[tptacek]

Part of the notion that suggests people should be forced into sharing those risks is that nobody can rationally rule out future unbounded medical expenses; you can't predict the future, and virtually nobody has enough money to cover every plausible medical expense they might face.

So the freedom we're really talking about is --- notionally --- the freedom to make what basically must be an irresponsible choice.

It's true; single payer systems do create a monopoly for health care funding; that monopoly takes its place alongside the monopoly for military force, for air traffic control, for fire prevention, for oceanic weather surveillance, &c.

[anonymoushn]

It is entirely possible for a person to rationally rule out future unbounded medical expenses if he or she has no desire to live in agony and spend hundreds of thousands of dollars to prolong his or her life by weeks or months. Such people are forced to subsidize people who want to live in agony at high cost for small periods of time.

I don't think this is a significant problem, because the people who receive this subsidy vastly outnumber the people who provide it.

Edit: A liver transplant is a procedure with a very high expected value in terms of QALY/USD. Americans in aggregate spend a great deal of money and effort on procedures with very low expected QALY/USD. Some people, myself included, would prefer not to purchase a procedure with very low expected QALY/USD.

There was a good discussion on a similar subject earlier: http://news.ycombinator.com/item?id=3313570

[tptacek]

This argument basically says that people can avoid the expense of, say, a liver transplant by opting to die instead.

That's true, but it's not a winning argument.

[true_religion]

He's not arguing against liver transplants so you've just thrown a redherring into the discussion.

I believe his argument is that expensive end-of-life care is unnecessary because death at that point is inevitable in the immediate future. You can gain months on average, but those months aren't economically invaluable.

With limited resources, its better to spend on treatments with the greatest quality of life to cost ratio.

[tptacek]

And I'm not arguing about expensive end-of-life care. I don't have a strong opinion about end-of-life care. There could be a lot of value in changing the way we finance end-of-life care. That doesn't change the fundamental problems we have with health insurance now: either it chains you to your current employer, or threatens you with an intolerable risk of bankruptcy.

[anarchotroll]

In other words: you have no _freedom_ to pick insurance yourself. The current system gives benefits to employers and not to individuals.

I sincerely don't understand why people call it "free market".

[anarchotroll]

I am sorry but the logic above could be applied to anything.

"Part of the notion that suggests people should be forced into sharing those risks is that nobody can rationally rule out future unbounded <whatever> expenses; you can't predict the future, and virtually nobody has enough money to cover every plausible <whatever> expense they might face."

Meet socialism.