Interesting article: Is free market health care possible?

[BlueLabel]

http://www.theatlantic.com/business...g-free-market-health-care-is-possible/254648/

Though this article is about a year and a half old, it discusses the economics and to a certain extent the philosophy of health care in a way that doesn't really depend on current events. While the article itself is an interesting read, I was struck by this particular paragraph:

"When it comes to medicine, the internet has made great strides in reducing asymmetries of information. A parent of a child with a genetic disorder, or Lyme disease, is likely to know as much, if not more, about available treatments than will your garden-variety family practitioner. Patient forums and websites likeWebMD give people access to medical knowledge in a way that they didn't have it before."

The access the internet gives laypeople to medical information is indeed new and different, but I balked at the suggestion that a layperson is "likely to know more" about treatment options than a physician. And whether this is true, isn't it kind of a moot point anyway? Since in all likelihood the patient isn't going to be treated by a "garden variety family practitioner" in the first place, the point is kind of lost on me. Maybe there's something to be said for this, but I took that point as a little presumptuous. What do you think?

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[sinombre]

Wow, that was hard to read. The top comment was refreshing though.

 

[ruralsurg4now]

No offense to the OP, but this thread is irrelevant. Free market healthcare is possible, but it won't happen for two big reasons:

1) People have been trained (by Democrats) to believe that healthcare is their right, whether or not they can pay for it.
2) People also believe that they are entitled to the best medical care, regardless of whether they pay for it. If a millionaire can get an MRI, then so can a homeless drug addict.

Therefore, there are two options available for the long-term future of healthcare:

1) Everyone will get equal care, which will force everyone to get equally limited care (aka, "death panels") until services are so minimal that the system collapses. Of course, by that time nobody will claim any responsibility, which is par for the course for Democrats.
2) We'll wise up, which is unlikely.

 

[ruralsurg4now]

I'd like to see an example of a universal health care system that has collapsed under your reasoning.

It hasn't happened yet, but your observation is quite irrelevant for a simple reason. Similar to the general economics of, say, European nations, flawed systems are quite capable of being sustained for long periods of time, even decades. People used to love to point to the European Union as proof that socialized democracies were economically viable, despite all evidence to the contrary. Right now, you're in the "limited medical care, but not totally collapsed" interim period. By the way, a large part of that is due to the actual population. In these other countries, the citizens have been trained to accept limited care as "the norm," which would certainly not be the case here. In fact, due to Democrats, it's entirely the opposite, where people believe they are entitled to "everything possible" and that it will be paid for by someone else. So the shock of their new healthcare reality is going to be doubled, which will only serve to amuse me (by the way, this has already begun, as Democrats made wild promises about how healthcare would become cheaper and now people are finding that they can't afford healthcare or their plans are being cancelled, lol).

 

[histidine]

It hasn't happened yet, but your observation is quite irrelevant for a simple reason. Similar to the general economics of, say, European nations, flawed systems are quite capable of being sustained for long periods of time, even decades. People used to love to point to the European Union as proof that socialized democracies were economically viable, despite all evidence to the contrary. Right now, you're in the "limited medical care, but not totally collapsed" interim period. By the way, a large part of that is due to the actual population. In these other countries, the citizens have been trained to accept limited care as "the norm," which would certainly not be the case here. In fact, due to Democrats, it's entirely the opposite, where people believe they are entitled to "everything possible" and that it will be paid for by someone else. So the shock of their new healthcare reality is going to be doubled, which will only serve to amuse me (by the way, this has already begun, as Democrats made wild promises about how healthcare would become cheaper and now people are finding that they can't afford healthcare or their plans are being cancelled, lol).

The EU is a poor example. Lots of economists criticized the idea of a bunch of nations with independent governments sharing a single currency. You can view the US like the EU, where states are like independent governments that utilized the same currency. The important difference is that money freely flows between states to support each other. Did you know that the Blue states are the net loaners while the Red states are the net borrowers? The Democrats are the ones who actually know how to balance the budgets on the state levels.

Our healthcare system would have bankrupted us. It was a mess - people without insurance could still get treated at hospitals, but taxpayer money would be used to cover that, raising costs for everyone. It was a pseudo-socialized system.

Mandating insurance for everyone is a good step in the right direction. Insurance (which is actually a socialist idea - pooled risk) doesn't work if individuals in different "classes" separate out into different pools, either by choice or by insurance policies (pre-existing conditions).

