I'm not a fan of the guy, but this is probably the most important/good thing he did with his presidency. Price transparency is the most fundamental first step to driving down health care costs. Once people get a taste of it, it will drive even more, better and accurate data. Start real conversations about costs and open the door to measureable improvement through innovation.
Price transparency is a pointless shell game designed to keep everyone strung along on the entrenched, failed system. When you're having a heart attack, the last thing you're doing is shopping around for the best prices on heart attack emergency treatment.
The free market has no place in health care, because in the hands of the free market the first thing that will happen in a life-threatening emergency is for you to transfer 100% of your wealth to the party that has 100% of the leverage.
Not all health care is heart attacks. "Health care" is a huge bucket containing everything from buying a bottle of cough syrup to the heart attacks you mention.
For life threatening emergencies, I'm with you. Let's fund that care through the state.
But excluding the market from everything is not the answer. The problem with using insurance for all these non-urgent things is that insurance distorts the market and price discipline goes out the window.
We don't have to reinvent the wheel. Other countries have solved these problems. They have better health care than we do. It's measurable, it's been measured, and no surprise, they have flat-out superior outcomes. They are dramatically more efficient. Our market focus is a cargo cult.
What market focus? Prices were completely opaque until just a few months ago. Any economist on the planet will tell you that would lead to awful outcomes for everyone except the powerful healthcare lobby.
Yes, we have a thoroughly regulated, negotiated, contractually obligated system. You can't have a true "free market" in health care without some truly egregious outcomes because when people are in health crisis they will pay anything to stay alive, and we already know we won't countenance the (let's call it what it is) extortion that the free market would produce in those scenarios. Because we want to feel like it's a free market, because free market economics is a cargo cult when it comes to health care, we get the worst of both worlds.
Not sure how you get reinventing the wheel from my comment.
What I described would move us in the direction of the countries you're talking about.
I have lived in the UK, and seen doctors through the NHS. I have bought cough medicine at the chemist, and no it was not state-funded. I have visited patients at NHS hospitals where you are one patient sharing a room with 20 others in the same ward. I have talked to people on the waitlist for months to get surgery.
I still think the UK system is better than ours in the US for urgent care. I don't want anyone to be financially ruined because of some unforeseeable accident or emergency.
But I maintain that "health care" is way too big a category to be absolutist about using or not using free market principles in it. There are parts of health care where markets do not make sense. There are other parts where they do.
On the contrary, there is, the problem (for some) is that it is indeed a bullet and the people getting (figuratively) shot are the ones who, under this system, are getting very fat on the inefficiencies. They're able to use their illicit wealth to exploit our very broken system of government to maintain their rent-seeking successes.
No system is perfect. If the US had a universal healthcare system, it would suck in many ways. People do, after all, travel to the US for medical care. My point is that there is likely a better local optimum out there than the one you suggest, and coming off as if the problem of healthcare is “solved” is news to people under any system who are suffering due to its inefficiencies or inequities. For example, I live in the US - I have CF and have been taking a drug for more than a year that is extremely effective. It has yet to be approved in some universal healthcare systems, likely due to its high cost (given the small patient population and its extremely high R&D costs.) This is literally killing people who would be alive had they been able to access the drug.
There may be edge cases, but on the whole if people in the US had the health care systems of the UK, France, Germany, Japan, or pretty much any other developed country, they would riot in the streets if the US system were suddenly forced on them.
Nothing funny about it. It's grim, but it beats dead people as the default case. We have a lower life expectancy in the US than Cuba, a nation with a GDP per capita of 8,821 USD. A country where the average person's annual wages wouldn't buy them half of a ten year old used Toyota Corolla has better health outcomes. We have people begging bystanders not to call them an ambulance when they're grievously injured, because they can't afford it.
So yeah, there are a handful of people out of thousands where this system works great. We shouldn't optimize the entire system for hundreds of millions of people for these edge cases.
You've set up a nice little fallacy for yourself in the form of declaring people you don't care about as "edge cases." I'm glad you're acknowledging that your original claim of the problem of allocating heathcare for people is not "solved" though.
Let me cut to the chase: a better system is probably one where competitive market forces are leveraged to drive down (actual) costs and drive up innovation where it is an optimal strategy, and social program-oriented solutions are deployed when that is the bad, unethical, impractical or suboptimal approach, with an overarching mechanism to regulate over time the transition from the former to the latter. If you remove the incentives that come with a free market for healthcare, it comes with benefits and costs. Stop acting as though it is cost free. It isn't.
I never took issue with your claim that healthcare in the US has problems which are solved through universal systems. I took issue with your claim that universal systems are a panacea that solve all relevant problems, and the implication that trying to hill climb to a better optimum is not worthwhile to improve outcomes.
> You've set up a nice little fallacy for yourself in the form of declaring people you don't care about as "edge cases."
I never said I don't care about anyone. This is a pretty simple trolley problem. One track has 1 million people tied up, one track has ten. I value the lives of everyone equally.
> I took issue with your claim that universal systems are a panacea that solve all relevant problems
I never said that. I said they were superior to our system, which is apparent in terms of costs and outcomes.
>When you're having a heart attack, the last thing you're doing is shopping around for the best prices on heart attack emergency treatment.
This is a tired, nonsensical argument. The vast, vast majority of medical procedures are not last minute emergencies. Furthermore, with price transparency you will clearly be able to evaluate which hospitals may or may not be generally in your price range and choose a default to visit for an emergency (assuming you're not carted off in an ambulance).
More importantly, this will absolutely force competition and some degree of price correction.
I agree that it's pointless for emergency surgery, but there are plenty of other cases where a consumer could shop around (colonoscopy, ACL repair, etc), and I'd argue these are actually the majority rather than the minority of cases.
To me it comes down to - if we are going to pretend we have a market based system for health care (that's what we say we have now), we need pricing transparency to have any hope of it working.
I think forcing hospitals to at least list something is a good start. It won't be perfect but it will make people more aware of how hospitals and insurance companies are working usually to screw people when it comes to billing. Any transparency is a good thing whether it is perfect or not.
Price gouging especially in a system with transparent pricing is not difficult to prevent with laws.
This is really is the ideal place for government in healthcare. Make the laws, set the standards, level the playing field and let the free market work just like in every other facet of society.
It’s funny people who see how incompetent and irresponsible our government is on a daily basis think that handing healthcare over to them is a good idea.
