[BobbyJo]

> A system that rations care based on ability to pay... is immoral.

You lost me there. What makes it immoral? Money is an asset allocation tool, so why is it morally wrong to use it for medicine the same way we do for food and housing?

Genuine question. I have a hard time understanding what sets medicine apart from everything else when people think healthcare should be universally free, but not food, water, clothing, housing, etc. especially considering those other things are more directly necessary for survival.

[andi999]

The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand)

If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.

[tryptophan]

> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.

Yes it can... there is more than one oncologist in the world. Competition exists.

As for if youre talking about the chemo drugs, you don't have to use the latest-and-greatest on-patent treatment. There are now decades of drugs that are off patent. They may not be as good, but then again, it is your life so many choose to pay for the new better ones. If it was illegal to pay more for better drugs than they would never exist (and don't talk to me about government funding; not a single socialized medicine country has innovated any drug of value in the past 50 years, and yes, they do steal from us in the USA by taking our IP and not paying for it).

[soneil]

The first covid vaccines came out of the UK and Germany. Whoever told you we're just stealing from the US has their head firmly in the sand.

[beerandt]

Medical prices being inelastic (to the extent they are) has much more to do with medicare/medicaid/FDA regulations, govt & insurance allowable reimbursement rate lists, and costly govt requirements to even participate in a govt funded plan (like electronic medical records).

Proof? Services not typically covered, like plastic surgery or cosmetic dermatology. Clearly listed and even advertised prices for their services, openly discussed up front.

But if the govt reimbursement rate for an annual checkup is $x, why would anyone need to list that price up front, or have reason to ever charge any less?

[refurb]

Your last comment is the reason for the massive gap between list price versus net price in the US system.

The US has a rule about “usual & customary price”. That’s a legal definition and providers can’t charge any customer more than that.

If you’re looking to price discriminate, you set your U&C price as high as possible, maybe 2-5x what you’d accept. That way if you find a customer willing to pay 4X, you’re not running afoul of the law.

For everyone else, you negotiate a much more reasonable net price, typically through insurance.

The people who get screwed in the end are ones without insurance. They get billed the imaginary number nobody ever intended anyone to pay.

[BobbyJo]

> The demand price curve is different. If housing gets more expensive you could (although) difficult move into a smaller apartment, or different region. (Similiar with food up to a certain amount). This allows the market to find the best/right price by supply and demand. (I think this is called inelastic demand)

Changing housing situations is exactly as easy as changing hospitals and emergency rooms no? Since the latter are mostly decided by where you live. In fact, most mid to large cities feature many hospitals near any given residence, so it is actually easier. I would also point out that the demand curve for housing, energy and food are far more inelastic than for medicine.

> If you have cancer though than basicall the market cannot find a price, and it would tend towards to: 'give me all you have'.

Why couldn't the market find a price? Cancer actually seems like the worse example possible. The people I've known who've been diagnosed with cancer have shopped around for care from many different hospitals. It would seem that cancer would be the perfect candidate for market forces to lower prices since a diagnosis generally affords a bit of time to find and decide on treatment options. Even in the extreme case of 'you have months to live' people tend to spend a few weeks collecting different opinions.

[jatone]

You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated. markets don't deal with this situation well. changing hospitals don't change the baseline costs for providing health care in a significant manner for there to be competition nor are many hospitals in a competitive market (often there is only one hospital for an entire rural region).

that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.

[BobbyJo]

> You're choices are: die, or pay whatever cost is associated. its not a choice that can be negotiated

This account, or at least should account, for a very small minority of interactions with healthcare facilities. Saying that's why the whole market is defunct is recklessly reductionist.

> markets don't deal with this situation well.

They don't deal with it at all. Imagine if some people needed bread or they'd die, would that change the price on the shelf? No, because the bread didn't get there because of that niche market, it got there because most people eat it. It is the same with healthcare. If a hospital exists because people routinely visit the doctor, some people needing their life saved isn't going to suddenly change prices.

> that's before even getting into pharma. which can charge millions of dollars for life saving/changing drugs for single course treatments. hell take a look at what happened with epipens. there is no protection against profiteering via nebulous 'markets' when your choices are 'purchase or die'.

