Why can't free markets provide healthcare?

[Freiheit Reich]

I'm not saying that the doctor would be terrible, but why should someone have to visit an under-qualified doctor because of their ability to pay?

And medicine has obviously progressed alot since the 18th/19th century..

Don't be silly.

Everyone knows that if your leg is broken, you amputate it.
If you're anemic, you cover yourself in leeches.
If you get a cold, you drink some Dr. Flimflams Miracle Tonic (tm)
If you get pneumonia, you start writing your will.

This is what we did in the olden days, and that's what we should do now!

A doctor with 2 years of training would know not to do those things. He would still have access to medical journals and textbooks. He couldn't perform complex operations but for basic things (like telling a patient top take 2 Aspirin and call him in the morning) he could handle the tasks.

I believe you are exaggerating.

[Freiheit Reich]

No, which is why government involvement in healthcare is necessary.

Precisely. Government involvement is necessary.

The US govt. is penalizing people for not buying PRIVATE FOR PROFIT INSURANCE. Imagine if customers were forced to buy a minimum of 5 pounds of beef per week, the price of beef would explode. More customers and same supply equals higher costs.

My idea to increase supply of medical providers (nurses and doctors) will decrease wages for medical staff and make medical care cheaper. Importing cheaper drugs from abroad will reduce drug costs. Giving poor access to lower quality (but still OK) clinics will also reduce costs.

You pay more and you get more. For example, poor people might drive Fords while wealthy people drive Cadillacs. We have to accept the fact that poor people will not have the same quality of goods as wealthy people.

[Yorkopolis]

Too often I hear the arguments from liberals that healthcare is somehow different than buying potatoes or an ipod, that the free market cannot work. I think these arguments are a load of rubbish.

Information asymmetry exists in all markets, you don't know where your potatoes come from or how much pollution making them costs. There are various concentrations in various industries, many of them successfully run by the free market. If you buy a parachute and you choose wrong you still die, but the free market runs the parachute industry with success. So why not free markets?

Could it be that liberals don't want to give the American way a chance before they go around making things more socialist? I sense some bias at work here.

I do sense a lot of bias at work here, too. For a first, dearest friend, liberalism does not equate socialism. Socialism is a different set of ideologies and belief systems altogether. For a second, the "free" market has provided healthcare in the US for ages, and the costs we have seen. I am not saying that the "free" market cannot provide healthcare, and your scenario seems very idealistic. Realistically, however, a "free" market-provided healthcare is often far more costly for those who are in need of healthcare, and will mean that those who cannot afford healthcare, will not get healthcare. That, in my opinion, is already very unfair. Imagine now, my friend, you had cancer. Said cancer could get healed if you get the appropriate amount of healthcare. However, you can not afford healthcare, which basically means that you will not get it. So, you are left to die because you cannot afford healthcare.

See the wrongness in there? It's not that the "free" market cannot provide healthcare, it's more or less just the fact that it's not a very fair system for those who cannot afford it.

[New Chalcedon]

Don't be silly.

Everyone knows that if your leg is broken, you amputate it.
If you're anemic, you cover yourself in leeches.
If you get a cold, you drink some Dr. Flimflams Miracle Tonic (tm)
If you get pneumonia, you start writing your will.

This is what we did in the olden days, and that's what we should do now!

A doctor with 2 years of training would know not to do those things. He would still have access to medical journals and textbooks. He couldn't perform complex operations but for basic things (like telling a patient top take 2 Aspirin and call him in the morning) he could handle the tasks.

I believe you are exaggerating.

*nods* Clearly, a second-year med student can do all the things a GP does. Why, we don't need the full five-year degree (plus internship) for GP certification at all - they're just wasting over half of their training time, the lazy bums!

/sarcasm

More seriously, I note no effort to respond to my criticism of free-market fundamentalism in healthcare, so I'll repost it:

Too often I hear the arguments from liberals that healthcare is somehow different than buying potatoes or an ipod, that the free market cannot work. I think these arguments are a load of rubbish.

Information asymmetry exists in all markets, you don't know where your potatoes come from or how much pollution making them costs. There are various concentrations in various industries, many of them successfully run by the free market. If you buy a parachute and you choose wrong you still die, but the free market runs the parachute industry with success. So why not free markets?

Information asymmetry is (a) not the whole point of why private-sector healthcare doesn't do enough; and (b) particularly bad in healthcare. To take up your (and Justice Scalia's) argument that health insurance is inherently similar to buying broccoli:



Those are just three ways that the private health insurance market routinely screws its customers over. And it's not just an information asymmetry - it's a power asymmetry as well. The absolute last person who can, as a practical matter, go shopping around for health care alternatives is someone who actually needs the care. By the time you need the care, you've got better (or at least more life-preserving) ways to spend your time and energy, and no sane insurer will take on someone who needs care right now anyway - they'll be out of pocket a lot of money on your treatments, with no guarantee you'll stick around afterward.

