[d_burfoot]

America cannot, as a country, discover a reasonable approach to managing health care costs because Americans do not have a sufficient core set of shared political values. The solution is to end regulation at the federal level, and allow the states to determine what regulations they may deem appropriate. As a New Hampshire libertarian, I do not want Californian progressives telling me how our state must manage health care spending, and I am sure they feel the same way about me.

[f33d5173]

I think the vast majority of people agree on the generalities and care enough about solving the issue to be able to come to an agreement on the particulars. The problem is that the people who get rich off the current system won't agree to any solution that reduces their profits, and have thus far managed to fillibuster attempts at such a solution through a combination of buying politicians and propagandizing certain segments of the population into rejecting solutions that would benefit them.

[cucumber3732842]

Healthcare is ~17% GDP

Slavery was estimated at ~12% and "hey, you need to lose a few % of your margin and actually pay those people" started a war.

Now, there's an argument to be made about ideology, geographic concentration of industry, etc. doing a fair bit of lifting kicking that off (their own neighbors telling them to stop surely would have gone over better than a bunch of smarmy northerners in their ivory towers telling them the same thing). But the fact remains that you cannot make a large fraction of the country take a haircut without causing strife.

The only way to fix this "nicely" at this point is to boil the frog over decades.

[d_burfoot]

I'll accept your first sentence for the sake of argument. You are still better off with a localist / federalist approach, because state governments are much less vulnerable to corruption and bribery. It is far more economically efficient for the bad guys (whoever they are in your view) to bribe a few DC legislators than dozens of state politicians in places like Montpelier and Hartford. Centralized, unaccountable power in DC means that when big rich corrupt companies bribe the right people, they can force the entire country to followed their preferred policies. A good example is how Purdue Pharma bribed the head of the FDA to approve OxyContin, leading directly to the opioid crisis.

[ceejayoz]

> It is far more economically efficient for the bad guys (whoever they are in your view) to bribe a few DC legislators than dozens of state politicians in places like Montpelier and Hartford.

State politicians are much cheaper, and no one from the New York Times pokes around when you buy off the state representative of East Bumfuck, Montana.

[jmspamerton]

so, your answer is OMG, they are making money!11! It's not a money probelm, it's a resources problem. We simply don't have enought hospital resources to serve everyone in the us. it's not making money, it's not having enough beds and skilled people to do the work.

Get an MD and help out, then you'll discover how you really DONT want the government to tell you which patients to serve.

[ceejayoz]

> It's not a money probelm, it's a resources problem.

Most people would consider money a resource, and quite a few rural hospitals are closing because of a lack of that specific resource.

> you'll discover how you really DONT want the government to tell you which patients to serve

Yeah, wait until you hear about private for-profit insurers doing that instead.

[outside1234]

Honestly, after stories like these, I don't want a corporation telling me which patients to serve even more. At least government is theoretically accountable for their decisions.

[selectodude]

As long as you accept the outcome of “drop dead” when something happens to you.

Problem is you’ll go right to the emergency room when you have a heart attack.

[expedition32]

Yep they will move to California the moment they get cancer. Never trust a libertarian.

[ervine]

What's a libertarians take on how health care should work? Completely privatized, completely socialized, somewhere in between?

[datsci_est_2015]

“I’ll put out this fire for you if you pay me $5000”

[hydrogen7800]

This is one of those things that, if it weren't already a public service, could never be implemented as one today. Add to that list public schools and public libraries.

[outside1234]

"I don't want to be forced to pay for insurance, but will move to a state with subsidized insurance the second I need it."

[jmspamerton]

The fact that the hospital doesn't know what a procedure costs (they make it up based on deals with medicare, medicaid, and individual insurance companies) should give you a hint.

Yes, the patient needs skin in the game. People need to take care of their own health. Most procedures are given to grossly unhealthy people.

Yes, completely privatize it. Make people pay for their care so their daily decisions are weighed against what affect it will have on their overall health.

[ceejayoz]

> Most procedures are given to grossly unhealthy people.

Well, yeah. That's the idea behind "medically necessary". We don't do elective heart transplants on healthy people for funsies.

[vjvjvjvjghv]

“ The fact that the hospital doesn't know what a procedure costs (they make it up based on deals with medicare, medicaid, and individual insurance companies) should give you a hint.”

The hint here is that the random pricing needs to stop. Same procedure for the same price. No market can work if participants don’t know the actual price. Insurance and hospitals probably have a very good idea but patients are being kept totally in the dark. You are expected to just accept what this opaque machinery comes up with.

[Sohcahtoa82]

So what if someone gets cancer or some other potentially fatal disease despite eating healthy, exercising, not smoking, etc, and they can't afford to pay for treatment?

They just get to die, or what?

[array_key_first]

Ah yes, more fragmentation. Surely that will lower the complexity and administrative burden, thereby leading to reduced costs!

The reason healthcare in the US is expensive is very simple: too many cooks in the kitchen. Private insurance simply should not exist. The undeniable reality is that the only way to achieve maximum efficiency is top-down administration.

I understand that that makes libertarians uncomfortable. But what we all have to acknowledge is what we have is not working. Other countries have worked it out. There's no reason to reinvent the wheel here.