Totally agree. The issue there is regulation and how we allow companies to be a position of no competition. If the government stepped in and payed those prices for you, it wouldn't solve the problem.

[jatone]

> This account, or at least should account, for a very small minority of interactions with healthcare facilities.

sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.

there is a reason preventative medicine is cheaper (overall) than delaying care until a condition has progressed.

the capitalists idea of a market simply doesn't apply to healthcare.

> If a hospital exists because people routinely visit the doctor.

this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.

you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.

[BobbyJo]

> sadly its not. you're in pain? you need to visit a medical facility to figure out whats wrong. without knowing how serious it is it can lead to a life long issue. again you don't really have choices here. pay the healthcare tax or risk long term issues.

I don't see how that is a congruent thought. The 'sadly it's not' doesn't follow from your statement after. If you are in pain without knowing how serious it is, you would likely get opinions from several doctors. You're not going to walk into the first hospital you find and say "I'll pay anything you ask just fix me."

> the capitalists idea of a market simply doesn't apply to healthcare.

You still haven't made a logically coherent argument as to why it doesn't. The vast majority of healthcare transactions are made between two lucid and consenting parties.

> this isn't true. we fund hospitals in rural areas because there literally isnt enough people to keep one operating via patient care.

That backs my point, right? Those hospitals aren't funded by emergency care either, which means the point about costs being a one sided negotiation while the other party is dying is still inaccurate.

> you're also asserting that if the populace can't sustain the healthcare system then it shouldn't be available to people. which is fairly cruel and immoral.

I don't think recognizing the limits of a given resource is cruel or immoral, it's reality. Us not having perfectly clean energy is killing us all, but it isn't cruel and immoral, it's a problem that needs solving. If a town can't afford a hospital, and you want to live in a town with a hospital, move, right? I don't see any reason why taxpayers should pay so a small mountain town in the middle of nowhere can have a staff of doctors and nurses to support a population of 100 people. If someone wants to live in the mountains of Oregon, I don't see how we have a responsibility to pay for a medical care facility to follow them up.

[mnhn1]

I don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc.

And indeed the US has many such services, though they are often overwhelmed, or performed through a complex set of nonprofits combining govt funds with donor money as best they can to provide good support. Sometimes they are overwhelmed specifically because of externalities related to the for-profit insurance healthcare system. The high and often unpredictable cost of any medical situation, means people with tight budgets become sicker before getting care, if they ever get it, leading to a higher percentage of bad outcomes, up to and including job loss and homelessness for the individual, and knock-on effects for the rest of their family. This puts extra pressure on the parts of the support system that do exist - those already mentioned, and, of course, the police, who end up getting called to many situations that could have been prevented by the people involved having better services to begin with, to meet their health, food, and housing needs.

[BobbyJo]

> don't think it's inconsistent. The people who advocate for free healthcare would probably also advocate for other parts of a social safety net, like food banks, food stamp programs, free access to water, temporary housing for the homeless and programs to get them to permanent homes, etc.

Isn't it though? "This thing should be free for everyone all the time" is a lot different than "we should help people out a little if they're down on their luck". Temporary housing, food banks, etc are the latter, and I'm all for the same with medicine. The fact that food and housing are subject to markets makes it easier for organizations to carry out such missions, which is one of the barriers you mention in your second paragraph when you talk about the complexities of dealing with insurance companies.

[mnhn1]

People don't consume healthcare "all the time" the same way they do food, housing, water. Preventive healthcare is cheaper/less work than treating illnesses that have gotten more serious, leading to less total consumption of healthcare (and those other downstream resources impacted by people avoiding preventive care). Also "Free healthcare available to all" doesn't preclude a private market. The Govt Healthcare is not always timely, may not cover treatments people want, or cover certain elective surgeries. Some people will always choose to participate in a private insurance market that provides value above a baseline govt health plan.

[BobbyJo]

You can't pitch ways of increasing demand as a fix for a supply shortage. You're just shuffling around how who gets what is decided. Why is a government agent deciding any more ethical than your bank account?

