| >The reason why inefficiency is tied to equitability in the real world is because equitability is enforced, which means you spend resources to achieve it Now you're switching around your causality. Earlier you said: "inefficiency tends to harm both equitability and value/cost" So you don't believe that inefficiency causes equitability, just that equitability causes inefficiency? >No..if it had, we wouldnt be talking about a problem of healthcare in the US. Its grown disproportionately here. But the whole point is that 50-60 years ago, healthcare was cheap and it was private. So, in response to demographic changes across the western world (like an aging population) a bunch of countries made their systems more public and were able to keep costs down and the US has kept theirs more private and costs have ballooned. Maybe the answer is self-evident. >I will be more practical then. What do you think are the top 3 issues that make healthcare expensive? I think there is basically one cause: the existence of for-profit insurance companies. In a public system where government provided healthcare there would be a large monolithic body which could assert it's power to keep prices down. In a market with multiple insurance companies, they'll never have enough individual power to keep prices low. That's how the market is supposed to work by keeping power divided, it's just that healthcare is a terrible place for markets. >Mine is that lightly regulated free healthcare markets will be efficient (though might not be equitable). So to get you to change your mind that public systems are better than private equitability never comes into play? What is the point of efficiency if not to help people? If the point of efficiency is to help people then how is equitability not important? |
I've had private insurance my entire life in a western country with free public healthcare. I have practical experience of the trade-offs of public vs private as a consumer and a tax-payer. The demographics changes hit my home country just like any other, but it didnt make public more efficient than private, nor more effective.
> I think there is basically one cause: the existence of for-profit insurance companies.
I have mentioned 2 counter examples: my home country (argentina) and historical US. You can also see Germany also has public/private mix systems. Health insurance companies actually have very low profit margins. Lower than the general market, lower than insurance companies, etc etc. They are not raking it in. The ones that are raking it in are providers.
> In a public system where government provided healthcare there would be a large monolithic body which could assert it's power to keep prices down. In a market with multiple insurance companies, they'll never have enough individual power to keep prices low. That's how the market is supposed to work by keeping power divided, it's just that healthcare is a terrible place for markets.
There is some contradiction in the previous statement (for profit) vs this one. You are arguing insurance companies cant negotiate prices down because they are not a monopoly, not because they are for profit. If there were only 1 insurer, they could definitely keep prices down, particularly the price of providers. But its hard to think a monopoly is the solution to a market problem.
Moreover, you say the state would have the power to drive prices down. This contradicts reality today, where Medicare by law cant negotiate prices. The government is eager to put itself a restriction on negotiating, and is politically unable to remove it. If it cant change medicare when its a fraction of the market, do you think it will change more when its 10 times its size?
The state can, in 24 hours, reduce healthcare prices by just removing economic consented bad regulation. Read what the healthcare economists say: allow free trade for drugs and doctor immigration and you solve such a massive part of the cost immediately. The government has full power today to solve those problems and it cant. Doesn't that make you lose any faith in the government's capacity to solve healthcare?
Do you remember the Obamacare website debacle? Do you think medicare will make a kickass insurance website?