago
    • brazzy 13y ago
      Nonsense. It works quite well pretty much everywhere in Europe. Better that in the USA, at any rate.
    • danbruc 13y ago
      It works really well in Germany with about one quarter of the population of the states. You pay about 15% of your salary split roughly 50/50 between the employee and the employer and that's basically it. You have to pay some additional money for different things - drugs (10% of the price, maximum 10,- €), hospital stay (10,- € per day, maximum 28 days) and so on. If you are unemployed, the state will pay for you. Finally you are free to opt out and get private health insurance - this may be cheaper when you earn much and are healthy but it may also turn against you. The price of this is a very large bureaucracy regulating all this and of course costing quite some money that does not go into actual medical treatment.
      • jeltz 13y ago
        > The price of this is a very large bureaucracy regulating all this and of course costing quite some money that does not go into actual medical treatment. I still think it is smaller than the bureaucracy of the insurance companies in the US. I do not know about Germany specifically but the US has perhaps the largest administrative overhead in the world.
    • rayiner 13y ago
      People waiting is better than poor people not getting any health care at all.
    • femto 13y ago
      I gather the NHS (UK) is similar to Medicare, in Australia, where I live. Under Medicare, highest priority is given to life threatening conditions. For example, if you have a heart attack, you will be treated without delay and to the highest standard. Non-critical cases, such as a knee reconstruction go on a waiting list and it is relatively common for such operations to be postponed multiple times, as higher precedence emergencies arrive at short notice. Basically, a person who might die will receive care over an uncomfortable person. It can suck if you have a painful, but not life threatening condition, but it is an attempt to give the best overall service within available resources. The public system will treat you if you're not going to die and normally do so well, but in the worst case (that typically makes the news) it can take a long time. There is always the option of having an operation done privately, and either paying for it yourself, or having insurance to pay for it. Medicare has broad support within Australia.
    • danieldk 13y ago
      Where does it work well? A small country with a homogenous population can pull it off but there isn't a single large country where it works. The Netherlands has a heterogeneous population (I don't see why size matters) with strongly government regulated sector of private insurance companies and hospitals. The net result is that we pay far less per capita than citizens of the US, yet the healthcare system is judged to be much better: http://www.reuters.nl/article/2010/06/23/us-usa-healthcare-last-idUSTRE65M0SU20100623 http://www.reuters.nl/article/2010/06/23/us-usa-healthcare-l... http://www.commonwealthfund.org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx http://www.commonwealthfund.org/Publications/Fund-Reports/20...
    • arethuza 13y ago
      "Also the quality is also quite poor" If the quality of care is so poor presumably voters here in the UK would be falling over ourselves to get rid of the NHS and replace it with a more efficient and cheaper private system? The NHS is far from perfect, but in my experience (and I have private health insurane through my employer - which I personally have never used, although my son has) is that the standard of care generally in the NHS is very high - my son was born in an NHS hospital, my wife has been treated for life threatening injuries more than once (e.g. climbing accident) and the standard of care and the attitude of the doctors and nurses was great. Private health care in the UK is mostly about getting access to non-vital procedures more quickly than others (my son had his tonsils removed) and getting a nicer room.
    • bane 13y ago
      > They keep their costs down by rationing coverage with wait-lists. I know a few people from the UK where their family members lived in daily pain and had to wait YEARS for their number to be called. They also limit the availability to the best medications and procedures to keep costs down. Also the quality is also quite poor, hundreds of people in the UK have died of dehydration in the hospital because the staff forgot to give them water. So we don't have these problems in the U.S. under the current "free market" system? Before you answer, I already know that the answer is "yes we do".
• psaintla 13y ago
  It's really not that simple and I say this as someone who works in health care. Doctors control how many new doctors there will be in any given medical discipline and they do this via accreditation, residencies and fellowships. You can introduce all of the free market forces and relaxed regulations you want but until doctors no longer control the supply of doctors you're wasting your time.
  • mseebach 13y ago
    Doctors only have this control because regulation says so. But as long as there are such steep price differences across state borders, it seems that there are, in fact, lower hanging fruit than busting the doctors' monopoly.
    • psaintla 13y ago
      Strictly speaking this is not controlled by any regulation You simply aren't going to get the experience necessary to perform certain surgeries with any proficiency without the aide of the gatekeepers. Also the reason for the steep price differences from state to state is partly due to a lack of a supply of doctors with a booming population of people who are seeking more medical care so I would argue decreasing the barrier to entry into the medical field while not decreasing standards should be a part of the plan.
      • mseebach 13y ago
        I'm not familiar with the system, but I find it extremely unlikely if >600,000 doctors are able to organise to form a watertight gate without any help from regulation. Surely they control licensing or something?
        • psaintla 13y ago
          If you aren't familiar with the system why make the claim that doctors have control because regulation says so?
• untog 13y ago
  You can't say that all government regulation of healthcare is a bad thing. It literally saves lives. If healthcare was left as a completely free market I dread to think how many people would die as a result of cut corners and rushed diagnoses.
  • curt 13y ago
    You can still sue a doctor or hospital for malpractice. EDIT (answering the responses): - Overseas you can buy a cheap insurance policy to cover the cost of a lawsuit. The underwriter determines your likelihood of success and charges accordingly. - You really think regulations stop that from happening now? People still get the wrong limbs operated on and amputated.