And if there's one thing that most "free-market enthusiasts" don't know about free market economics - it's that one key, underlying assumption behind all classic microeconomic theory is that neither party to a bargain has undue power over the other. By failing to satisfy that key condition, healthcare disqualifies itself - from the very start - from consideration as a perfect private good.

Could it be that liberals don't want to give the American way a chance before they go around making things more socialist?

It's had 200 years. To paraphrase Jim Hacker (who does at least have a wonderful turn of phrase when he wants to), "I think it may perhaps be coming to the end of its trial period, don't you think?" It's been given a chance and a long trial, and the verdict is in: the free-market healthcare system sucks. And this stacks up with the theory of healthcare economics (more on that below), so it's hardly a surprise to any honest analyst with any knowledge of practical economics.

I sense some bias at work here.

Reality often does seem to have a left-wing bias. Let's look at the facts:

(1) The US healthcare system is very, very expensive.



The US healthcare system accounts for 16% of the economy. Sixteen percent - or one-sixth - of all your economic production is spent on keeping people healthy. And not all of this spending is from the customers (consumers, etc.) of healthcare - the US Government spends more on healthcare per person on its own than total public and private spending on healthcare in most of the rest of the OECD:



"Ah, well", you might say, "We spend a lot on it, but least we get a first-class healthcare system, not like those socialist healthcare rationers in the rest of the world."

But this is....half-true. At best. You see....

(2) The US healthcare system delivers very, very poor outcomes for all that money spent.

This isn't just my personal opinion - no matter what metric you use or which body you go to for the data, the US healthcare system ranks at or near the bottom of the industrialized world in terms of overall outcomes. For instance, the Commonwealth Fund's 2014 report, "Mirror, Mirror":



Eleven first-world countries were chosen for this study, and assessed on their healthcare outcomes. Each and every one of the ten countries that placed ahead of the USA in health outcomes (i.e., every country in the study other than the USA) spent less to achieve more. Why? Because for all its shortcomings, a public healthcare system isn't greedy. And if there's one word that describes US healthcare providers, it's "greedy". It's no good to have all those fancy devices, MRIs, prototype drugs etc. available....if only the upper-crust can afford them. And between health insurance companies screwing their customers at every turn, and the obscene cost of actually delivering the treatment thanks to all the padding for CEO salaries (and bonuses), shareholder dividends, obscene IP payment rates and the like....only the upper crust can afford all the good treatments.

It's why some (rich) people go to the USA for treatment that isn't available elsewhere. They've got the money to pay all those fees and costs, and if you can afford it, the healthcare that the fortunate few at the top get really is the best in the world. But what about the other 99.5% of us? This brings me to my third point:

(3) Healthcare is inherently a communal good.

This one should be simple, but....some people seem to have trouble with it. So here it is. If we share a work environment, and I get sick....you get sick too. If I get my symptoms treated and take a sick day - you don't get sick. That's not ideology - that's germ theory at work. If we're supposed to be collaborating to make stuff (or ideas, or anything) for our employer, there's no practical way to prevent me giving you the disease.

Which is why you really, really want me to get healthcare. By providing healthcare to me, whomever did it (be it public hospital or private practice) also did you, and all the other people I may have passed that sickness on to, a favour. A rather large one. This, in economics, is called a positive externality: the idea that a deal made between two people (me and my health carer) has benefited a third party who didn't take part in that deal, nor pay any costs associated with it (you).

This simple fact - the fact that you benefit from my healthcare despite not paying for it, means that the free market will always under-provide healthcare relative to the economically optimum level. Always. Without exceptions. Because you - the inadvertent "free-rider" - cannot be charged your due share of the costs of my healthcare in a free-market system. Which means that I will under-value the benefits of it from a broader economic perspective. Which means that I'll be less inclined to seek (and pay for) health care than I would otherwise be.

***

There. Now do you understand why healthcare isn't broccoli?

[Freiheit Reich]

average of ten years of apprenticeship and/or formal training.

Oof, that's a nasty burn there. Frei better put leeches on it.