The "everything is possible" entitlement is shared by republicans and democrats because the voters love to hear it because no one likes to compromise. Definitely a problem though.

 

[ruralsurg4now]

Did you know that the Blue states are the net loaners while the Red states are the net borrowers?

That's actually an often quoted fallacy, aka "talking point." It's funny because the blue states are the ones that are the most broke (e.g., New York, California, Michigan, Illinois) and yet they are said to be funding everyone else. You really need to rethink that because it only makes sense if you're totally blinded by partisanship.

 

[mcloaf]

Ugh. Going to try not to get dragged into this thread, but I will say that the guy who wrote that article is a tool.

 

[histidine]

That's actually an often quoted fallacy, aka "talking point." It's funny because the blue states are the ones that are the most broke (e.g., New York, California, Michigan, Illinois) and yet they are said to be funding everyone else. You really need to rethink that because it only makes sense if you're totally blinded by partisanship.

There are exceptions to every generalization.

 

[Reckoner]

That's actually an often quoted fallacy, aka "talking point." It's funny because the blue states are the ones that are the most broke (e.g., New York, California, Michigan, Illinois) and yet they are said to be funding everyone else. You really need to rethink that because it only makes sense if you're totally blinded by partisanship.

If you like actual data: http://taxfoundation.org/tax-topics/federal-taxes-paid-vs-spending-received-state

Also, a state's balance sheet doesn't have anything to do with federal tax revenues from that state. But back to the article. It seems to me the author's solution could only make healthcare more expensive. It would force the poor and uninsured to forgo healthcare until illnesses become catastrophic, in which case their only option would be socialized emergency care. To me it sounds like a less effective, more expensive version of medicare/medicaid.

 

[Beargryllz]

I pay for Medicare just like everyone else. I am discriminated against due to my age and cannot use this service. I am outraged. Put everyone on this plan and be done with the whole mess.

 

[BlueLabel]

Ugh. Going to try not to get dragged into this thread, but I will say that the guy who wrote that article is a tool.

Are you saying you know the author to be a tool from other work, or he's a tool for writing this piece? Definitely picked up some tool-y vibes.

 

[ruralsurg4now]

If you like actual data: http://taxfoundation.org/tax-topics/federal-taxes-paid-vs-spending-received-state

I don't think you seem to understand, buddy boy. I don't care if you give me a link. Try doing something called "thinking" instead of regurgitating the same link that has been used by every other Democrat for years. Why don't you explain to me how the brokest and most bankrupt states are funding America? Have fun because you can't.

 

[mcloaf]

I don't think you seem to understand, buddy boy. I don't care if you give me a link. Try doing something called "thinking" instead of regurgitating the same link that has been used by every other Democrat for years. Why don't you explain to me how the brokest and most bankrupt states are funding America? Have fun because you can't.

 

[sinombre]

...because it only makes sense if you're totally blinded by partisanship.

 

[Reckoner]

I don't think you seem to understand, buddy boy. I don't care if you give me a link. Try doing something called "thinking" instead of regurgitating the same link that has been used by every other Democrat for years. Why don't you explain to me how the brokest and most bankrupt states are funding America? Have fun because you can't.

If you don't believe census data, and don't know the difference between federal tax revenues and state budgets, nothing I say is going to mean anything to you. And I'd rather not highjack this thread over such a trivial point, sorry.

 

[ruralsurg4now]

If you don't believe census data, and don't know the difference between federal tax revenues and state budgets, nothing I say is going to mean anything to you. And I'd rather not highjack this thread over such a trivial point, sorry.

That was a very lengthy way of admitting you can't explain your data. As predicted.

 

[Beargryllz]

Ah yes, I'm familiar with the classic "sky is falling" propaganda argument when it comes to universal health care. Can you provide me proof that any of these systems are even on the trajectory towards collapse? Without even having to explore this topic deeply: nearly every other developed nation has some form of universal health care and they often have better health outcomes and are less expensive than the US' system. That doesn't seem like limited care to me.

In communist fail countries you have to like, wait for a doctor's appointment and stuff. Also, you pay high taxes. They're basically all failures and this proves it.

 

[ruralsurg4now]

Without even having to explore this topic deeply: nearly every other developed nation has some form of universal health care and they often have better health outcomes and are less expensive than the US' system. That doesn't seem like limited care to me.

