[underlipton]

Regulatory capture is likely the most important component. People complain about government spending, but those close to progressive issues can tell you that it's just as likely, if not more likely, to be remarkably stingy when it wants to be. The issue isn't government, it's who's using government; access to capital on top of that government influence gets you a lot closer to that bottomless wallet.

[eru]

> The issue isn't government, it's who's using government; access to capital on top of that government influence gets you a lot closer to that bottomless wallet.

One issue is a big disconnect between user and payer. Government is especially prone to that, but any big organisation can have this problem.

[beaeglebeachh]

This is why I'm for total deregulation of healthcare. Government fucks it up so bad hamstringing access that some hack work with 15 minutes of YouTube training plus whatever pills drop out the dark web is often better than not being able to access it at all.

Right now we basically end up going to Mexico if we can help it, where there's basically no real oversight or regulation to raise cost so long as the doc/pharmacy pays off the cartels.

[newsclues]

Regulations should be voluntary and exist in a market with options.

I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.

[xyzzy_plugh]

This doesn't really work. An unregulated market has every opportunity to undercut a regulated market in almost every dimension. Do you expect that a highly regulated market would become sustainable let alone affordable? You may as well just demand that regulations are removed.

The only way this works is if the government subsidizes the regulated market such that it is accessible (and sustainable) to an appropriate market. It also generally puts some populations at severe disadvantages, and usually those populations are disadvantaged to begin with.

This may seem good to you but, unless your fellow man is equally wealthy, it is problem detrimental to your fellow man.

[newsclues]

Has the concept ever been really tested?

If you play the idea out (I’ve thought about this for years, perhaps you have fully considered it).

I think this works for people of all economic backgrounds.

There would be multiple competing standards for lower cost businesses, will the low standards business exist if people get sick, or will a slightly higher priced but much safer low cost standard excel in the market?

I think many of the issues you bring up already exist in the current market.

[eru]

That's why I am in favour of more city states like Singapore, or at the very least towards pushing more responsibilities from the federal level to the state level. (The Catholics and EU call that concept 'subsidiarity', handle everything as locally as possible and have the higher levels only there to help when the lower levels can't handle it.)

Eg the FDA ought be to dissolved, and replaced with state level agencies. The state level agencies are, of course, free to cooperate and coordinate. Comparable to how the traffic signs work already in the US.

It's good for Hawaii and New York to have the same road signs, but they can agree on that voluntarily. No need to have a central party force them. Similarly, it's good for both states to have the same or similar rules on drugs, but no need to force them.

See also how the recent wave of cannabis legalisation has been driven by the states. I want to see more of that innovation and experimentation.

> I want a market where I can choose a highly regulated healthcare system or a system with no regulations and a system somewhere in between.

In what I suggest each state would most likely still have mandatory regulation, but it's a lot easier to move between states to find a place that suits you best, instead of moving between entire countries.

I have lots of sympathy for your position, and I would hope that at least some states would take a more laissez faire approach. But the policies you get will ultimately still be decided by what's popular with voters, and they can be a fickle bunch.

[vkou]

> Similarly, it's good for both states to have the same or similar rules on drugs, but no need to force them

I can't wait for drugs having to be certified safe in 50 different jurisdictions, instead of one, with 50 different agencies, each with a different set of politicians putting their thumbs on the scale having their own rules for them.

That'll really bring down medical costs, and will not at all destroy the incredible economies of scale that a single 350 million person national market creates.

I also can't wait for the cross-state litigation when an upstream state's equivalent of the EPA will be paid off to allow a firm to dump toxic waste into a river, that will be poisoning the people downstream.

[eru]

States can voluntarily choose to have a unified certification process, exactly to enjoy the economies of scale you are describing.

> I also can't wait for the cross-state litigation when an upstream state's equivalent of the EPA will be paid off to allow a firm to dump toxic waste into a river, that will be poisoning the people downstream.

How much is that happening between eg Canada and the US at the moment?

[vkou]

So, the best case outcome is a less-democratic version of status quo (just like how California unilaterally drives ~all automotive regulations in the country, with nobody else having any input on them, despite every state having the 'freedom' to make their own), and the worst-case is a complete collapse of the common market.

Is that really what you want? It sounds absolutely mad to me. Your ideology is driving you to ask for a monkey's paw.

[hallway_monitor]

Yes please. We don't need to get rid of the FDA, just make it optional. If I want to trust the government's opinion of a doctor or drug, I can look for the FDA seal of approval.

[justinclift]

> This is why I'm for total deregulation of healthcare.

Is that a good idea for an industry that seems filled with completely immoral bastards that'll screw over everyone ("they'd sell their own grandmother!") to make an extra cent, or save themselves a cent?

I could see it might be a good thing where an industry has a good reputation for fair dealing. US health care doesn't seem to fit that description though.

[underlipton]

All of the responses to this post are unhinged and it truly makes me despair for this country.