[iaw]

Libertarian arguments only hold for free markets. Even eliminating all regulations and restrictions imposed by the government, healthcare does not become a free market for two reasons:

1) Information is not symmetric, contractual obligations are made before pricing information can be discovered (thereby compared and moving into market dynamics)

2) Services are requested under the duress of health problems without the ability to end the agreement.

Not everything is a free market.

[conanbatt]

I think we can agree that there are degrees of freedom in a market, and that the us healthcare market is far from a the freest possible version of healthcare.

Im not sure about the information asymmetry argument: insurance companies also lack lots of information. And some of that the patient knows and the insurance doesn't. (pre-existing conditions for example). Also, there's plenty of markets with information asymmetry that dont show the backwardness of US Health care.

> Services are requested under the duress of health problems without the ability to end the agreement.

That is the nature of any insurance market. You cant bargain with your fire insurance when your house is burning down. Well, not effectively, if you look at the richest man in old rome.

[iaw]

Definitely agree that there are degrees of freedom, I'm just not confident that a removal of regulations in the healthcare market would lead to a positive outcome (higher quality/less expensive healthcare).

>> Services are requested under the duress of health problems without the ability to end the agreement.

>That is the nature of any insurance market.

I was actually thinking about when medical treatment is being received. Once you're under a hospitals care you're largely subject to their pricing for services (e.g. I can't choose to use the cheaper MRI machine down the street). There's a bundling of services at a healthcare provider that seems to contradict free market arguments as well, but I was mainly trying to get at the (effectively) binding agreement to use a particular facility once you are checked into it.

Edit: To be a little more concise, you agree to a particular payment structure for services without knowing what the cost of the services are or which services you'll be receiving when checking into a hospital, this opacity in hospital pricing also means that different parties are paying different rates for the same service at the discretion of the billing department.

[conanbatt]

> Definitely agree that there are degrees of freedom, I'm just not confident that a removal of regulations in the healthcare market would lead to a positive outcome (higher quality/less expensive healthcare).

Economists have a high degree of confidence that some of the rules that are restrictive of a free market account for sizable chunks of the cost: not being able to import pharma and immigrant restriction on doctors being quintessential.

Not being able to import pharma is denounced both by Bernie Sanders and Rand Paul (whereas the first wants to socialize medicine, and the latter remove regulations).

Doctor's immigration restrictions are large but also very hard to politically fight. Also the high cost and restrictions of medical licensing. Friedman was very unsuccessful in turning the public against them.

> I was actually thinking about when medical treatment is being received. Once you're under a hospitals care you're largely subject to their pricing for services (e.g. I can't choose to use the cheaper MRI machine down the street).

This applies only to emergency care: if you have cancer, for example, you have plenty of time to choose going to the cheaper chemo. And even a smaller fraction of emergency care: breaking a leg is painful but it does not incapacitate you to choose one hospital or the other: in fact, we do that all the time by picking which one is closest (choice that must indubitable be made in comparison to another option).

And after that, you have an insurable market, which means that you have all the time in the world to choose between options.

> you agree to a particular payment structure for services without knowing what the cost of the services are or which services you'll be receiving when checking into a hospital, this opacity in hospital pricing also means that different parties are paying different rates for the same service at the discretion of the billing department.

Same as car insurance, or mal practice insurance, or house fire insurance, or renters insurance. Not knowing what you will get is at the core of the insurance service models.

I see a struggle to find what makes heealthcare unique to falter in two regards: first, that finding that quality that makes healthcare a unique market does not show anything other than identity: it might be the quality found points to private healthcare instead of public. But also, the extreme difficulty to find a qualitative difference between health and other markets is due to the fact that it might actually not be qualitatively different at all.