I know, it's marvelous, isn't it? I've seen various people quote U.N. and WHO statistics saying that countries that you've never heard of have the #1 best healthcare in the world. For example, WHO cites the best healthcare countries as: #1 France, #2 Italy, #3 San Marino, #4 Andorra, #5 Malta according to Wikipedia. Isn't that fantastic? I think so.

 

[ruralsurg4now]

By the way, bonus points for anyone who can find San Marino on a map without using the Internet.

 

[mcloaf]

What can I buy with my bonus points?

 

[ruralsurg4now]

Some rationed healthcare.

 

[Goucher2013]

Whenever I hear that free-market healthcare can work, I'm reminded of the old European lefties who insisted that communism would work if only everyone behaved like they were supposed to.

The answer's the same: Yeah. Sure. Whatever.

 

[ruralsurg4now]

Whenever I hear that free-market healthcare can work, I'm reminded of the old European lefties who insisted that communism would work if only everyone behaved like they were supposed to.

The answer's the same: Yeah. Sure. Whatever.

That's pretty odd, since communism has been tried multiple times and always failed. Whereas nobody has been allowed to try free-market healthcare. So you're basically just making a random assumption based on your own pre-conceived biases.

 

[histidine]

Socialized healthcare? That's COMMUNIST BRO

Socialized military? That's DIFFERENT BRO

Socialized infrastructure? That's DIFFERENT BRO

Socialized education? That's DIFFERENT BRO

Socialized research funding that has led to breakthroughs in medicine? THAT'S AWESOME BRO

 

[Lya]

If you like actual data: http://taxfoundation.org/tax-topics/federal-taxes-paid-vs-spending-received-state

Also, a state's balance sheet doesn't have anything to do with federal tax revenues from that state. But back to the article. It seems to me the author's solution could only make healthcare more expensive. It would force the poor and uninsured to forgo healthcare until illnesses become catastrophic, in which case their only option would be socialized emergency care. To me it sounds like a less effective, more expensive version of medicare/medicaid.

Can you elaborate further on why the author's suggestion could only make healthcare more expensive and why the uninsured and the poor will forgo healthcare until it's too late?

I did not read the whole article except for the last part, but I agree that non-acute, non-urgent medical visits can be something that people can "shop" for. If the uninsured and the poor can seek early medical care with cheaper price tags than acute, urgent medical visits, isn't that going to be a good incentive for them to seek healthcare early? Or am I missing something?


EDIT: I think there are several reasons they could forgo their medical care for different reasons, however. Examples could be: a lack of infrastructure or information on which clinics offer the cheapest or the "best-value" care in the context of what each consumer is able to pay or what type of medical care he or she seeks, not enough time to actually shop and visit, distance or inconveniences with transportation, the cost of medical visits that could seem expensive and overwhelming for the poor, and so forth. I believe, though, that these are details we can discuss after the general approach suggested by the author is agreed.

 

[ruralsurg4now]

Socialized research funding that has led to breakthroughs in medicine? THAT'S AWESOME BRO

It has? Sure, government funding has improved medicine. And so has private funding. Actually private funding probably does more, by the way. Also, "government" doesn't mean "socialized," but I bet you knew that. Right?

(If the answer is that you didn't know that, don't admit it in public.)

 

[ruralsurg4now]

I know right? France? Where the heck is that?!

But instead of having you search around the world for San Marino. I'll give you a hint to find a country that offers universal health care, that constantly out performs the US in health outcomes: all you have to do is look to our neighbors in the north, a place quite similar to the US in culture and customs.

Also still waiting for proof that the sky is falling.

Oh, so you think France IS number one? That's pretty awesome.

By the way, Canada ranked #30. Below Cyprus. That's called getting owned.

 

[histidine]

It has? Sure, government funding has improved medicine. And so has private funding. Actually private funding probably does more, by the way. Also, "government" doesn't mean "socialized," but I bet you knew that. Right?

(If the answer is that you didn't know that, don't admit it in public.)

basic science vs translational research. but you knew there was a difference, right?

Go back to econ 101 if you don't think most government programs are socialist. If you thought the government only made laws, take some gov 101 while you're at it.

 

[ruralsurg4now]

Go back to econ 101 if you don't think most government programs are socialist.

I think you need to look up that word because you don't know how to use it.

 

[ruralsurg4now]

But at least you're forceful and authoratative in your ignorance. That's always good, I guess.

 

[histidine]

I think you need to look up that word because you don't know how to use it.

But at least you're forceful and authoratative in your ignorance. That's always good, I guess.

each one of your comebacks could be copy pasted back against yourself. But I guess that's the circular republican logic we've come to expect.