Average medical education was not as great as he thinks. Apprenticeship is fine as well. Perhaps a clinic with 1-2 cheaper foreign doctors and several trainees will be OK. The Philippines has many good English speakers and they will be happy to work for $2,000-$3,000 a month in the USA (plus free housing) considering their wages in the Philippines are much less. The condition of the visa would require working in a poorer clinic in a town with a need (the govt. could give them a list of places with high needs that they could choose from).

http://www.encyclopedia.com/topic/Medic ... ation.aspx

Though the first schools were created with lofty ambitions, the quality of instruction at the proprietary schools rapidly deteriorated, even based on the standards of the day. Entrance requirements were nonexistent other than the ability to pay the fees. Disciplinary problems arising from outrageous student behavior were commonplace. The standard course of instruction in the mid-nineteenth century consisted of two four-month terms of lectures during the winter, with the second term identical to the first. The curriculum generally consisted of seven courses: anatomy; physiology and pathology; materia medica, therapeutics, and pharmacy; chemistry and medical jurisprudence; theory and practice of medicine; principles and practice of surgery; and obstetrics and the diseases of women and children. Instruction was wholly didactic: seven or eight hours of lectures a day, supplemented by textbook reading. Laboratory work was sparse, and even in the clinical subjects, no opportunity to work with patients was provided. Examinations were brief and superficial; virtually the only requirement for graduation was the ability to pay the fees. Students who wished a rigorous medical education had to supplement what they learned in medical school in other ways, such as through enrollment at non-degree-granting extramural private schools, study in Europe, or work in hospitals as "house pupils." -

[Republic of Coldwater]

How about countries such as Hong Kong and Singapore with true, not phony free market healthcare?

Singapore? With it's government subsidies of bills and compulsory medical savings accounts?

http://www.moh.gov.sg/content/moh_web/h ... ncing.html

Doesn't really sound like free market to me. Neither does Hong Kong, where 42 out of 53 hospitals are owned by the government.

http://en.wikipedia.org/wiki/Health_in_Hong_Kong

Singapore's Health Insurance however, is unregulated, the same thing with Hong Kong. Hong Kong does have public hospitals, but health insurance is free-market, yet they have good health conditions.

[Death Metal]

A doctor with 2 years of training would know not to do those things. He would still have access to medical journals and textbooks. He couldn't perform complex operations but for basic things (like telling a patient top take 2 Aspirin and call him in the morning) he could handle the tasks.

I believe you are exaggerating.

*nods* Clearly, a second-year med student can do all the things a GP does. Why, we don't need the full five-year degree (plus internship) for GP certification at all - they're just wasting over half of their training time, the lazy bums!

Not to mention, as you probably got but obviously went miles over FR's head, that my comment was some of my trademark satire, pointing out that there's a reason why we don't and shouldn't comply to 1800s medical standards.

Perhaps he would have understood it if I used a telegraph. What's morse code for a facepalm smiley again?

[New Chalcedon]

*nods* Clearly, a second-year med student can do all the things a GP does. Why, we don't need the full five-year degree (plus internship) for GP certification at all - they're just wasting over half of their training time, the lazy bums!

Not to mention, as you probably got but obviously went miles over FR's head, that my comment was some of my trademark satire, pointing out that there's a reason why we don't and shouldn't comply to 1800s medical standards.

Perhaps he would have understood it if I used a telegraph. What's morse code for a facepalm smiley again?

..-. .- -.-. . .--. .- .-.. --

....I think.

[Death Metal]

Not to mention, as you probably got but obviously went miles over FR's head, that my comment was some of my trademark satire, pointing out that there's a reason why we don't and shouldn't comply to 1800s medical standards.

Perhaps he would have understood it if I used a telegraph. What's morse code for a facepalm smiley again?

..-. .- -.-. . .--. .- .-.. --

....I think.

Thank ya kindly.

BTW, if you saw on the last page I cited the 2011 economic freedom index from the Frasier Institute, can you check Spain and Italy's ranks for me? I had to google for Italy and couldn't find spain at all, and this computer (and it's user) hates Adobe Reader.

I mean, Spain's has to be at least in the 50s as Wiki only had the top 50, but having the exact number would be nice.

[Freiheit Reich]

*nods* Clearly, a second-year med student can do all the things a GP does. Why, we don't need the full five-year degree (plus internship) for GP certification at all - they're just wasting over half of their training time, the lazy bums!

Not to mention, as you probably got but obviously went miles over FR's head, that my comment was some of my trademark satire, pointing out that there's a reason why we don't and shouldn't comply to 1800s medical standards.

Perhaps he would have understood it if I used a telegraph. What's morse code for a facepalm smiley again?

The doctor with 2 years training in a US medical program today and with access to modern technology would probably be better than the average doctor from 1800 (maybe even 1900). Yes, the quality would not be the best but the prices would be lower and the care would probably exceed the health care received by poor people in many third world nations. It will still be better than no health care at all (the choice that many poor people have to make now due to ridiculous costs of US medical care at present).

Wealthy people will always have more options-including access to better health care. Don't hate, congratulate.

[New Chalcedon]

Singapore? With it's government subsidies of bills and compulsory medical savings accounts?

http://www.moh.gov.sg/content/moh_web/h ... ncing.html

Doesn't really sound like free market to me. Neither does Hong Kong, where 42 out of 53 hospitals are owned by the government.

http://en.wikipedia.org/wiki/Health_in_Hong_Kong

Singapore's Health Insurance however, is unregulated, the same thing with Hong Kong. Hong Kong does have public hospitals, but health insurance is free-market, yet they have good health conditions.

