[pdonis]

> emergency / end of life care

Emergency care, yes, that's unpredictable, and that's the sort of thing that health insurance should cover.

End of life care is not always unpredictable. In fact it rarely is in terms of the general need. Yes, you can't predict the exact point in time at which an 80-year-old person, say, will have an event that makes them require assisted living or a nursing home, but you can certainly foresee well in advance that such a need will arise at some point around that age. So this is not an unexpected need in the sense that emergency care is. And there's no reason why the same health plan should have to cover both needs, yet that is what the US health system does.

> you can't leave in practice even if its theoretically legally possible

Yes, this example of yours is an case of an unexpected need that health insurance should cover. However, I don't know of any "health insurance" in the US that only covers cases of unexpected need like this, and does not also cover everything else that is in any way involved with health care.

[VLM]

People like to think competition results in variety, like the difference between Walmart and Nordstrom.

The reality is the unified vocational training and the court system and malpractice insurance system and fluidity of employee transfers and government licensing standards mean the variety in care available is more like the difference between McDonalds and Burger King and this aspect is extremely carefully avoided in the debates. Price competition simply will not happen in medical care, theres a lot more required to initiate it than merely messing with the insurance system, it goes very deep.

I think you miss the difficulty of walking out in mid treatment. Yes sure in theory its possible for people to get reservations at three restaurants and eat appetizers and drinks at one, the main meal at the second, and desert at the third. In practice roughly zero people do this even though in the restaurant marketplace they're hopefully not in pain or dying or semi-senile or some other medical distress, and their family isn't panicking. To get the restaurant marketplace analogy correct above, you'd have to use McDonalds, Burger King, and Wendys as your examples, so even if you wandered back and forth between restaurants, the bill would be about the same in the end if not higher on a system perspective from all the paperwork and increased transactional costs. The main, possibly only, effect of playing patient "hot potatoe" would be increasing suffering of sick people.

[pdonis]

> the unified vocational training and the court system and malpractice insurance system and fluidity of employee transfers and government licensing standards mean the variety in care available is more like the difference between McDonalds and Burger King

In other words, regulations, mostly from the government, prevents competition from resulting in variety. I propose to fix it by less regulation--letting more of the benefits of competition be realized. You propose to fix that--how, exactly? With more regulation?

> Price competition simply will not happen in medical care

In the current regulatory regime, you are correct, it won't, because there is no incentive for it. But that's not because price competition is inherently impossible in health care? Or is it because the regulations are removing the incentives for it?

> I think you miss the difficulty of walking out in mid treatment.

I agree that it's hard to change providers in mid treatment when it's urgent, yes. But urgent care is not the only opportunity you have to evaluate providers. In a competitive environment, smart providers would view ordinary care like annual physicals or shots as opportunities to show potential patients their competence, and smart patients would take such opportunities to evaluate the competence of providers. Plus, families and friends can pool information--people do that now. The value of such information is limited now because there is not much choice in the marketplace, yes (hence your McDonalds vs. Burger King analogy). But, once more, why is there such limited choice? Because competition is inherently impossible in this domain? Or because it's regulated out of existence?