[indoordinosaur]

I would argue that because healthcare is so regulated its more of a public sector thing. Also, an enormous amount of money going into the healthcare sector comes from public sources (medicare, medicaid, obamacare, etc.)

Note: I'm not saying regulation is bad. Just making the point that healthcare is really not a free-market in this country and never has been.

[ska]

Almost nothing is a free market - so you have to be careful of the no true Scotsman fallacy.

[adventured]

Except that's nowhere close to a no true Scotman context.

The US healthcare system is extremely far away from being a free market style system. Healthcare hardly even crosses state lines. It's absurdly regulated. It's about as regressive in terms of markets as it gets these days. Over half the US system is government healthcare now, either directly or indirectly; eg heavy subsidies, SSD, Medicare, Medicaid, CHIP, VA, numerous other programs.

Part of the reason for the vast cost inflation, is that the system has gradually spread out to cover a lot more people over the last 30 years. 5% of people are half of the cost in the US system. In a market system, if you focus on covering the other far healthier 95%, the system is dramatically cheaper - that's how it worked in the 1970s-1990s, and US healthcare was radically less expensive. 50% of people in the system (in terms of cost) are only 3% of the total cost of all healthcare in the US, you can cover those people for extremely inexpensively in a free market system.

By changing the system as they have, such that you commingle government and quasi-private systems, you risk dramatically screwing up a private market system and the government system simultaneously. Ultimately you can do one or the other, you can't do both at the same time and in the same phone booth where they constantly collide. You get the worst aspects of both worlds, which is what the US now has.

[ska]

I think you missed the point I was attempting to make. So I’ll try again. Yes, the healthcare system is very distorted - but that is entirely common for the US.

The Scotsman here in particular is a truly free market.

[humanrebar]

No True Scotsman is about moving goalposts within a conversation. Bringing up, say, a lack of transparent pricing for commodity services (x-rays or pregnancy tests, for example) isn't a No True Scotsman fallacy.

[ska]

Ok, it my be pushing it a little bit - but the point is that the US economy is chock full of things like the healthcare system. You can’t easily argue that these are just outliers and the “real” economy is extremely free market. They are, in fact, completely normal parts of how the economy works.

Arguing the converse would be precisely the no true Scotsman fallacy.

[humanrebar]

Who's arguing that the American economy is exceptionally free market? It's certainly not centrally controlled as much as in other places, but I'm not sure "free market" is any more accurate. Large sectors (probably even a majority) of the economy is heavily regulated, monopolistic, monopsonistic, oligopolistic, etc.

The original point, that it's not fair to blame the free market for the dysfunction in the American healthcare system, is still a valid one. A main point is that "shopping around", even for commodity procedures, isn't really possible. Also, there aren't many remedies for consumers caught in undesirable contracts with health insurers. Quitting a job or moving states to fire an insurer is wholly unreasonable.

[ska]

Actually the original point was that “best, most efficient” is not a feature of many significant parts of the US economy. Of which healthcare is only one example. Not sure why that caused confusion.

[ucaetano]

You're mixing free market and laissez faire. Any market without monopolistic forces and where prices are set freely by the balance of supply and demand and competitive forces is essentially a free market.

[ska]

No, I’m not. Your description here is fine, but it does not fit a huge chunk of the real economy, which was the point. Healthcare is just one example of many (agriculture, energy, telecom, etc.)

[ucaetano]

> Healthcare is just one example of many (agriculture, energy, telecom, etc.)

That depends on the country. Energy and telecom are quite free markets in many countries, especially with local loop unbundling and separation of generation, transmission and distribution.

And compare that to "Almost nothing is a free market" which you claimed. Now it's the opposite: most markets are free, but some, which depend on restricted physical infrastructure, are not.

Very different from your claim.

[ska]

No - My claim was narrower than that. In essence, that while we tend to think of the USA as very free market, in fact a huge fraction of the US economy is very much not free market. Enough so that any claim about free markets leading to strength in US economy is at least worth a second look.

At any rate I’m obviously not big articulate in the time I have for here, so I’ll leqve it at that.

[ucaetano]

You literally said: "Almost nothing is a free market".

> in fact a huge fraction of the US economy is very much not free market

Indeed, many industries depend on highly limited resources, such as land, natural resources and so on.