<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>hharrison</author><text>I&amp;#x27;m surprised that this point hasn&amp;#x27;t come up yet in this conversation: the whole point of insurance is to &lt;i&gt;pool risk&lt;/i&gt;.  The basic principle is that of everyone who pays in, the lucky ones subsidize the unlucky ones.&lt;p&gt;Obviously, this works best the more people who pay in. When people don&amp;#x27;t get insurance until they need it, it raises the cost for everyone. When people don&amp;#x27;t get insurance and &lt;i&gt;still&lt;/i&gt; end up burdening those who did (by going bankrupt when faced with monstrous E.R. bills, for a common example), costs go up for everyone. In these situations, there&amp;#x27;s only way to make the system work: &lt;i&gt;enforce&lt;/i&gt; that &lt;i&gt;everyone&lt;/i&gt; buys in. That&amp;#x27;s why I support single-payer.&lt;p&gt;Here&amp;#x27;s another car analogy: car insurance is mandatory for drivers in the U.S., and most countries. Because the system only works when everyone buys in.&lt;p&gt;Of course it offends the libertarian sensibility to &lt;i&gt;force&lt;/i&gt; people to buy something. How barbaric! Personally, I&amp;#x27;m a libertarian-to-leftist convert. I think society needs a monopoly on force, and that monopoly goes to the government. The use of that force should be minimized, but one of reasons we need it is to &lt;i&gt;force&lt;/i&gt; people to chip in for the common good. When it comes to pooled risk for catastrophic events, it&amp;#x27;s worth it. I have no moral qualms. It&amp;#x27;s not a matter of who&amp;#x27;s doing the planning, it&amp;#x27;s a matter of societal choices that just plain don&amp;#x27;t work if not everyone&amp;#x27;s on board. You&amp;#x27;re right that central planning is not voluntary. &lt;i&gt;That&amp;#x27;s the whole point&lt;/i&gt;.&lt;p&gt;&lt;i&gt;&amp;gt;  But outside of &amp;quot;character&amp;quot; or other intangibles, there&amp;#x27;s no incentive to avoid the safety nets—in fact there&amp;#x27;s every incentive to use them, lest you be a sucker. Only suckers pay for things.&lt;/i&gt;&lt;p&gt;&amp;quot;Yeah, look at all those suckers, &lt;i&gt;paying&lt;/i&gt; for things, how stupid. Why bother trying to make more money? It&amp;#x27;s not like I value character-building.&amp;quot;
- single mom making $12,000&amp;#x2F;year, and (gasp) receiving government assistance&lt;p&gt;Do you &lt;i&gt;really&lt;/i&gt; think government assistance makes poverty appealing?</text><parent_chain><item><author>bhauer</author><text>&amp;gt; &lt;i&gt;That is why we have the FDA etc, and that is why doctors are rigorously vetted and trained through the med school&amp;#x2F;residency process, and I think most people would agree that that is a good thing.&lt;/i&gt;&lt;p&gt;With the amount of error we have (see malpractice suits) as it is, I&amp;#x27;m not convinced that what we have right now is actually yielding better overall results than a free market would with actual price signals.&lt;p&gt;Reason being that medical care quality is usually not a binary matter—with outcomes of either total success or total failure.  Usually it&amp;#x27;s a broad continuum, and yet mediocre doctors are presently extremely difficult to differentiate from superb doctors because of the lack of price signals.&lt;p&gt;Malpractice suits would still exist in a free market, of course.  And if care lead to death, there would be lawsuits.  But in a majority of cases, bad care would lead to non-death but non-ideal resolution.  That&amp;#x27;s where price signals will flourish.&lt;p&gt;Ironically, I see the current situation as an all-or-nothing where I want more nuance.  We currently treat all doctors as essentially similar because they have all completed the same rigorous training and certification process, and we few other measures to use.  (Some above-market review systems notwithstanding.)&lt;p&gt;Finally, don&amp;#x27;t be certain that doing away with regulation would lead to certifications evaporating.  It more likely would mean variation in certification.  A less politically-entrenched alternative to the AMA perhaps.  (Of course, I&amp;#x27;m also not necessarily bowled over by certification.  I put no stock in computer programming certifications.)&lt;p&gt;&amp;gt; &lt;i&gt;And of course the typical libertarian response is &amp;quot;tough luck&amp;quot; or &amp;quot;work harder&amp;quot;.&lt;/i&gt;&lt;p&gt;While true, this shouldn&amp;#x27;t be dismissed cavalierly.  We tend to speak without as much political thought as the right and left—saying apparently heartless things like &amp;quot;work harder.