 

[Reckoner]

That was a very lengthy way of admitting you can't explain your data. As predicted.

Not sure why I even bother, but fine. Maybe it will inspire you to think critically about your stances. In the US there is the federal government and there are state governments. Both of which raise revenue largely by taxing individual citizens. Many state governments are in bad shape financially because they owe massive pension obligations and don't have the revenue to pay them. But that's just the state's government, not its citizens. And those citizens are the ones paying federal income taxes. So states with large populations (which tend to lean left politically, except for Texas) pay large amounts of income taxes to the federal government. If you look at how much the federal government spends in each state, the majority of states (but not all) that receive more federal spending per capita than federal tax revenues per capita are red states (19 vs. 13 blue states in 2012). I know you don't like links, but wikipedia has a nice well organized chart comparing revenue to spending: http://en.wikipedia.org/wiki/Federal_taxation_and_spending_by_state

 

[mcloaf]

But at least you're forceful and authoratative in your ignorance. That's always good, I guess.

I don't think you seem to understand, buddy boy. I don't care if you give me a link. Try doing something called "thinking" instead of regurgitating the same link that has been used by every other Democrat for years. Why don't you explain to me how the brokest and most bankrupt states are funding America? Have fun because you can't.

That was a very lengthy way of admitting you can't explain your data. As predicted.

 

[ruralsurg4now]

each one of your comebacks could be copy pasted back against yourself.

They could be, yes, but it wouldn't be correct.

 

[Lya]

I pay for Medicare just like everyone else. I am discriminated against due to my age and cannot use this service. I am outraged. Put everyone on this plan and be done with the whole mess.

We cannot even lower the age requirement for Medicare. Putting everyone on this plan might be unrealistic, at least for some decades to come.

 

[ruralsurg4now]

Not sure why I even bother, but fine. Maybe it will inspire you to think critically about your stances. In the US there is the federal government and there are state governments. Both of which raise revenue largely by taxing individual citizens. Many state governments are in bad shape financially because they owe massive pension obligations and don't have the revenue to pay them. But that's just the state's government, not its citizens. And those citizens are the ones paying federal income taxes. So states with large populations (which tend to lean left politically, except for Texas) pay large amounts of income taxes to the federal government. If you look at how much the federal government spends in each state, the majority of states (but not all) that receive more federal spending per capita than federal tax revenues per capita are red states (19 vs. 13 blue states in 2012). I know you don't like links, but wikipedia has a nice well organized chart comparing revenue to spending: http://en.wikipedia.org/wiki/Federal_taxation_and_spending_by_state

Oh, so somehow the states are "in bad shape financially" and yet their citizens continued to fund the rest of the country. That's interesting.

 

[histidine]

They could be, yes, but it wouldn't be correct.

socialism in medicine would be the government dictating the jobs and pay for doctors and the production of said doctors etc.

I'm arguing that our military is socialist in many respects - their jobs and salary are dictated by the government and, to an even greater extent than in medicine, demand for goods is unlinked to supply.

 

[Reckoner]

Can you elaborate further on why the author's suggestion could only make healthcare more expensive and why the uninsured and the poor will forgo healthcare until it's too late?

I did not read the whole article except for the last part, but I agree that non-acute, non-urgent medical visits can be something that people can "shop" for. If the uninsured and the poor can seek early medical care with cheaper price tags than acute, urgent medical visits, isn't that going to be a good incentive for them to seek healthcare early? Or am I missing something?


EDIT: I think there are several reasons they could forgo their medical care for different reasons, however. Examples could be: a lack of infrastructure or information on which clinics offer the cheapest or the "best-value" care in the context of what each consumer is able to pay or what type of medical care he or she seeks, not enough time to actually shop and visit, distance or inconveniences with transportation, the cost of medical visits that could seem expensive and overwhelming for the poor, and so forth. I believe, though, that these are details we can discuss after the general approach suggested by the author is agreed.

It seemed to me that the author is arguing for a total free market approach on outpatient care, but completely socialized inpatient care. This seems like it would make primary care unreachable for the poor, since they can't really participate in a free market. Perhaps I'm missing something from the article?

 

[ruralsurg4now]

Also, I looked at his link and it's the same as the WHO statistics. Get this: DELAWARE has the most revenue per capita of any state in America. That's right, when you think "economic engine of America," think Delaware.

