[mikeash]

People with serious diseases will outspend their voucher, and then many of them will die unnecessarily.

Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind. I've yet to see one, though. Not being allowed to refuse treatment screws up too much.

[burntsushi]

> Give me a proposal that stops poor people from dying of treatable diseases (or at least gives the appearance of legitimately attempting to, as is the current state of things) while preserving market forces, and I'll change my mind.

No such proposal exists. Any proposal that does requires a third party to intervene as either an angel to donate whatever resources are needed or as an agent enforcing policy that one group of people must provide services to another group of people regardless of means.

Both of the aforementioned scenarios do not exist within the realm of market forces because market forces cannot make guarantees.

People will always die because they don't have the resources to fix what ails them. We can only hope to lower the amount of resources to get treatment, and "market forces" are absolutely a legitimate solution to that.

But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely.

[mikeash]

"But if you're stuck on "stop people from dying from preventable diseases" or "appearing to do so", then you've implicitly ruled out market forces completely."

We are in agreement. My point is that society is stuck on this (note that I have made no value judgment in these comments myself) and until and unless that changes, market forces are implicitly ruled out.

[beagle3]

Actually, the Israeli system does sort-of stop people from dying yet still lets market forces do some magic. It is single payer (gov) through taxes, every person chooses their HMO. The HMOs get paid per member (so they compete for the members) and they are also allowed to offer extra services to their members (which they also compete on). And finally - and I think this is also crucial - the government has a special fund for expensive life saving treatments that the HMOs tap into when needed - so they do not have an incentive to avoid those treatments.

[baddox]

People with sufficiently serious diseases will die, period, even if they're the wealthiest people on Earth. I don't see how the inevitability of death caused by disease is a useful argument. If there was some disease that one person had, and that could be cured only by pooling the entire wealth of the Earth, should we forcefully take that wealth to cure that one person?

[wpietri]

That would be an interesting hypothetical if anybody sensible had ever suggested anything close to that.

[mseebach]

> Give me a proposal that stops poor people from dying of treatable diseases while preserving market forces, and I'll change my mind.

See my comment elsewhere on the swiss model.

[sp332]

Death isn't preventable, you can only delay it. Should the people pay for someone's heart surgery if their kidneys are on track to fail in a few months anyway?

[Klinky]

Life expectancy estimates are often all over the board and wrong. Imagine it's a close relative who is having the heart surgery. Would you actively try to persuade them to not do the surgery to possibly extend their life because their kidneys might fail later, so they might as well die now because they're not worth the money that would go into the surgery?

It's easy to say a Big Mac isn't worth the cost on the menu, it's harder to say that your mom's life isn't worth the cost.

Keep in mind we're talking purely about economics here, as that is what your post is about. We're not talking about quality of life.

[sp332]

Economically speaking, I think it's fine for a person to spend huge amounts of their own money that way if they want. Also, it's fine if they ask around for friends, family, or even total strangers to finance their health. But forcing people to pay (via taxes) for an operation seems outrageous to me.

[Klinky]

Not really the point I was making. People will go to great lengths and effectively destroy their own life in the pursuit of saving a loved one. This makes it hard to take seriously the concept that a a free market full of economically rational consumers would exist when it comes to costly medical decisions.

It's easy to say "if you didn't want to be poor, you shouldn't have bought that plasma tv or new smartphone", versus "if you didn't want to be poor you should have let your wife die instead of taking a second mortgage out on your house".

Most people do not have a maximum price on something they consider priceless.

[vidarh]

You benefit immensely from society. To expect you to pay some portion of your income to help that society function is not unreasonable, and extensive healthcare is consistently one of the things people in most developed societies see as one of the top priorities for society to spend that money on.

I'd fully support your right to opt out of taxes if you also opt out of each and every benefit society otherwise provides you.

[sp332]

If the government starts paying (at least some) of people's medical bills, there will be a committee somewhere that determines who is deserving of care and who is not.

[vidarh]

If the government doesn't, peoples finances decide who is deserving of care and who is not, which more often than not means an insurance company decides.

Personally I'm far more comfortable with a board under democratic control setting rules based on clinical considerations for whether or not someone is suitable for care, than having someone with a profit motive to avoid paying for my care making that decision.

[bane]

there already is, and always has been

[mikeash]

I don't know, but people in general seem to think the answer is "yes". Until and unless that changes, market forces won't really work in health care.