&amp;quot;  But what we mean in practice is that there would be more emphatic pressure on individuals to work to solve their own life situations first and only in extreme cases leverage safety nets.&lt;p&gt;We have a situation today where half of the country uses some form of government assistance.  That&amp;#x27;s not what safety nets should be for.  But outside of &amp;quot;character&amp;quot; or other intangibles, there&amp;#x27;s no incentive to avoid the safety nets—in fact there&amp;#x27;s every incentive to use them, lest you be a sucker.  Only suckers pay for things.&lt;p&gt;When I had an electric car, I momentarily reeled at the $5,000 federal government incentive because it goes against my every belief.  But, come on.  Who is going to pass on such a sweet kick-back?  I took the money.  We all do.&lt;p&gt;Yes, it&amp;#x27;s &lt;i&gt;utterly impossible&lt;/i&gt; for a libertarian paradise to provide a 50% safety net.  But we feel we have such a large safety net because it&amp;#x27;s a venus fly trap, not because it is necessary to have a 50% safety net as a first principle.&lt;p&gt;Furthermore, many libertarians are amenable to a basic income, and with a basic income and a free market for health care and health insurance, it&amp;#x27;s almost a foregone conclusion that a great deal of competition would angle for that demand.&lt;p&gt;&amp;gt; &lt;i&gt;Compromise shouldn&amp;#x27;t be such a dirty word in today&amp;#x27;s political discussions, it&amp;#x27;s a sad state of affairs&lt;/i&gt;&lt;p&gt;The trouble with compromise is what I said earlier.  We&amp;#x27;re willing to allow central planners to build within a free market, to create a voluntary consortium of participants supporting one another through centrally-planned distribution of resources.  But reverse the tables and we&amp;#x27;re absolutely never permitted the same freedom.  Central-planning is not voluntary; it a piece of totalitarianism.&lt;p&gt;So compromising with central planners means totally conceding.  Either they plan for you or you plan for you.  I prefer planning for me, difficulties and all.</text></item><item><author>pyoung</author><text>One major oversight that you fail to address in you hypothetical free market scenario is that supply is still constrained. In a truly free market, anyone can set up shop and try to market and sell their services.  If I buy a TV that craps out in two days, I either get it fixed by warranty or I go online and write a bad review which hopefully contributes to the demise of the company.  If I get a bad surgery from a poorly trained doctor I die.  That is why we have the FDA etc, and that is why doctors are rigorously vetted and trained through the med school&amp;#x2F;residency process, and I think most people would agree that that is a good thing.&lt;p&gt;Another issue I have is your mention of &amp;#x27;charity&amp;#x27;.  Almost anytime this gets used in a political&amp;#x2F;economic discussion, it is used to dismiss a whole class of problems that the author does not want to deal with in their argument.  In this particular case you mention that if you cannot afford a &amp;#x27;free market&amp;#x27; doctor&amp;#x2F;treatment, then you can turn to charity to provide the funds.  Of course we all know that charity will never come close to providing for the entirety of society, so you are left with a situation where almost everyone except those who can afford treatment are forced to go without it.  And of course the typical libertarian response is &amp;quot;tough luck&amp;quot; or &amp;quot;work harder&amp;quot;.  But here is the thing, health, similar to environmental issues has strong public effects.  There are a number of diseases and  illnesses that, if left untreated in a large portion of the population, can have devastating impacts on society.  A healthy population is a necessity of a first world economy and relying on charity to ensure positive, society level outcomes is absurd and ignores reality.&lt;p&gt;Look, I lean libertarian on many issues, but there are certain aspects of society that are just not suited to a free market.  I want to be able to go to a restaurant without being terrified of catching TB from the waiter or getting salmonella poisoning from the food.  I don&amp;#x27;t want industrial companies polluting the ocean and rivers that I surf and fish in.  The free market can be very powerful, but it is also fairly dumb, it cannot recognize when it is doing more collective harm than good.  I don&amp;#x27;t see why so many libertarians think in terms of all or nothing.  Compromise shouldn&amp;#x27;t be such a dirty word in today&amp;#x27;s political discussions, it&amp;#x27;s a sad state of affairs.