Singapore's health insurance market is, by definition, a public (government-owned) one, with all citizens paying into Medisave for their own healthcare and the Central Provident Fund to subsidize the healthcare of those who cannot afford it. The private sector is mostly for specialist operations and noncitizens, not the day-to-day healthcare needs of Singaporeans. Essentially, the private healthcare market in Singapore is a boutique market, not the bread-and-butter it is in America.

Which may have something to do with how it works better...I must admit to being perplexed at how anyone can look at the catastrophic consequences of deregulating Wall Street, and still come up with "Deregulation!" as the answer to every economic or social ill.

Not to mention, as you probably got but obviously went miles over FR's head, that my comment was some of my trademark satire, pointing out that there's a reason why we don't and shouldn't comply to 1800s medical standards.

Perhaps he would have understood it if I used a telegraph. What's morse code for a facepalm smiley again?

The doctor with 2 years training in a US medical program today and with access to modern technology would probably be better than the average doctor from 1800 (maybe even 1900). Yes, the quality would not be the best but the prices would be lower and the care would probably exceed the health care received by poor people in many third world nations. It will still be better than no health care at all (the choice that many poor people have to make now due to ridiculous costs of US medical care at present).

Wealthy people will always have more options-including access to better health care. Don't hate, congratulate.

Still not responding to my criticism of the idea of healthcare as a private product, I see. At least not with anything but standard libertarian pablum. Desiring more equitable access to healthcare has nothing to do with hating the wealthy, but your strawman is noted.

[Chestaan]

Precisely. Government involvement is necessary.

The US govt. is penalizing people for not buying PRIVATE FOR PROFIT INSURANCE. Imagine if customers were forced to buy a minimum of 5 pounds of beef per week, the price of beef would explode. More customers and same supply equals higher costs.

My idea to increase supply of medical providers (nurses and doctors) will decrease wages for medical staff and make medical care cheaper. Importing cheaper drugs from abroad will reduce drug costs. Giving poor access to lower quality (but still OK) clinics will also reduce costs.

You pay more and you get more. For example, poor people might drive Fords while wealthy people drive Cadillacs. We have to accept the fact that poor people will not have the same quality of goods as wealthy people.

Fuck that. If the free market fails, it fails and we should correct that failure. I would say that allowing poor people to die when the treatments necessary to save them are available is a complete failure.

People seem to forget that the free market is capitalism's system for distributing the worlds resources. If our distribution system is broken (and not being able to get the resources that are needed to those who need them, e.g medicine to the sick, is the very definition of a broken distribution system) then you fix it as best you can until you can replace the system with something better.

[Republic of Coldwater]

A doctor with 2 years of training would know not to do those things. He would still have access to medical journals and textbooks. He couldn't perform complex operations but for basic things (like telling a patient top take 2 Aspirin and call him in the morning) he could handle the tasks.

I believe you are exaggerating.

*nods* Clearly, a second-year med student can do all the things a GP does. Why, we don't need the full five-year degree (plus internship) for GP certification at all - they're just wasting over half of their training time, the lazy bums!

/sarcasm

More seriously, I note no effort to respond to my criticism of free-market fundamentalism in healthcare, so I'll repost it:

Information asymmetry is (a) not the whole point of why private-sector healthcare doesn't do enough; and (b) particularly bad in healthcare. To take up your (and Justice Scalia's) argument that health insurance is inherently similar to buying broccoli:



Those are just three ways that the private health insurance market routinely screws its customers over. And it's not just an information asymmetry - it's a power asymmetry as well. The absolute last person who can, as a practical matter, go shopping around for health care alternatives is someone who actually needs the care. By the time you need the care, you've got better (or at least more life-preserving) ways to spend your time and energy, and no sane insurer will take on someone who needs care right now anyway - they'll be out of pocket a lot of money on your treatments, with no guarantee you'll stick around afterward.

And if there's one thing that most "free-market enthusiasts" don't know about free market economics - it's that one key, underlying assumption behind all classic microeconomic theory is that neither party to a bargain has undue power over the other. By failing to satisfy that key condition, healthcare disqualifies itself - from the very start - from consideration as a perfect private good.



It's had 200 years. To paraphrase Jim Hacker (who does at least have a wonderful turn of phrase when he wants to), "I think it may perhaps be coming to the end of its trial period, don't you think?" It's been given a chance and a long trial, and the verdict is in: the free-market healthcare system sucks. And this stacks up with the theory of healthcare economics (more on that below), so it's hardly a surprise to any honest analyst with any knowledge of practical economics.



Reality often does seem to have a left-wing bias. Let's look at the facts:

(1) The US healthcare system is very, very expensive.



