There’s plenty about it that’s defensible, the part that seems indefensible to me is the regulatory capture that leads to situations covered in the blog where insurance won’t cover cutting edge treatments. There’s a good argument to be made that deregulation would encourage innovation and lead to dropping prices and greater supply - why capitalism should stop working its usual magic when it comes to medicine is a mystery.
Plenty of single payer systems (like where I live in Canada) don't cover this stuff either. The difference is is in the US it's an insurance company saying "no" and in Canada it's the gov't saying "no". And actually, since it's one system, the doctors already know it's not covered so it never comes up.
Capitalism can't work its magic because healthcare is not a free market. It has a unique set of constraints that capitalism is particularly weak at dealing with: lack of choice (you don't get to choose which hospital you go to in a lot of circumstances), high barrier to entry, constantly changing regulatory environment, etc...
The reason single payer systems work is because they're at a specific advantage for all of the constraints that healthcare systems face, including a better overall incentive alignment.
> Capitalism can't work its magic because healthcare is not a free market.
That's exactly my argument, regulatory capture precludes a market from being free.
> It has a unique set of constraints
I fail to see how the points you list make it unique.
> lack of choice (you don't get to choose which hospital you go to in a lot of circumstances)
Then make that possible. I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
> high barrier to entry
For whom at with what?
> constantly changing regulatory environment
Yes, so deregulate and move towards a freer market.
> The reason single payer systems work
Do they? If you have a heart attack in the US vs one in the UK then you are more likely to survive in the US. Blanket statements about what "works" are meaningless when talking about complex systems with multiple outcomes across large populations. The US outranks many countries that aren't using its system in many health outcomes, and if you have insurance then you will get a very high standard of care. Poor health outcomes for those at the bottom are bad but that's only one way to measure efficacy.
Japan has a single payer insurance system but I can also point to many negatives, as well as many positives. None of these provide any refutation to a free(r) market providing the benefits that other markets receive.
> Then make that possible. I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
I don’t believe you will be choosing which hospital you go to if you’re unconscious, or facing a serious acute medical concern placing you in desperation. Coincidentally, those tend to be the times when costs also skyrocket.
—
The issue with treating healthcare like a free market is that some people just won’t get healthcare. Free markets aren’t going to build a hospital in a small enough town because the cost can’t be justified.
Your point that the US outranks most other countries is perhaps true for some things, but completely false for baseline measures such as infant mortality, life expectancy, cost per capita, etc. As a country the US can sometimes pull ahead on specialized care in part because of a prevalence of supporting technology compared to other countries, and I’ll grant that. But our system is hardly “better” than other developed nations on almost any objective measure.
> I don’t believe you will be choosing which hospital you go to if you’re unconscious, or facing a serious acute medical concern placing you in desperation. Coincidentally, those tend to be the times when costs also skyrocket.
Firstly, emergency treatment is a tiny sliver of all healthcare, in terms of volume and cost. If you want to argue about healthcare in general based on that - nay, on the miniscule number of unconscious people admitted to hospital - be my guest, "never interrupt your enemy when he is making a mistake" and all that.
Secondly, I think you should look into how the Japanese system works before making statements about it. Your beliefs are of no concern to truth or proper analysis, especially when they don't accord with reality.
> The issue with treating healthcare like a free market is that some people just won’t get healthcare. Free markets aren’t going to build a hospital in a small enough town because the cost can’t be justified.
The issue with treating computing like a free market is that some people just won’t get computers. Free markets aren’t going to provide computers to small businesses because the cost can’t be justified.
I think the 70s is calling and wants your argument back. Before you reply with "computing and healthcare aren't comparable" they are, in fact, incredibly comparable. Health is like computing power, the more you have the more you want and can do, and hence - due to demand and people seeking to satisfy that demand - the more you can get. Reading these forums it seems like a quite profitable endeavour that is unlikely to end soon, much like healthcare.
> Your point that the US outranks most other countries is perhaps true for some things, but completely false for baseline measures such as infant mortality, life expectancy, cost per capita, etc.
That is something we agree on because that is the accepted starting point of the discussion, not a refutation to anything I have written or proposed.
> But our system is hardly “better” than other developed nations on almost any objective measure.
Back to the black and white thinking.
It is better in several ways and yet I am not an advocate of it because it is not a free market so I might ask why you're responding to me as if I am an advocate of it, but that is black and white thinking in a nutshell so I won't.
The problem is how to get more and better healthcare to more people. Aside from the endless examples outside of healthcare, less regulated markets in healthcare have met these requirements. For example, cosmetic surgery and things like lasik, the quality has gone up, the costs have dropped, availability is widespread and even approach normal.
Computer has Moore's law, but healthcare hasn't. What is worse, it's labor-intensive work so very difficult to optimize even compared to other industry. Possibly robots can replace human but I don't think it moving forward without public health insurance. (Gov has incentive to develop technology to reduce healthcare cost)
Healthcare relies on Moore’s law. You’re also going to receive, this year, a vaccine that will be among the fastest ever developed. The number of services and treatments that didn’t even exist 10 years ago is increasing year on year, and the efficiency of them increases too - and would increase faster and hence become cheaper if they were deregulated.
> regulatory capture precludes a market from being free.
Yes, and healthcare is a good thing to regulate, you know, cause of all those pesky ethics and morals that get involved with human life.
brigandish 2 days ago | parent | on: Notes on My Chemotherapy
> Capitalism can't work its magic because healthcare is not a free market.