</text></item><item><author>bhauer</author><text>&amp;gt; &lt;i&gt;That&amp;#x27;s a fine bit of conservative nonsense you just regurgitated&lt;/i&gt;&lt;p&gt;Conservative, libertarian, I guess they are more or less the same for this subject.  Fine.&lt;p&gt;&amp;gt; &lt;i&gt;coming to the conclusion that the problem the U.S. is suffering from is &amp;quot;too much health care&amp;quot;&lt;/i&gt;&lt;p&gt;I suppose you&amp;#x27;re saying that because higher prices suggest a glut of supply?  Wait, no.&lt;p&gt;I&amp;#x27;m not sure why you say that is the conclusion of my argument.  I certainly never said the US has too much healthcare, nor imply it.&lt;p&gt;In fact, if anything the US is supply-constrained in healthcare thanks to the AMA, FDA, etc.  There is plenty of demand for healthcare, but the supply is pretty well controlled through regulation.&lt;p&gt;I certainly can&amp;#x27;t start selling healthcare.  Even with a lot of studying, I still couldn&amp;#x27;t just &lt;i&gt;sell&lt;/i&gt; healthcare.  Making additional healthcare supply isn&amp;#x27;t like making more supply of furniture, food, or even cars (which is closer on the regulation spectrum to healthcare, meaning it requires a herculean effort to enter this industry—witness Tesla).&lt;p&gt;&amp;gt; &lt;i&gt;therefore the solution is to reduce access to healthcare and insurance&lt;/i&gt;&lt;p&gt;What?&lt;p&gt;No, I&amp;#x27;d rather make these services &lt;i&gt;more&lt;/i&gt; readily available to everyone by making them available in the same way nearly every other product is available to anyone.  Is the iPad unavailable to me because my employer doesn&amp;#x27;t provide tablet insurance?  Just sell me healthcare and health insurance on regular markets, please.  Nothing could be &lt;i&gt;more&lt;/i&gt; available in my opinion.&lt;p&gt;As it is, the &amp;quot;availability&amp;quot; of healthcare in my life is extremely narrow (again thanks to what evolved from 1940s price controls).  I have a small set of options from one vendor selected by my employer.  With the ACA, I will now have that option (maybe, though it&amp;#x27;s an HSA and I&amp;#x27;ve been told to kiss HSAs goodbye) and a few other ratified options that have been selected by a central planning committee.&lt;p&gt;If I can&amp;#x27;t afford routine health care on a regular market, I&amp;#x27;d rather work harder to get a better job.  In a worst-case scenario, I&amp;#x27;ll plead with friends and family or charities.  I genuinely would prefer this to the current model.  I&amp;#x27;d pick up insurance to handle catastrophic events.  I&amp;#x27;d donate more to charity to boot.&lt;p&gt;&amp;gt; &lt;i&gt;your health is worth an infinite amount of money to you&lt;/i&gt;&lt;p&gt;Actually, not really.  If I have a quality of life issue and I can improve my quality of life for $500, I will weigh the pros and cons and probably go for it.  If it costs $500,000, I&amp;#x27;ll suck it up until someone innovates the cost down to something I can afford.&lt;p&gt;Even if I have a catastrophic issue and I have no insurance, and the only resolution is something that costs $1M, this is something my family (friends, charities) should decide.  Sell&amp;#x2F;refinance property or pull the plug?  Bottom line, it&amp;#x27;s a local decision to pull the plug, not something for a central planning board.&lt;p&gt;&amp;gt; &lt;i&gt;Further, healthcare prices are unpredictable&lt;/i&gt;&lt;p&gt;This is not a counter-argument to using regular price signals.  Services that are unpredictable are usually billed at hourly rates or time and materials with an estimate.  If I have the termite guy out to check my house, he&amp;#x27;s not going to be able to give me a quote until he assesses the situation.  Even then, it may be worse than he thought.  But he has a price sheet of hours and services and I can look at that and select a different termite guy if the price sheet seems out of line.  Better yet, other people will have paid termite guys and give me a basic feel for what a termite guy charges.  When he says his hourly rate is $5,000, I&amp;#x27;ll know he&amp;#x27;s a nutcase.&lt;p&gt;Today, if I heard it cost $5,000&amp;#x2F;hr for some medical procedure, I wouldn&amp;#x27;t even know how to react.  Is that a lot?  Is it low?  I don&amp;#x27;t even know who I could ask for a guess.&lt;p&gt;&amp;gt; &lt;i&gt;which has been discovered by every advanced nation on Earth except the U.S.&lt;/i&gt;&lt;p&gt;I don&amp;#x27;t enjoy the argument that everyone else does something a given way, so why don&amp;#x27;t you get in line already.  The way I see it, this country has been doing healthcare &lt;i&gt;more similar&lt;/i&gt; to other countries (no true market, no price signals) than similar to what I want for decades.