The US healthcare system accounts for 16% of the economy. Sixteen percent - or one-sixth - of all your economic production is spent on keeping people healthy. And not all of this spending is from the customers (consumers, etc.) of healthcare - the US Government spends more on healthcare per person on its own than total public and private spending on healthcare in most of the rest of the OECD:



"Ah, well", you might say, "We spend a lot on it, but least we get a first-class healthcare system, not like those socialist healthcare rationers in the rest of the world."

But this is....half-true. At best. You see....

(2) The US healthcare system delivers very, very poor outcomes for all that money spent.

This isn't just my personal opinion - no matter what metric you use or which body you go to for the data, the US healthcare system ranks at or near the bottom of the industrialized world in terms of overall outcomes. For instance, the Commonwealth Fund's 2014 report, "Mirror, Mirror":



Eleven first-world countries were chosen for this study, and assessed on their healthcare outcomes. Each and every one of the ten countries that placed ahead of the USA in health outcomes (i.e., every country in the study other than the USA) spent less to achieve more. Why? Because for all its shortcomings, a public healthcare system isn't greedy. And if there's one word that describes US healthcare providers, it's "greedy". It's no good to have all those fancy devices, MRIs, prototype drugs etc. available....if only the upper-crust can afford them. And between health insurance companies screwing their customers at every turn, and the obscene cost of actually delivering the treatment thanks to all the padding for CEO salaries (and bonuses), shareholder dividends, obscene IP payment rates and the like....only the upper crust can afford all the good treatments.

It's why some (rich) people go to the USA for treatment that isn't available elsewhere. They've got the money to pay all those fees and costs, and if you can afford it, the healthcare that the fortunate few at the top get really is the best in the world. But what about the other 99.5% of us? This brings me to my third point:

(3) Healthcare is inherently a communal good.

This one should be simple, but....some people seem to have trouble with it. So here it is. If we share a work environment, and I get sick....you get sick too. If I get my symptoms treated and take a sick day - you don't get sick. That's not ideology - that's germ theory at work. If we're supposed to be collaborating to make stuff (or ideas, or anything) for our employer, there's no practical way to prevent me giving you the disease.

Which is why you really, really want me to get healthcare. By providing healthcare to me, whomever did it (be it public hospital or private practice) also did you, and all the other people I may have passed that sickness on to, a favour. A rather large one. This, in economics, is called a positive externality: the idea that a deal made between two people (me and my health carer) has benefited a third party who didn't take part in that deal, nor pay any costs associated with it (you).

This simple fact - the fact that you benefit from my healthcare despite not paying for it, means that the free market will always under-provide healthcare relative to the economically optimum level. Always. Without exceptions. Because you - the inadvertent "free-rider" - cannot be charged your due share of the costs of my healthcare in a free-market system. Which means that I will under-value the benefits of it from a broader economic perspective. Which means that I'll be less inclined to seek (and pay for) health care than I would otherwise be.

***

There. Now do you understand why healthcare isn't broccoli?

America is in that condition not because it lacks Universal Care, but because of regulations on the market that if lifted, will lower costs. People are forced to buy from insurers within state lines, decreasing competition, resulting in higher prices and bad quality, but if we lift that regulation, it would increase competition and thereby drive down costs and increase quality via competition. The reason why England and Switzerland bear good health conditions is due to the government taking a lot from the taxpayer and from other countries and using that cash on public healthcare, which with such amounts of cash would increase quality and artificially drive down costs. However, the prices would still be high for a large majority of the taxpayers (probably higher than the US due to high tax rates), while a true free market system that promotes competition would result in lower prices and higher quality for all.

[New Chalcedon]

Precisely. Government involvement is necessary.

The US govt. is penalizing people for not buying PRIVATE FOR PROFIT INSURANCE. Imagine if customers were forced to buy a minimum of 5 pounds of beef per week, the price of beef would explode. More customers and same supply equals higher costs.

Nice idea. Sadly for you, reality contradicts it - health insurance rates were going up double-digits every year before the Affordable Care Act was even a gleam in President Obama's eye. And if anything, the rate of increase has slowed since the ACA was introduced.

Care to try again?

[New Chalcedon]

America is in that condition not because it lacks Universal Care, but because of regulations on the market that if lifted, will lower costs. People are forced to buy from insurers within state lines, decreasing competition, resulting in higher prices and bad quality, but if we lift that regulation, it would increase competition and thereby drive down costs and increase quality via competition.

Now that's one reform I could accept - at the very least, removing the state-line restriction on health-insurance purchase can't hurt.

The reason why England and Switzerland bear good health conditions is due to the government taking a lot from the taxpayer and from other countries

Excuse me? Other countries?

and using that cash on public healthcare, which with such amounts of cash would increase quality and artificially drive down costs.

They provide it directly, yes.

However, the prices would still be high for a large majority of the taxpayers (probably higher than the US due to high tax rates), while a true free market system that promotes competition would result in lower prices and higher quality for all.