That's exactly my argument, regulatory capture precludes a market from being free.
> It has a unique set of constraints
>> I fail to see how the points you list make it unique.
If you can't seen why healthcare a specifically constrained market, you're being either intentionally obtuse or incredibly naive.
> I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
Yeah, I choose my dentist, too dawg, doesn't mean that I can choose what E.R. I get dropped off at when I get in a car wreck. I can't shop around for prices on concussion doctors when I'm unconscious in a gurney. Don't be obtuse. Sure, emergency services are only a small part of the pie, but they're the ones that bankrupt people. No one went bankrupt getting their contacts done, and dental and vision are frequently separated _for the exact reason_ that they're not ever medical emergencies, and when they are, they send you to a specialist anyway.
> high barrier to entry
>> For whom at with what?
This is starting to border on bad-faith. I'm not going to spell out every piece of my argument here. If you can't accept the premise that healthcare is a high barrier to entry market, then you're not familiar with the problem.
> constantly changing regulatory environment
>> Yes, so deregulate and move towards a freer market.
You can't just deregulate things and hope it'll fix it. de-regulate _what_? You haven't even proposed a solution here, you've just yelled "Free market!" and "Deregulate healthcare!" But all that will do is worsen the quality that we see and encourage a bunch of snake oil companies to become even more common.
> The reason single payer systems work
>> Do they?
Yes, the evidence says a resounding yes in basically every country, including the U.K., even when the NHS is underfunded. Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries. It's embarrassing.
This is not Reddit or wherever you've been hanging out online up till now, so do not refer to me - or anyone else here - as "dawg", and try to find some basic respect for the people you're engaging with on HN.
In a thread where I've already warned about black and white thinking we have this:
> Yes, and healthcare is a good thing to regulate, you know, cause of all those pesky ethics and morals that get involved with human life.
Since when does deregulation mean to remove all regulations and laws? Then we have this:
> you're being either intentionally obtuse or incredibly naive.
Aside from more of the inability to show basic respect we've already touched on, it's like a parody of black and white thinking with the invidious false dilemma, but it doesn't end there:
> Yes, the evidence says a resounding yes in basically every country, including the U.K., even when the NHS is underfunded. Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries
Imagine turning a complex issue into this statement. It's not beyond parody but it's approaching that point.
> This is starting to border on bad-faith.
No, it's not. You continue about how you're unwilling to spell out your argument and then, further into your response, continue by saying that I'm "just yelling" without expanding on my points.
a) I'm not yelling. No one is yelling. Try not to react emotionally to those who disagree with you and/or project emotions onto them that they haven't at least alluded to.
b) If you're unwilling to state your argument clearly and succintly then it is hypocritical to accuse others of also not doing so (and you're incorrect anyway, so it's blatant hypocrisy).
> If you can't accept the premise that healthcare is a high barrier to entry market, then you're not familiar with the problem.
I'm not going to accept the premise until you state the reasoning behind the premise. Perhaps you react the way you have because you're unused to being challenged. If so, you shouldn't engage in discussion on the internet, and certainly not here.
Regardless, let's answer some of these from the absurd straw man you've perpetrated, and hopefuly, afterwards, you'll take some time to acknowledge the benefits of not reducing everything down to binary, childish imitations of an argument.
> > I live in Japan, I choose the hospital/clinic/doctor that I see, for everything.
> Yeah, I choose my dentist, too dawg, doesn't mean that I can choose what E.R.
I've already responded to the fatuous ER argument elsewhere, but if you'd done any research into Japan - where you claim single payer "works" without it being "embarrassing" - you'd know that the way ambulances are provided and hospitals are chosen in an emergency is embarrassing, but then you're clearly "not familiar with the problem".
I'd explain it to you myself but I'm not in a generous mood for some reason (note the allusion to an actual emotion I'm experiencing).
> You can't just deregulate things and hope it'll fix it
I'm not basing my ideas on hope but on reason and consideration.
> You haven't even proposed a solution here, you've just yelled "Free market!" and "Deregulate healthcare!"
The Socratic method would blow your mind. Regardless, I provided some explanation in the form of comparison in another comment.
> But all that will do is worsen the quality that we see
Perhap you could tell us, with regards to LASIK[1]:
a) Has the cost come down since FDA approval?
b) Has the quality gone down?
c) Is the availability greater now than then, and to what extent?
d) Has there been a lesser or greater number of unethical actions in the provision of LASIK than other, more regulated treatments?
e) Has there been a lesser or greater number of bothched treatments in the provision of LASIK than other, more regulated treatments?
You may pick the regulated treatment to compare with.
> Like another poster pointed out, basically any base-line metric puts the U.S. in ranks with most third-world countries. It's embarrassing.
What's embarrassing is not knowing the difference between the mean, mode and median (a look at the average salary of baseball teams is always good for this). This is why any analysis made should be multivariate and not black and white, or you end up with childish conclusions.
For analyses that take into account more than one measure, you get very different outcomes[2]:
> if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.
That's just one, small example. The article contains others and there's more out there. If you're able to respond in the way befitting of the vast majority of HNers then we could discuss those.
Then we can get on to why there are more doctors taking the R.O.A.D. path and why this might do well to be applied to things like surgery, and the actual OECD figures for the UK and US. They'll be highly instructive.
Edit: no blood, please!