&lt;p&gt;A free market can support a central-planning model inside of itself, but vice-versa is never possible.  This is why those of us who support free markets are so sensitive to those who would shut them off.  Central planners don&amp;#x27;t have to &lt;i&gt;kill&lt;/i&gt; the free market to do their central planning exercise, but they &lt;i&gt;always&lt;/i&gt; choose to.&lt;p&gt;We don&amp;#x27;t ask them to kill central planning so we can have a free market.  In fact, we don&amp;#x27;t even care how central planners want to arrange their centrally-planned plan inside the free market, as long as it&amp;#x27;s voluntary.  Have fun!&lt;p&gt;If I had my way, the ACA would make centrally-planned healthcare an entirely in or entirely out proposition.  Voluntary.  Don&amp;#x27;t want in?  Fine, you&amp;#x27;re on your own.  Entirely.&lt;p&gt;I&amp;#x27;d opt out.  And soon enough, I&amp;#x27;d find people ready to sell me health care.  Then I&amp;#x27;d give more to charity.  I&amp;#x27;d be so much happier.</text></item><item><author>jellicle</author><text>That&amp;#x27;s a fine bit of conservative nonsense you just regurgitated, coming to the conclusion that the problem the U.S. is suffering from is &amp;quot;too much health care&amp;quot;, and therefore the solution is to reduce access to healthcare and insurance.  It rests on the assumption that patients get frivolous medical procedures (open heart surgery for you! and open heart surgery for you! and open heart surgery for you!) because they may not pay full price for them, a claim which, like the teapot orbiting the sun directly opposite the Earth, has never been observed in real life.&lt;p&gt;In actuality, healthcare is a well known example of a market failure - there cannot be a normal market in healthcare ever, because definitionally, your health is worth an infinite amount of money to you (how much would you pay not to be a slave? how much would you pay not to have your hands and feet chopped off?).&lt;p&gt;Further, healthcare prices are unpredictable.  How much does a gall bladder surgery cost?  Did I mention that the patient got a flesh-eating bacterial infection as a result of the surgery?  That&amp;#x27;s true and will always be true even if prices were posted at the door, which they are not.&lt;p&gt;The solution - which has been discovered by every advanced nation on Earth except the U.S. - is having the government strongly involved in paying for healthcare, insuring across the entire population to even out costs and making sure that, e.g., medical device manufacturers can&amp;#x27;t gouge the unknowing public.  Monopsony powers nicely counteract the inherent power imbalance that healthcare providers normally have over the sick, and everything works just fine, costing each of those nations less to cover their entire nation than the U.S. currently spends to cover a small segment of its population.</text></item><item><author>bhauer</author><text>This particular invisible hand has been hamstrung by malignant forces.  Notably, the &lt;i&gt;payer&lt;/i&gt; in a typical healthcare transaction is not the same as the &lt;i&gt;recipient&lt;/i&gt;, splitting the typical &lt;i&gt;buyer&lt;/i&gt; role into two.&lt;p&gt;Because health insurance is now commonly provided by employers because of World War II price controls, and because we have become accustomed to using health insurance to pay for all matter of health care, including routine visits, consumers are often ignorant of health care costs.&lt;p&gt;Customer A: My insurance will pay?  Fine, let&amp;#x27;s do this.  Cha-ching, price rises.&lt;p&gt;Customer B: My insurance will pay?  Fine, let&amp;#x27;s do this.  Cha-ching, price rises.&lt;p&gt;Customer C: Oh, insurance won&amp;#x27;t pay?  How much?  Whoa!  How did the price get so high?&lt;p&gt;It&amp;#x27;s no surprise then that the invisible hand works in a way that appears flawed when one of its inputs (the buyer&amp;#x27;s sensitivity to price) is frustrated.&lt;p&gt;People of my persuasion often make the case that if automobile insurance worked the same as health insurance, and we used insurance to pay for oil changes, the price of oil changes would shoot up wildly.  Reason being that you would no longer care what it costs.&lt;p&gt;Obviously the seller (the doctor in the case at hand) wants the price to be as high as possible.  The invisible hand can&amp;#x27;t keep this in check—it cannot discipline the seller with lost sales—when so many buyers do not act with actual price sensitivity.</text></item><item><author>cs702</author><text>Many aspects of US society today are organized under the assumption that if every individual pursues what is in his&amp;#x2F;her best &lt;i&gt;financial&lt;/i&gt; interest, the &amp;quot;invisible hand of the free market&amp;quot; will produce the best possible outcome for everyone.&lt;p&gt;Yet here we have reputable doctors acting in their self interest, and the result is that they are ordering unnecessary surgeries for financial gain.  Meanwhile, patients are essentially unable to protect themselves against this travesty.&lt;p&gt;Maybe in this case the invisible hand cannot be seen because it is not there?</text></item></parent_chain></comment><story><title>Profit affects doctors&apos; treatment decisions</title><url>http://globaleconomicanalysis.blogspot.com/2013/10/unnecessary-surgeries-you-bet-doctors.html</url></story>