 

[ruralsurg4now]

Stilllll waiting on sky is falling proof, which you seem to be ignoring.

And Canada is still above the USA. And I hope you realize, that these small countries do well because it is a lot easier to implement complex policies on a smaller more uniform population. That doesn't invalidate the WHO's rankings.

I also hope you can tell the difference between best health care systems as ranked by the WHO (which aggregates data from a variety of indicators) vs. looking at specific health outcomes (maternal mortality rates, infant mortality rates).

Ooo, his counter is that Canada is better than America on that list, which somehow negates the fact that Cyprus is above Canada. I see how that works.

 

[Chipster.]

Oh, so you think France IS number one? That's pretty awesome.

1. So are you saying you don't buy into the WHO rankings that France is #1?

Oh, so somehow the states are "in bad shape financially" and yet their citizens continued to fund the rest of the country. That's interesting.

2. Your continued refusal to accept these simple, and correct, explanations that are being provided with evidence is just plain embarrassing for someone in your position. You haven't made any logical arguments here and your blatantly false claims are unbecoming of a physician. It might be best to stop embarrassing yourself in front of some pre-meds and go back to the forums where you complain about not having a girlfriend...

 

[ruralsurg4now]

I'm a girl And your counter seems to be: ignore anything anyone says that I don't like.

No, my counter is to point out that you guys are excellent at repeating things that other people told you without putting any thought into it whatsoever.

 

[ruralsurg4now]

So are you saying you don't buy into the WHO rankings that France is #1?

That's right. Oh, by the way, before you ask, nor do I believe Italy is number two. Or, for that matter, the rest of their list.

 

[Reckoner]

Also, I looked at his link and it's the same as the WHO statistics. Get this: DELAWARE has the most revenue per capita of any state in America. That's right, when you think "economic engine of America," think Delaware.

Not sure what you're talking about, but that data comes from the US Census and the IRS...

 

[ruralsurg4now]

Not sure what you're talking about, but that data comes from the US Census and the IRS...

You're not sure what I'm talking about? You mean you posted a link and you don't even know the contents of said link? Bravo. You're my hero.

 

[Reckoner]

I wasn't sure why you brought up the WHO, when they have nothing to do with the link I posted. Surely you're trolling, right? Nobody is this obtuse

 

[Chipster.]

That's right. Oh, by the way, before you ask, nor do I believe Italy is number two. Or, for that matter, the rest of their list.

And would you mind explaining why you don't believe any of it? Does it not fit your narrow view of the world?

 

[Lya]

It seemed to me that the author is arguing for a total free market approach on outpatient care, but completely socialized inpatient care. This seems like it would make primary care unreachable for the poor, since they can't really participate in a free market. Perhaps I'm missing something from the article?

That makes sense.

So, even the "cheap" cost after having a total free market system on outpatient care might not be "cheap" for the poor? The amount of information accessible for the poor might not be the same as other upperclass families, so I see why a disparity could still emerge even after the free-market outpatient care. Having a "default" choice or showing preselected outpatient services according to each income level and general locations will be helpful, though.

In other words, if we assume that we are unable to address these details fully while pursuing this approach, a medical service system with different levels of "tiers" seems to be inevitable, just as we have different plans (e.g., silver plan vs. bronze plan) for insurance coverages. (Otherwise, the disparity between the poor and others could worsen.) But does that mean this approach and the total free market approach on outpatient care are mutually exclusive? I wonder if we can have a similar health marketplace or "exchange" for outpatient services, not just insurances. This could also emphasize the transparency in costs and services. However, this will also accelerate the trend that medical services are behaving more like a commodity.



EDIT: One of comments points out an important point that the free-market outpatient services would not work for the old patients with chronic illnesses, the major consumer in healthcare, because they need to be charged highly for their care, while young, healthy generations will be charged cheaply since their demands are very low. The young generations will forgo their outpatient care if they are charged equally as other older generations, because their demands and needs are not the same, so free-market outpatient services might not be sustainable financially and will be bankrupted. (And thus we have ACA to spread the costs or everyone pays their his or her tax for federal programs like Medicare/Medicaid.)

So it looks like free-market approaches might not work as well as I expected previously.

 

[Lya]

I'm starting to think that too. Time to step out of this thread.

I sometimes wish we could have a sub-thread where people can argue offensively each other in another place..

 

[mcloaf]

I sometimes wish we could have a sub-thread where people can argue offensively each other in another place..

Wolf's Den.