[mizay7]

I think you are making a more articulate defense of private/market based health care than i usually hear. but i think fundamentally health care has too many forces that make it untenable for a market. there is no real satiation point in care, people are price inelastic, many services cannot be priced before delivery, there is little opportunity to do repeated business for most of the costliest services, comparison between providers is very difficult, most of the choice happens under incredible duress when you are your weakest point. health care is just not a consumer good that responds well to market mechanisms.

[bravo22]

I suppose it all depends on how you define market mechanisms. What I've found -- after personally studying the subject -- is what a lot of people consider free market is the opposite of what the literature considers it to be.

To answer your point:

Most/all of the issues you raised are met by "pooling" aka insurance. The need arises at random and when it does there is a massive cost and you urgently need the service. This is what insurance is for.

What I was suggesting isn't that people go and pay the doctor out of pocket -- although they can. Rather that they purchase insurance. Those who can't get $$ indexed to some national average or whatever scheme you prefer. The point is everyone gets to purchase insurance if they so prefer.

The problem is that choice of insurance providers is artifically limited right now and the choice of healthcare providers is as well. So you have a system where you are captive to the need and those who provide the service have a monpoly. Naturally costs will rise. Putting political preassure on government to increase spending is easy way out but that will only shovel more money from the pockets of the many into the pockets of the few. In fact this was predicted when Medicare was first introduced, and here we are. It is not like doctors and providers magically became greedy capitalists in the last 40 years.

Also to be very clear this isn't an issue of "profits". Insurance companies don't have huge profit margins. They make their "wealth" by being a monopoly. The execs make their money on the rise in stock prices which isn't sensitive to their 3-5% profit margin.

[mizay7]

so you are arguing that many small insurers, with insurance not bound to employment, would create a healthy price-quality structure in us health care? akin to the german model?

i think that has some merit, but its hard for me to imagine that having the payer, be disconnected from the consumer can really create a stable market without heavy handed regulation.

i dont think insurance can really get you to an efficient market. health care is simply not a good where price and substitution apply as in many other markets. and rather than jumping through hoops to invent such a market lets agree that this an ethical part of social contract and manage it with the best technocratic solutions that our society can offer. E.G. NHS and NICE