<instructions>Your goal is to analyze the following comment and estimate how highly it will be upvoted by the Hacker News community.</instructions><comment><author>warfangle</author><text>&amp;gt;But in a majority of cases, bad care would lead to non-death but non-ideal resolution. That&amp;#x27;s where price signals will flourish.&lt;p&gt;Conjecture. Got proof? (let&amp;#x27;s say, a statistical analysis between the recent spate of doctors who no longer accept insurance -- only cold hard cash or credit -- and their Swedish counterparts in both patient care and malpractice suite rate)&lt;p&gt;That&amp;#x27;s the thing about this entire argument. We&amp;#x27;re point at those other folks that seem to be a doing a lot better job at this whole keeping people healthy thing than we are. And you&amp;#x27;re pointing at this conjecture that maybe people make rational decisions in a market.&lt;p&gt;And we know that&amp;#x27;s not true.&lt;p&gt;Just look at homeopathic medicine to see how well the free market does, without FDA intervention, at keeping people healthy - and getting them healthy if they aren&amp;#x27;t.</text><parent_chain><item><author>bhauer</author><text>&amp;gt; &lt;i&gt;That is why we have the FDA etc, and that is why doctors are rigorously vetted and trained through the med school&amp;#x2F;residency process, and I think most people would agree that that is a good thing.&lt;/i&gt;&lt;p&gt;With the amount of error we have (see malpractice suits) as it is, I&amp;#x27;m not convinced that what we have right now is actually yielding better overall results than a free market would with actual price signals.&lt;p&gt;Reason being that medical care quality is usually not a binary matter—with outcomes of either total success or total failure.  Usually it&amp;#x27;s a broad continuum, and yet mediocre doctors are presently extremely difficult to differentiate from superb doctors because of the lack of price signals.&lt;p&gt;Malpractice suits would still exist in a free market, of course.  And if care lead to death, there would be lawsuits.  But in a majority of cases, bad care would lead to non-death but non-ideal resolution.  That&amp;#x27;s where price signals will flourish.&lt;p&gt;Ironically, I see the current situation as an all-or-nothing where I want more nuance.  We currently treat all doctors as essentially similar because they have all completed the same rigorous training and certification process, and we few other measures to use.  (Some above-market review systems notwithstanding.)&lt;p&gt;Finally, don&amp;#x27;t be certain that doing away with regulation would lead to certifications evaporating.  It more likely would mean variation in certification.  A less politically-entrenched alternative to the AMA perhaps.  (Of course, I&amp;#x27;m also not necessarily bowled over by certification.  I put no stock in computer programming certifications.)&lt;p&gt;&amp;gt; &lt;i&gt;And of course the typical libertarian response is &amp;quot;tough luck&amp;quot; or &amp;quot;work harder&amp;quot;.&lt;/i&gt;&lt;p&gt;While true, this shouldn&amp;#x27;t be dismissed cavalierly.  We tend to speak without as much political thought as the right and left—saying apparently heartless things like &amp;quot;work harder.&amp;quot;  But what we mean in practice is that there would be more emphatic pressure on individuals to work to solve their own life situations first and only in extreme cases leverage safety nets.&lt;p&gt;We have a situation today where half of the country uses some form of government assistance.  That&amp;#x27;s not what safety nets should be for.  But outside of &amp;quot;character&amp;quot; or other intangibles, there&amp;#x27;s no incentive to avoid the safety nets—in fact there&amp;#x27;s every incentive to use them, lest you be a sucker.  Only suckers pay for things.&lt;p&gt;When I had an electric car, I momentarily reeled at the $5,000 federal government incentive because it goes against my every belief.  But, come on.  