[danaris]

> Having a profit motive is only a serious problem when there is insufficient competition. Otherwise companies that try to make outlandish profits would lose business to companies that offer better coverage for lower premiums by taking smaller profits.

This works in an idealized free market.

Health care is, for a variety of reasons, fundamentally incompatible with this, even if the powerful and wealthy interests within it are not actively working to destroy some of the basic premises of a free market (like equal information).

[AnthonyMouse]

> This works in an idealized free market.

It works in any kind of market that isn't a dumpster fire. The closer to idealized it is the better it works, but it still works in real markets that actually exist. The people who sell towels to Walmart are not an "idealized free market" but it's close enough for practical purposes.

> Health care is, for a variety of reasons, fundamentally incompatible with this, even if the powerful and wealthy interests within it are not actively working to destroy some of the basic premises of a free market (like equal information).

Health care is not incompatible with it. People place a high value on life-saving treatment, but that's as it should be. It has a high value. If it costs a lot to provide or develop, it's worth the cost. The key is to not pay that cost in cases when it isn't necessary -- but you still want to in cases when it is.

The state of US health care and insurance regulations, however, are a dumpster fire. It doesn't have to be like this. The status quo is not optimal.

As you say, even just having real price transparency would mark a significant improvement.

Fixing that is hard because there are powerful interests behind the status quo, but the same interests are aligned against a single payer system. You can't use it as an argument against one and not the other.

[danaris]

> The people who sell towels to Walmart are not an "idealized free market" but it's close enough for practical purposes.

Towels are a commodity: they're functional, fairly easy to produce, and differentiation is a pretty straightforward tradeoff of higher price for more luxury towels.

Health care is not a commodity. Different services are not interchangeable, and for anything more specialized than basic care, there may only be one provider within a reasonable distance of you that can offer it at all, let alone at an acceptable level of quality.

Furthermore, at the point of sale, much of the time, the "customer" is neither in a condition nor a position to be shopping around. Sometimes, they're literally unconscious. And while some elective procedures and preventative visits can be scheduled and planned, emergency care is by definition not something you can plan ahead for to determine where you can get the best value for your money.

None of these things are because of the specific sorry state of healthcare in the US. They are all fundamental to its very nature. It is impossible to have a truly free market for healthcare, because getting it is literally a matter of life and death for the patient in many cases, which means that by the economics of an unregulated market, the provider can charge them literally whatever they can afford to pay. Or more.

> Fixing that is hard because there are powerful interests behind the status quo, but the same interests are aligned against a single payer system. You can't use it as an argument against one and not the other.

Great, I completely agree.

So instead of trying to fight for a tiny baby step that will improve the system by 1%, let's fight the same people for single payer, a meaningful change that will improve the system by 1000x.

[AnthonyMouse]

> Health care is not a commodity. Different services are not interchangeable, and for anything more specialized than basic care, there may only be one provider within a reasonable distance of you that can offer it at all, let alone at an acceptable level of quality.

In what way is it not a commodity? Does the medical practice in the next town over not have an X-ray machine or an operating room or whatever it is that you need? There are very few procedures that can only be done by one provider in the world.

Reasonable distance is also related to price. If the local provider is asking $10,000 then a $300 plane ticket to use a provider that charges a quarter of the price is completely reasonable. Which, if we had meaningful price transparency, would then prevent the local provider from charging $10,000 to begin with or else nearly everybody would know to buy the plane ticket and they would have no patients.

> Furthermore, at the point of sale, much of the time, the "customer" is neither in a condition nor a position to be shopping around. Sometimes, they're literally unconscious. And while some elective procedures and preventative visits can be scheduled and planned, emergency care is by definition not something you can plan ahead for to determine where you can get the best value for your money.

So have your city provide emergency rooms the same way they provide fire departments. What does that have to do with the majority of medical care which is not done on an emergency basis?

> It is impossible to have a truly free market for healthcare, because getting it is literally a matter of life and death for the patient in many cases, which means that by the economics of an unregulated market, the provider can charge them literally whatever they can afford to pay.

Being a matter of life and death doesn't break markets in any way. Markets operate through competition. It may be worth a million dollars to you to save your life, but if it only costs $200 then providers will be lining up to charge $250 and make $50.

Food is a matter of life and death too. Does that mean we should have socialized farming?

> So instead of trying to fight for a tiny baby step that will improve the system by 1%, let's fight the same people for single payer, a meaningful change that will improve the system by 1000x.

Because you can get a lot more than 1% improvement from things like price transparency or addressing existing constraints on the number of new doctors, which are easier to pass because for each one you only have to fight 10% of the incumbent apparatus instead of the whole thing aligned together.

Also because single payer doesn't actually solve problems by magic, so you still have to solve each of the individual problems anyway. If the FDA approval process continues to be very expensive and thereby causes drugs to only come to market when they're expected to be very profitable, how is single payer supposed to reduce drug prices without reducing the number of new drugs? How does it address the de facto limits on the number of new doctors? They're still independent problems.

[danaris]

Your answers talking about taking plane trips to get to other providers show that you are only considering the effects of these things on the fairly-well-off and up, and completely ignoring how they affect the poorest 50% of the population. This is not terribly surprising, on HN, but it is disappointing in a discussion of how health care and the population at large interact.

There are so, so many broken assumptions that go into your response here, from assuming that it's trivial to find out that a $300 plane trip would get you to a cheaper provider, to the idea that "the next town over" is a reasonable place to go when that's an hour's drive away and you've just been in a car crash. It's just not worth trying to address every way in which you clearly don't understand what it's like not to make 6 figures and live in a major metropolitan area.

[bhupy]

> completely ignoring how they affect the poorest 50% of the population

You're absolutely right that there are some poor people that don't have the ability to shop around. The solution to this isn't to centrally plan resource allocation, it's to just give poor people money (UBI/NIT).

We do this already for food (food stamps). Food is also a life-or-death good, one starves and dies if they don't have access to food.

There's definitely an argument to be made to increase food stamps and also turn it into straight cash, but that's orthogonal.

[danaris]

And I completely agree. I'm 100% for a true UBI, but as long as that's not yet politically feasible, I'm also for other solutions we can more likely implement in the meantime (like Medicare For All).