[api]

US healthcare is very strange in that on one hand it pinches pennies and is incentivized to not fund treatment, but on the other hand there seems to be some kind of internal incentivize to spend liberally and do everything.

The whole system is a mess of perverse incentives. I've often described it as "everything bad about socialized medicine combined with everything bad about privatized medicine."

[modeless]

Some people thought it was a good idea to cap [administration cost + profit] of health insurance companies as a percentage of premiums. As a result, health insurance administrators have two ways to increase their compensation: they can compete to acquire more customers, or they can artificially inflate costs per customer. Guess which one is easier! Now you don't have to wonder why medication is half the cost when you buy it without insurance...

Love to hear all the time how the "free market" is ruining healthcare. Of course everyone knows a "free market" is when you have profit caps, supply restrictions (residency cap), government-run marketplaces, byzantine tax subsidies tying insurance to employment for no reason, etc etc

[api]

That's what I meant. It's over-regulated and sclerotic, criticisms often levied at socialized medicine, but is also unequal, expensive, and excludes many people. So it's like everything that sucks about socialized medicine without the upside.

[Eisenstein]

> Love to hear all the time how the "free market" is ruining healthcare. Of course everyone knows a "free market" is when you have profit caps, supply restrictions (residency cap), government-run marketplaces, byzantine tax subsidies tying insurance to employment for no reason, etc etc

What people are talking about with regard to health insurance being ruined by being market based is that the profit motive should not be applied to it. The basic fact is that it should be some form public service and not reliant on a system which has as its incentive maximizing profits, and attempting to regulate it into being patient first and not profit first will always have side-effects like you pointed out.

[modeless]

Removing the "evil" profit motive has always been an argument for socialism. If it would work for healthcare, why not everything?

[api]

Steel man counter-argument: health care is weird and different and special in lots of ways.

The people who need it most are often the least profitable to treat and the least able to pay for it. That's because being sick negatively impacts your earning potential. The sicker you are the less you can afford a way to pay for treatment to not be sick. It's analogous to the problem with debtors' prison.

Obscure or low-survival-rate conditions are almost by definition unprofitable to treat. Rare condition? Stage four cancer? It's most profitable to let you suffer or die. There's not enough of a market for the former and the latter has a low probability of leaving someone behind to pay the bill.

Old age care can't be profitably offered on insurance or credit. Old? Pay cash or die.

Demand is not infinite because (excluding certain neuroses) people generally do not want health care. They only get it when they need it. Demand does not skyrocket with reduced price or free availability, so the system doesn't automatically just drown in demand when you take the cost away.

Competition is sparse because talent is scarce and the cost means there tend to be only one or a few hospitals covering an area. Specialty services and general practitioners are different, but for advanced and expensive care it tends to be not quite a natural monopoly but almost one. It's like how there's not very many space launch companies. Because it's so f'ing hard the supply of competitors is small.

Lastly, because customers are ignorant (very few people are qualified to evaluate health care tech or treatments), quackery is structurally more profitable than medicine that works. It's hard to have a healthy market when fraud is massively easier and more profitable and the customer finds it hard to tell the difference. Add to that the fact that try before you buy and comparison shopping are almost impossible, especially for serious medical care. You can't exactly toss out or return a surgery.

[iso1631]

Well it does work for healthcare pretty much everywhere.

Why is the fire service socialised in the US. Why are roads. Why is water?

[Eisenstein]

Are we socialist because we don't charge people for investigating crimes they report?

[Avicebron]

If anyone is curious, this the USA, it came from the ACA in 2010 championed by Democrats. It's almost like it doesn't matter which jersey is being worn.

[alightsoul]

This is what happens when healthcare is for profit.

[m0llusk]

It is more complicated than that. Markets have the structure and regulations we give them. Health care gets set up and delivered with very different concepts and guidance in various places regardless of whether it is for profit.

[laughing_man]

We don't have a true free-market in health care, so regulations and various programs are meant to create an environment where we get the benefits of a free market while still having universal availability and a universal "standard of care".

Of course it doesn't work very well. That's asking too much of any system.

[iso1631]

the only problem with communism is nobody's actually tried #TrueCommumismTM

[alightsoul]

How is not weighing risk not for profit, when not weighing it is crucial for profit?

[iso1631]

The UK has healthcare for profit, and not just the private healthcare options like BUPA -- GP surgeries are privately owned.

Does it happen there?

[alightsoul]

I live in Panama and yes it happens in for profit healthcare.