Who is going to pass on such a sweet kick-back?  I took the money.  We all do.&lt;p&gt;Yes, it&amp;#x27;s &lt;i&gt;utterly impossible&lt;/i&gt; for a libertarian paradise to provide a 50% safety net.  But we feel we have such a large safety net because it&amp;#x27;s a venus fly trap, not because it is necessary to have a 50% safety net as a first principle.&lt;p&gt;Furthermore, many libertarians are amenable to a basic income, and with a basic income and a free market for health care and health insurance, it&amp;#x27;s almost a foregone conclusion that a great deal of competition would angle for that demand.&lt;p&gt;&amp;gt; &lt;i&gt;Compromise shouldn&amp;#x27;t be such a dirty word in today&amp;#x27;s political discussions, it&amp;#x27;s a sad state of affairs&lt;/i&gt;&lt;p&gt;The trouble with compromise is what I said earlier.  We&amp;#x27;re willing to allow central planners to build within a free market, to create a voluntary consortium of participants supporting one another through centrally-planned distribution of resources.  But reverse the tables and we&amp;#x27;re absolutely never permitted the same freedom.  Central-planning is not voluntary; it a piece of totalitarianism.&lt;p&gt;So compromising with central planners means totally conceding.  Either they plan for you or you plan for you.  I prefer planning for me, difficulties and all.</text></item><item><author>pyoung</author><text>One major oversight that you fail to address in you hypothetical free market scenario is that supply is still constrained. In a truly free market, anyone can set up shop and try to market and sell their services.  If I buy a TV that craps out in two days, I either get it fixed by warranty or I go online and write a bad review which hopefully contributes to the demise of the company.  If I get a bad surgery from a poorly trained doctor I die.  That is why we have the FDA etc, and that is why doctors are rigorously vetted and trained through the med school&amp;#x2F;residency process, and I think most people would agree that that is a good thing.&lt;p&gt;Another issue I have is your mention of &amp;#x27;charity&amp;#x27;.  Almost anytime this gets used in a political&amp;#x2F;economic discussion, it is used to dismiss a whole class of problems that the author does not want to deal with in their argument.  In this particular case you mention that if you cannot afford a &amp;#x27;free market&amp;#x27; doctor&amp;#x2F;treatment, then you can turn to charity to provide the funds.  Of course we all know that charity will never come close to providing for the entirety of society, so you are left with a situation where almost everyone except those who can afford treatment are forced to go without it.  And of course the typical libertarian response is &amp;quot;tough luck&amp;quot; or &amp;quot;work harder&amp;quot;.  But here is the thing, health, similar to environmental issues has strong public effects.  There are a number of diseases and  illnesses that, if left untreated in a large portion of the population, can have devastating impacts on society.  A healthy population is a necessity of a first world economy and relying on charity to ensure positive, society level outcomes is absurd and ignores reality.&lt;p&gt;Look, I lean libertarian on many issues, but there are certain aspects of society that are just not suited to a free market.  I want to be able to go to a restaurant without being terrified of catching TB from the waiter or getting salmonella poisoning from the food.  I don&amp;#x27;t want industrial companies polluting the ocean and rivers that I surf and fish in.  The free market can be very powerful, but it is also fairly dumb, it cannot recognize when it is doing more collective harm than good.  I don&amp;#x27;t see why so many libertarians think in terms of all or nothing.  Compromise shouldn&amp;#x27;t be such a dirty word in today&amp;#x27;s political discussions, it&amp;#x27;s a sad state of affairs.</text></item><item><author>bhauer</author><text>&amp;gt; &lt;i&gt;That&amp;#x27;s a fine bit of conservative nonsense you just regurgitated&lt;/i&gt;&lt;p&gt;Conservative, libertarian, I guess they are more or less the same for this subject.  Fine.&lt;p&gt;&amp;gt; &lt;i&gt;coming to the conclusion that the problem the U.S. is suffering from is &amp;quot;too much health care&amp;quot;&lt;/i&gt;&lt;p&gt;I suppose you&amp;#x27;re saying that because higher prices suggest a glut of supply?  Wait, no.&lt;p&gt;I&amp;#x27;m not sure why you say that is the conclusion of my argument.  I certainly never said the US has too much healthcare, nor imply it.&lt;p&gt;In fact, if anything the US is supply-constrained in healthcare thanks to the AMA, FDA, etc.  