Er, wrong.



As of 2010, the UK spent $3,433 per capita (at purchasing power parity) on healthcare, with 85% of that being from the public purse.

The USA? Spent, in that same year, $8,233 per capita - over twice what the UK spent, per person. What's more, because of the clumsy, inefficient network of special-interest (read: Big Pharma lobbyist - see Medicare D for one example how that political corruption works) subsidies throughout the structure, the US Government spent, privately, more than the UK total spending per person - and the US private customer for healthcare spent more still!

[Death Metal]

Singapore's Health Insurance however, is unregulated, the same thing with Hong Kong. Hong Kong does have public hospitals, but health insurance is free-market, yet they have good health conditions.

Singapore's health insurance market is, by definition, a public (government-owned) one, with all citizens paying into Medisave for their own healthcare and the Central Provident Fund to subsidize the healthcare of those who cannot afford it. The private sector is mostly for specialist operations and noncitizens, not the day-to-day healthcare needs of Singaporeans. Essentially, the private healthcare market in Singapore is a boutique market, not the bread-and-butter it is in America.

Which may have something to do with how it works better...I must admit to being perplexed at how anyone can look at the catastrophic consequences of deregulating Wall Street, and still come up with "Deregulation!" as the answer to every economic or social ill.

The doctor with 2 years training in a US medical program today and with access to modern technology would probably be better than the average doctor from 1800 (maybe even 1900). Yes, the quality would not be the best but the prices would be lower and the care would probably exceed the health care received by poor people in many third world nations. It will still be better than no health care at all (the choice that many poor people have to make now due to ridiculous costs of US medical care at present).

Wealthy people will always have more options-including access to better health care. Don't hate, congratulate.

Still not responding to my criticism of the idea of healthcare as a private product, I see. At least not with anything but standard libertarian pablum. Desiring more equitable access to healthcare has nothing to do with hating the wealthy, but your strawman is noted.

Plus, we already have a third-world healthcare system. The only thing that makes our WHO rating as high as it is quality... as he wants to basically reduce that as his solution to cutting costs, we'd only slip further behind the rest of the world.

Not to mention that it's actually pretty easy to give all US citizens first-world healthcare... and that's do what the rest of the civilized world does, universalize it. And costs will go down THAT way because of the inflated cost of care under the pre-ACA system.

And under a mixed universalized + private supplemental firm system, there is nothing stopping the wealthy from getting the best care money can buy. So that aspect of his argument is bunk as well.

Not to mention that pre-ACA, there were groups that work pro bono. And some (St Jude) still do. Which goes contrary to his claim that poor people cannot get care. The problem is, these charitable options simply aren't good enough, and do not reach enough people, and for such options to be capable of handling what it would need to be handled to be a replacement for universal care would be such a massive burden on them that they cannot afford.

But he doesn't address any of this, unsurprisingly. All he does is offer ideas that even my cousin who thinks the word "computer" has a w in it can understand why they won't work.

He's officially worse than AuSable. And that's terrible.

[Death Metal]

By the way, here's my list of the WHO's top ten nations by healthcare again, with the number afterward denoting their 2011 Frasier Institute economic freedom ranking.

Note that the US ranks 17th on the Frasier ranking, and every single one of these nations outrank the US in healthcare by leaps and bounds.

France 40
Italy 83 (Out of 90!)
San Marino NR
Andorra NR
Malta 21
Singapore 2
Spain [Information Not Found, Has to be at least 50]
Oman 46 (Tied)
Austria 27 (Tied)
Japan 33 (Tied)

Chalce, feel free to use and expand on this. I'm outta here for now, you've got this anyway. You know what you doing, take off every zig, for great justice.

[New Chalcedon]

By the way, here's my list of the WHO's top ten nations by healthcare again, with the number afterward denoting their 2011 Frasier Institute economic freedom ranking.

Note that the US ranks 17th on the Frasier ranking, and every single one of these nations outrank the US in healthcare by leaps and bounds.

France 40
Italy 83 (Out of 90!)
San Marino NR
Andorra NR
Malta 21
Singapore 2
Spain [Information Not Found, Has to be at least 50]
Oman 46 (Tied)
Austria 27 (Tied)
Japan 33 (Tied)

Chalce, feel free to use and expand on this. I'm outta here for now, you've got this anyway. You know what you doing, take off every zig, for great justice.

Hey, I need sleep too, you know

[Freiheit Reich]

Singapore's Health Insurance however, is unregulated, the same thing with Hong Kong. Hong Kong does have public hospitals, but health insurance is free-market, yet they have good health conditions.

Singapore's health insurance market is, by definition, a public (government-owned) one, with all citizens paying into Medisave for their own healthcare and the Central Provident Fund to subsidize the healthcare of those who cannot afford it. The private sector is mostly for specialist operations and noncitizens, not the day-to-day healthcare needs of Singaporeans. Essentially, the private healthcare market in Singapore is a boutique market, not the bread-and-butter it is in America.