    • untog 13y ago
      If you're still alive, yes. And even then, if you were paralysed from the neck down (for example), would you really be able to enjoy the millions you got in court? Financial compensation for crippling illness always struck me as quite strange.
      • mseebach 13y ago
        The point of financial compensation isn't really to compensate the victim (or their family), it's to push the cost of the externality created back onto the provider, giving an incentive to act sensibly.
    • kmfrk 13y ago
      Lawsuits aren't free.
      • wyager 13y ago
        There are shitloads of lawyers who pick up malpractice lawsuits on contract, saying that they'll do the case for free if they get x% of the winnings.
• mikeash 13y ago
  You can get the free market back in health care once you can convince society in general that it's acceptable to let poor people die of treatable diseases. Until then, it's simply a question of how it'll be heavily regulated, not if.
  • curt 13y ago
    The United States is the most charitable country in the world. On top of that I never said to deny coverage to those that can't afford it. There are other ways. How about the giving them an annual voucher for $X, whatever they don't spend gets rolled over into the next year. Just like a HSA.
    • mikeash 13y ago
      People with serious diseases will outspend their voucher, and then many of them will die unnecessarily. Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. I've yet to see one, though. Not being allowed to refuse treatment screws up too much.
      • burntsushi 13y ago
        > Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. No such proposal exists. Any proposal that does requires a third party to intervene as either an angel to donate whatever resources are needed or as an agent enforcing policy that one group of people must provide services to another group of people regardless of means. Both of the aforementioned scenarios do not exist within the realm of market forces because market forces cannot make guarantees. People will always die because they don't have the resources to fix what ails them. We can only hope to lower the amount of resources to get treatment, and "market forces" are absolutely a legitimate solution to that. But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely.
• stevewilhelm 13y ago
  I would never make a personal health care decision based on price. I don't want to live in a society where we would let people suffer or die if they can not afford health care. Given these two conditions, free-market forces aren't very helpful.
  • mdesq 13y ago
    You already make personal health care decisions based on price. Did you get a complete physical and blood test today? If yes, will you do the exact same thing tomorrow?
    • gordaco 13y ago
      I'm guessing that those are a lot more based on the inconvenience of doing such things daily than their price.
      • growse 13y ago
        Price is about more than just cash.
• wpietri 13y ago
  That's a surprising conclusion given that countries who have the free market much less involved in health care have a much lower cost of care.
• anon292929 13y ago
  Free market doesn't really apply for emergency medicine. "Oh excuse me sir I am having a heart attack and dying please bring me to the hospital 30 minutes away because its 10 times cheaper"
• lucidrains 13y ago
  healthcare is only a free market to an extent. unlike consumer products, people are willing to pay any price for life or a guarantee of good health. and given care is so hard to quantify and there is so much uncertainty in comparing care, people will always simply trust the physician to pick whatever he/she thinks is best, with total disregard to the 'free market'. just my take on it.
• danmaz74 13y ago
  It's incredible how ideology can completely make you blind to facts. In most European nations hospitals are actually taken away from the free-market - they are State-run - and, guess what, health care is much less expensive and yet very effective by all metrics.
• rb2k_ 13y ago
  How come all the other countries that have regulated healthcare have costs that are usually at a fraction of the US? (http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us-compares-with-other-countries.html http://www.pbs.org/newshour/rundown/2012/10/health-costs-how...)
• nnnnni 13y ago
  You do realize that the regulations are in place to try to prevent quacks from killing people, right? You sound like one of those Tea Party idiots. You have no credibility.
• BenoitEssiambre 13y ago
  You can only get true free market in health care if people have the choice of when, where and how they fall ill and can evaluate quality of care themselves before buying it. Unfortunately getting sick is not like buying a TV.
• Spooky23 13y ago
  Not really. You're mixing up insurance costs with service costs. California is more expensive because all ratepayers are bearing the costs for people who do not participate in the insurance system or pay. We have this crazy system where we want cheap workers to build things and farm, but we don't want to provide them with the benefits of legitimate status. So, when a day laborer being paid off the books falls off a scaffold and requires hospitalization, that care turns into an unpaid debt. Because he gets kicked out of the hospital as soon as possible, he doesn't recover well and ends up back in the emergency room in a few weeks.
• dragonwriter 13y ago
  > How is this surprising? We've completely taken the free-market out of health care. The only way it will ever be solve is if we re-introduce market forces back into the mix. The theory of free market efficiency is based on low-entry-barrier wide-open competition, and perfect advance knowledge of costs and realized utilities by both buyers and sellers. There's lots of goods and services for which this is close enough to reality for the theory to mostly hold, but there's not much reason to think that healthcare is among them (and comparative quality and cost measures among real world healthcare systems don't support the idea that its a market where more "market forces" equals more efficiency.)
• rooker 13y ago
  Why apply free market tactics to a service that is almost certainly necessary for everyone in their lifetimes? If anything, I feel like that would make things more expensive because this is a resource that people can frequently NOT decline (at the risk of losing their life) because the cost is too high. People are essentially a captive audience, so that's where regulation should ideally step in to keep costs down. Obviously that's not working, though..hmm..