There is plenty of demand for healthcare, but the supply is pretty well controlled through regulation.&lt;p&gt;I certainly can&amp;#x27;t start selling healthcare.  Even with a lot of studying, I still couldn&amp;#x27;t just &lt;i&gt;sell&lt;/i&gt; healthcare.  Making additional healthcare supply isn&amp;#x27;t like making more supply of furniture, food, or even cars (which is closer on the regulation spectrum to healthcare, meaning it requires a herculean effort to enter this industry—witness Tesla).&lt;p&gt;&amp;gt; &lt;i&gt;therefore the solution is to reduce access to healthcare and insurance&lt;/i&gt;&lt;p&gt;What?&lt;p&gt;No, I&amp;#x27;d rather make these services &lt;i&gt;more&lt;/i&gt; readily available to everyone by making them available in the same way nearly every other product is available to anyone.  Is the iPad unavailable to me because my employer doesn&amp;#x27;t provide tablet insurance?  Just sell me healthcare and health insurance on regular markets, please.  Nothing could be &lt;i&gt;more&lt;/i&gt; available in my opinion.&lt;p&gt;As it is, the &amp;quot;availability&amp;quot; of healthcare in my life is extremely narrow (again thanks to what evolved from 1940s price controls).  I have a small set of options from one vendor selected by my employer.  With the ACA, I will now have that option (maybe, though it&amp;#x27;s an HSA and I&amp;#x27;ve been told to kiss HSAs goodbye) and a few other ratified options that have been selected by a central planning committee.&lt;p&gt;If I can&amp;#x27;t afford routine health care on a regular market, I&amp;#x27;d rather work harder to get a better job.  In a worst-case scenario, I&amp;#x27;ll plead with friends and family or charities.  I genuinely would prefer this to the current model.  I&amp;#x27;d pick up insurance to handle catastrophic events.  I&amp;#x27;d donate more to charity to boot.&lt;p&gt;&amp;gt; &lt;i&gt;your health is worth an infinite amount of money to you&lt;/i&gt;&lt;p&gt;Actually, not really.  If I have a quality of life issue and I can improve my quality of life for $500, I will weigh the pros and cons and probably go for it.  If it costs $500,000, I&amp;#x27;ll suck it up until someone innovates the cost down to something I can afford.&lt;p&gt;Even if I have a catastrophic issue and I have no insurance, and the only resolution is something that costs $1M, this is something my family (friends, charities) should decide.  Sell&amp;#x2F;refinance property or pull the plug?  Bottom line, it&amp;#x27;s a local decision to pull the plug, not something for a central planning board.&lt;p&gt;&amp;gt; &lt;i&gt;Further, healthcare prices are unpredictable&lt;/i&gt;&lt;p&gt;This is not a counter-argument to using regular price signals.  Services that are unpredictable are usually billed at hourly rates or time and materials with an estimate.  If I have the termite guy out to check my house, he&amp;#x27;s not going to be able to give me a quote until he assesses the situation.  Even then, it may be worse than he thought.  But he has a price sheet of hours and services and I can look at that and select a different termite guy if the price sheet seems out of line.  Better yet, other people will have paid termite guys and give me a basic feel for what a termite guy charges.  When he says his hourly rate is $5,000, I&amp;#x27;ll know he&amp;#x27;s a nutcase.&lt;p&gt;Today, if I heard it cost $5,000&amp;#x2F;hr for some medical procedure, I wouldn&amp;#x27;t even know how to react.  Is that a lot?  Is it low?  I don&amp;#x27;t even know who I could ask for a guess.&lt;p&gt;&amp;gt; &lt;i&gt;which has been discovered by every advanced nation on Earth except the U.S.&lt;/i&gt;&lt;p&gt;I don&amp;#x27;t enjoy the argument that everyone else does something a given way, so why don&amp;#x27;t you get in line already.  The way I see it, this country has been doing healthcare &lt;i&gt;more similar&lt;/i&gt; to other countries (no true market, no price signals) than similar to what I want for decades.&lt;p&gt;A free market can support a central-planning model inside of itself, but vice-versa is never possible.  This is why those of us who support free markets are so sensitive to those who would shut them off.  Central planners don&amp;#x27;t have to &lt;i&gt;kill&lt;/i&gt; the free market to do their central planning exercise, but they &lt;i&gt;always&lt;/i&gt; choose to.&lt;p&gt;We don&amp;#x27;t ask them to kill central planning so we can have a free market.  In fact, we don&amp;#x27;t even care how central planners want to arrange their centrally-planned plan inside the free market, as long as it&amp;#x27;s voluntary.  Have fun!