Which may have something to do with how it works better...I must admit to being perplexed at how anyone can look at the catastrophic consequences of deregulating Wall Street, and still come up with "Deregulation!" as the answer to every economic or social ill.

The doctor with 2 years training in a US medical program today and with access to modern technology would probably be better than the average doctor from 1800 (maybe even 1900). Yes, the quality would not be the best but the prices would be lower and the care would probably exceed the health care received by poor people in many third world nations. It will still be better than no health care at all (the choice that many poor people have to make now due to ridiculous costs of US medical care at present).

Wealthy people will always have more options-including access to better health care. Don't hate, congratulate.

Still not responding to my criticism of the idea of healthcare as a private product, I see. At least not with anything but standard libertarian pablum. Desiring more equitable access to healthcare has nothing to do with hating the wealthy, but your strawman is noted.

I will support the idea of socialized medicine if it is paid by a deduction of payroll (perhaps 7-8%). This means everybody will have it and the costs are capped based on percentage of income. The idea of paying $200 a month for health care with a $5,000 deductible when you only make $1,400 a month is ridiculous (a possible situation with Obamacare). Socialized medicine is worth supporting if the quality is good. However, the US govt. has a bad history of overspending though. Look at their poor job with education or prisons or the military for example. Imagine if you end up paying 19% of your wages for a crappy socialized healthcare plan with $500 (or higher) deductibles. I don't have confidence in the US govt. when it comes to healthcare.

Taiwan has a workable system, better than the healthcare in the USA.

http://en.wikipedia.org/wiki/Healthcare_in_Taiwan

http://www.npr.org/templates/story/stor ... d=89651916

Chile also has a decent model but Taiwan's seems to be superior. Chile people pay 7% of the wages to fund the healthcare system, I am unsure about Taiwan residents.

http://en.wikipedia.org/wiki/Healthcare_in_Chile

All workers and pensioners are mandated to pay 7% of income for health insurance (the poorest pensioners are exempt from this payment).

[Death Metal]

Since it turns out I'm not headed off yet, I'll add another thought;

Singapore having a high WHO ranking and a high economic freedom index rating is not proof that the free market system is superior. If anything, it is the exception that proves the rule; for not only is it an outlier (along with San Marino which while unranked in the Frasier Institute can be argued to be more right-capitalist than the US), but it falls short against Italy, who ranks 83... and I must again stress that that is 83 out of 90.

Surely if the free market system was superior, this wouldn't be, nor would Singapore and San Marino be outliers in a data plot that shows that tightly regulated nations not only have better healthcare than we do (and mind you, these regulated nations all have had higher WHO rankings than the US before the AHCA was even a thing), but the Western worlds most regulated nation has better healthcare than the least deregulated nations in the world.

And the nail in the coffin: Singapore and San Marino both have universal care.

So much for the magic of the "free" market.

[Jocabia]

*snip*

America is in that condition not because it lacks Universal Care, but because of regulations on the market that if lifted, will lower costs. People are forced to buy from insurers within state lines, decreasing competition, resulting in higher prices and bad quality, but if we lift that regulation, it would increase competition and thereby drive down costs and increase quality via competition. The reason why England and Switzerland bear good health conditions is due to the government taking a lot from the taxpayer and from other countries and using that cash on public healthcare, which with such amounts of cash would increase quality and artificially drive down costs. However, the prices would still be high for a large majority of the taxpayers (probably higher than the US due to high tax rates), while a true free market system that promotes competition would result in lower prices and higher quality for all.

Care to give an example of a country that utilized the solution you propose and it worked? Because every example I can think of improved their healthcare system by making it a public good (like every other necessary health service, i.e., police, fire, military, et al.)

Go ahead. Give an example isn't funded by the public like Taiwan and Singapore.

[Jocabia]

America is in that condition not because it lacks Universal Care, but because of regulations on the market that if lifted, will lower costs. People are forced to buy from insurers within state lines, decreasing competition, resulting in higher prices and bad quality, but if we lift that regulation, it would increase competition and thereby drive down costs and increase quality via competition.

Now that's one reform I could accept - at the very least, removing the state-line restriction on health-insurance purchase can't hurt.

I agree with almost all of your analysis but this is incorrect. The reason insurers are fighting so hard to lift state line restrictions is because right now the regulation of insurers is mostly up to states. They know that if we lift that restriction that they will find the most ridiculous state out there that is most willing to screw over their poor and that will be where all the insurers will call home.

In other words, that restriction lifted would encourage states to deregulate the market as much as they can and insurers to lower their standard of care. Both are bad for the consumer, unlike the BS claim being made by Conservative commentators. Yes, it might be cheaper, but you'd get a lot less care for your money, which is the problem we're trying to solve, not add to.