And creating a public market necessarily diminishes the private, driving up costs, as purchasers are now competing with government for the same supply.

[syki]

Of course healthcare isn’t and can’t be free. Unless by free you mean free at the point of usage. I support government provided healthcare and government runs off of tax revenue. Denying a person cancer treatment for no other reason than because they can’t pay $x at the point of usage is an immoral system. An analogous situation occurs with federal courts. Those who can’t afford filing fees have those fees waived and those that can pay them do so. This is done because the court system recognizes that access to the court system based on the ability to pay at the point of usage is a bad system.

[BobbyJo]

That's a bad comparison. The filing fee is small compared medical treatment, and it's in support of the government itself. The cost of doing that for people is tiny and doesn't really take away from anyone else.

Medicine is a scarce resource at this point, and, generally speaking, giving care to X often means Y won't get it. The fundamental problem with medical care is supply, lowering barriers for demand isn't a solution to that.

[syki]

The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage. In the U.S. system denials of care by insurance companies are not done so another person can get said care. They are done to increase profit margins and profiting from denying someone care is immoral.

[BobbyJo]

> The analogy is apt since it was an example of the idea that some people, thankfully, are aware that some services should not have their availability based on ability to pay at the point of usage

That last bit is exactly what we're in disagreement about, and I haven't seen a good case for it yet.

> In the U.S. system denials of care by insurance companies are not done so another person can get said care

True.

> They are done to increase profit margins

Indirectly, sure. Its a business where money out must be less than money in.

> and profiting from denying someone care is immoral.

Again, this is the disagreement, and I'm not really seeing a good argument for that being the case. Some people should be denied care. I don't see why performing a necessary function shouldn't be profitable, especially when it's beneficial to everyone in times of scarcity, like now.

[syki]

Police, most roads, and certain aspects of the legal system are free at the point of usage. It’s bad to have for profit police, court system, and Air Force. Some things ought not be profit driven. It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.

I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea. Unfortunately too many Americans embody the Bible’s warning regarding the love of money.

[BobbyJo]

Ahhh, ok. I see where we are disagreeing. You're assuming some equivalencies in what I'm saying that I do not.

> Police, most roads, and certain aspects of the legal system are free at the point of usage.

Sure, and those generally work well because the overhead is low. The per person cost of all of those services combined is extremely low compared to medical expenses. If giving everyone healthcare cost the same as giving every 911 service, this conversation wouldn't be happening.

> It’s bad to have for profit police, court system, and Air Force.

I think government and the monopoly on violence are generally good so long as the government is democratic, so sure.

> Some things ought not be profit driven

Totally agree. Executions and jails for instance. Anything were the service involves inflicting violence or removing rights is probably better left to a democratically elected organization.

> It’s quite disconcerting that someone sees no problem with a person profiting from denying healthcare. I should not be able to enrich myself by denying you health care. Tough decisions need to be made and the motive for the decision should not be profit.

You're confusing the role with the action. I think 'being the organization that prioritizes care' can be profitable and ethical. That's different from saying 'an organization should get paid for saying no to someone'. Those are two different things and you're assuming that you can't have the first without the second. The insurance company doesn't make money off 'saying no', it makes money off codifying rules that distribute healthcare and enforcing them on a set of people buying into those rules. When more people are denied they make more money, but they aren't 'denying to make money'. It's a different incentive structure from you're describing. Also, nobody in that scenario is 'denying care' they are denying paying for the care. You're still free to go receive the care and pay for it yourself. You can also find a charity and convince them to pay, or crowd fund. That's actually a benefit of the market driven system: there is no such thing as a 'hard' no.

> I am not more important than you or anyone else. I don’t deserve health care before you just because I have more money. That’s a perverse idea.

Totally agree. Having the ability to purchase something is not the same as 'deserving' that something. Two entirely different concepts that live in different systems. One is grounded in the philosophical idea of fairness, and the other in the physical process of voluntary exchange.

> Unfortunately too many Americans embody the Bible’s warning regarding the love of money.

Totally agree here too, as an agnostic, although that's kind of a tangent.