&lt;p&gt;If I had my way, the ACA would make centrally-planned healthcare an entirely in or entirely out proposition.  Voluntary.  Don&amp;#x27;t want in?  Fine, you&amp;#x27;re on your own.  Entirely.&lt;p&gt;I&amp;#x27;d opt out.  And soon enough, I&amp;#x27;d find people ready to sell me health care.  Then I&amp;#x27;d give more to charity.  I&amp;#x27;d be so much happier.</text></item><item><author>jellicle</author><text>That&amp;#x27;s a fine bit of conservative nonsense you just regurgitated, coming to the conclusion that the problem the U.S. is suffering from is &amp;quot;too much health care&amp;quot;, and therefore the solution is to reduce access to healthcare and insurance.  It rests on the assumption that patients get frivolous medical procedures (open heart surgery for you! and open heart surgery for you! and open heart surgery for you!) because they may not pay full price for them, a claim which, like the teapot orbiting the sun directly opposite the Earth, has never been observed in real life.&lt;p&gt;In actuality, healthcare is a well known example of a market failure - there cannot be a normal market in healthcare ever, because definitionally, your health is worth an infinite amount of money to you (how much would you pay not to be a slave? how much would you pay not to have your hands and feet chopped off?).&lt;p&gt;Further, healthcare prices are unpredictable.  How much does a gall bladder surgery cost?  Did I mention that the patient got a flesh-eating bacterial infection as a result of the surgery?  That&amp;#x27;s true and will always be true even if prices were posted at the door, which they are not.&lt;p&gt;The solution - which has been discovered by every advanced nation on Earth except the U.S. - is having the government strongly involved in paying for healthcare, insuring across the entire population to even out costs and making sure that, e.g., medical device manufacturers can&amp;#x27;t gouge the unknowing public.  Monopsony powers nicely counteract the inherent power imbalance that healthcare providers normally have over the sick, and everything works just fine, costing each of those nations less to cover their entire nation than the U.S. currently spends to cover a small segment of its population.</text></item><item><author>bhauer</author><text>This particular invisible hand has been hamstrung by malignant forces.  Notably, the &lt;i&gt;payer&lt;/i&gt; in a typical healthcare transaction is not the same as the &lt;i&gt;recipient&lt;/i&gt;, splitting the typical &lt;i&gt;buyer&lt;/i&gt; role into two.&lt;p&gt;Because health insurance is now commonly provided by employers because of World War II price controls, and because we have become accustomed to using health insurance to pay for all matter of health care, including routine visits, consumers are often ignorant of health care costs.&lt;p&gt;Customer A: My insurance will pay?  Fine, let&amp;#x27;s do this.  Cha-ching, price rises.&lt;p&gt;Customer B: My insurance will pay?  Fine, let&amp;#x27;s do this.  Cha-ching, price rises.&lt;p&gt;Customer C: Oh, insurance won&amp;#x27;t pay?  How much?  Whoa!  How did the price get so high?&lt;p&gt;It&amp;#x27;s no surprise then that the invisible hand works in a way that appears flawed when one of its inputs (the buyer&amp;#x27;s sensitivity to price) is frustrated.&lt;p&gt;People of my persuasion often make the case that if automobile insurance worked the same as health insurance, and we used insurance to pay for oil changes, the price of oil changes would shoot up wildly.  Reason being that you would no longer care what it costs.&lt;p&gt;Obviously the seller (the doctor in the case at hand) wants the price to be as high as possible.  The invisible hand can&amp;#x27;t keep this in check—it cannot discipline the seller with lost sales—when so many buyers do not act with actual price sensitivity.</text></item><item><author>cs702</author><text>Many aspects of US society today are organized under the assumption that if every individual pursues what is in his&amp;#x2F;her best &lt;i&gt;financial&lt;/i&gt; interest, the &amp;quot;invisible hand of the free market&amp;quot; will produce the best possible outcome for everyone.&lt;p&gt;Yet here we have reputable doctors acting in their self interest, and the result is that they are ordering unnecessary surgeries for financial gain.  Meanwhile, patients are essentially unable to protect themselves against this travesty.&lt;p&gt;Maybe in this case the invisible hand cannot be seen because it is not there?</text></item></parent_chain></comment><story><title>Profit affects doctors&apos; treatment decisions</title><url>http://globaleconomicanalysis.blogspot.com/2013/10/unnecessary-surgeries-you-bet-doctors.html</url></story>