[Republic of Coldwater]

America is in that condition not because it lacks Universal Care, but because of regulations on the market that if lifted, will lower costs. People are forced to buy from insurers within state lines, decreasing competition, resulting in higher prices and bad quality, but if we lift that regulation, it would increase competition and thereby drive down costs and increase quality via competition.

Now that's one reform I could accept - at the very least, removing the state-line restriction on health-insurance purchase can't hurt.

The reason why England and Switzerland bear good health conditions is due to the government taking a lot from the taxpayer and from other countries

Excuse me? Other countries?

and using that cash on public healthcare, which with such amounts of cash would increase quality and artificially drive down costs.

They provide it directly, yes.

However, the prices would still be high for a large majority of the taxpayers (probably higher than the US due to high tax rates), while a true free market system that promotes competition would result in lower prices and higher quality for all.

Er, wrong.



As of 2010, the UK spent $3,433 per capita (at purchasing power parity) on healthcare, with 85% of that being from the public purse.

The USA? Spent, in that same year, $8,233 per capita - over twice what the UK spent, per person. What's more, because of the clumsy, inefficient network of special-interest (read: Big Pharma lobbyist - see Medicare D for one example how that political corruption works) subsidies throughout the structure, the US Government spent, privately, more than the UK total spending per person - and the US private customer for healthcare spent more still!

By other countries I mean borrowing money from other countries.

I terribly worded that, my bad. What I meant was that you are only re-directing costs into two channels, one via taxes and the other via purchasing, so you are artificially having less citizen healthcare spending, but if you include the tax, I doubt it would be as low as stated.

[Republic of Coldwater]

Now that's one reform I could accept - at the very least, removing the state-line restriction on health-insurance purchase can't hurt.

I agree with almost all of your analysis but this is incorrect. The reason insurers are fighting so hard to lift state line restrictions is because right now the regulation of insurers is mostly up to states. They know that if we lift that restriction that they will find the most ridiculous state out there that is most willing to screw over their poor and that will be where all the insurers will call home.

In other words, that restriction lifted would encourage states to deregulate the market as much as they can and insurers to lower their standard of care. Both are bad for the consumer, unlike the BS claim being made by Conservative commentators. Yes, it might be cheaper, but you'd get a lot less care for your money, which is the problem we're trying to solve, not add to.

Companies will not simply lower their standards, that will result in customers moving to another company or protesting, and historically, that has worked very well (take a look at protests against companies segregating). There will be all sorts of HealthCare Companies under the across state line solution I support, some for those willing to pay high prices for a lot of coverage, some which cost less but cover less, it is really up to the customer. Keep in mind that this will drastically increase competition, which will force companies to keep standards to a maximum and prices to a minimum without going broke to attract customers and make more cash. That has always been the case, as seen in the past, and I believe that this drastic increase in competition would help the customer and the provider.

[Republic of Coldwater]

Singapore's Health Insurance however, is unregulated, the same thing with Hong Kong. Hong Kong does have public hospitals, but health insurance is free-market, yet they have good health conditions.

Singapore's health insurance market is, by definition, a public (government-owned) one, with all citizens paying into Medisave for their own healthcare and the Central Provident Fund to subsidize the healthcare of those who cannot afford it. The private sector is mostly for specialist operations and noncitizens, not the day-to-day healthcare needs of Singaporeans. Essentially, the private healthcare market in Singapore is a boutique market, not the bread-and-butter it is in America.

Which may have something to do with how it works better...I must admit to being perplexed at how anyone can look at the catastrophic consequences of deregulating Wall Street, and still come up with "Deregulation!" as the answer to every economic or social ill.

The doctor with 2 years training in a US medical program today and with access to modern technology would probably be better than the average doctor from 1800 (maybe even 1900). Yes, the quality would not be the best but the prices would be lower and the care would probably exceed the health care received by poor people in many third world nations. It will still be better than no health care at all (the choice that many poor people have to make now due to ridiculous costs of US medical care at present).

Wealthy people will always have more options-including access to better health care. Don't hate, congratulate.

Still not responding to my criticism of the idea of healthcare as a private product, I see. At least not with anything but standard libertarian pablum. Desiring more equitable access to healthcare has nothing to do with hating the wealthy, but your strawman is noted.

Medisave isn't really a universal healthcare program by any means. It is sort of like Social Security, where you put some of your income into a savings account for later or for relatives, which can later be used to pay for Health Insurance, which is conducted by private industry. The Medisave program was targeted mainly for those retiring, as all the government is doing is being the agency that saves your healthcare money. Everything else, shall that be conducting surgeries, giving the treatment or the facilitation of such services is done by a private company, not by the government, effectively making the Singaporean system not entirely Capitalistic due to a government helping you save for medical expenses, but very capitalistic otherwise.