Health care is turning into a consumer product • Hacker News Board

Re: Health care is turning into a consumer product

#281

Post by wbsss4412 » Mon, Jan 10, 2022, 7:06 PM UTC

virgilp wrote: post #84

zimpenfish wrote: post #70

Earlier quoted context omitted.

> a full state-run system, which is vulnerable to undercapacity (which the UK is currently suffering from) That's more because we've had decades of deliberate underfunding due to the "austerity"/"capitalism++" lunatics in charge than a natural consequence of a state-run system though.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

Because government actors have agency, parent is implying that they made the choice to underfund the NHS. Such a choice was not inevitable. Contrary to “true communism has never been tried” the NHS was successful, and would be if the dominant austerity ideology had not taken hold.

Re: Health care is turning into a consumer product

#282

Post by virgilp » Mon, Jan 10, 2022, 7:06 PM UTC

terr-dav wrote: post #268

virgilp wrote: post #84

Earlier quoted context omitted.

But how is that not "expected"? Feels like the argument that "communism is good, it just wasn't implemented well anywhere so far". Well, sorry, but by this point I chose to believe that a full state-run system is vulnerable to under-funding in the long term.

I would rephrase that argument as, "communism is good, it has just been ruthlessly sabotaged by capitalist interests every time an ideologically communist regime forms". In the case of the NHS, my understanding is that neoliberal politicians have been pushing to privatize it, and have underfunded it to make it look like it's not working in order to make privatization more appealing. The same is true for many programs…

Nah, Stalin and the communist leadership were perfectly capable saboteurs, didn't need help from capitalist interests. In a system where "the state" has the capability to enforce "public good" policies above anything else, it's only natural that the following will happen:

- individual freedom will be suppressed (because "public good"; can't have greedy people doing greedy things, them weeds need to be killed early).

- since individual freedom is suppressed the regime is naturally going to be autocratic, which means that "the state" is actually a handful of people... who now get to freely decide how they define "public good".

The fundamental error of communism is that in any implementation, it doesn't really have mechanisms to "punish" greedy leadership, only greedy individual citizens. Which is an idea as good as it sounds.

Re: Health care is turning into a consumer product

#283

Post by hotpotamus » Mon, Jan 10, 2022, 7:11 PM UTC

mumblemumble wrote: post #189

dgb23 wrote: post #76

Earlier quoted context omitted.

I agree. The "everything is a market" ideology had a good run of almost half a century, but it should be heavily criticized in hindsight. Institutions like healthcare, education, public transport, prisons(!) and so on are more efficient, less corrupt and of higher quality when they are in large parts collectively and democratically organized and funded. The "in large parts" is important here: A community should agree…

One thing to note about US healthcare is that it seems almost deliberately engineered to not be a market. I've never received significant health care in another country, so I can't say how the US system differs from others with any expertise. But I can say how US health care differs from just about anything else I spend money on: 1. I don't really get to shop for health insurance providers. My employer picks one, may…

I would say price discovery is one of the main problems just as you've identified. The other is inelasticity of demand. To put it in a crass way, what's the market value of the morbidity and mortality of your child? I suspect the answer is often all you have and more and I think plenty of actors in the system are happy to take advantage of that.

Re: Health care is turning into a consumer product

#284

Post by [deleted] » Mon, Jan 10, 2022, 7:11 PM UTC

tablespoon wrote: post #171

dqpb wrote: post #111

Earlier quoted context omitted.

> The "everything is a market" ideology had a good run of almost half a century But that never actually happened. Externalities were never part of the market.

>> The "everything is a market" ideology had a good run of almost half a century > But that never actually happened. Externalities were never part of the market. But isn't the essence of an externality that it's a social cost not factored into the market price?

[deleted]

Re: Health care is turning into a consumer product

#285

Post by vorpalhex » Mon, Jan 10, 2022, 7:12 PM UTC

mindslight wrote: post #225

vorpalhex wrote: post #176

Earlier quoted context omitted.

That is the pro of a market system. A market with a malbehaving dominant party is liable to be upset by a new contender who will undercut them, thus depriving the misbehaving party of income.

This is true, but I haven't seen any coordinated efforts at market based healthcare reform. Some of the needed reforms are patently obvious (eg make arbitrary post-facto charges illegal, like every other industry), and yet there are no popular campaigns advocating for them. There are a few comments in this thread chiming in with lists of reforms, and I could write one of my own, but politically it's crickets (likely…

> make arbitrary post-facto charges illegal,

Hospitals now are required to make pricing transparent and surprise bills (out of network charges) are now prohibited, both are recent reforms.

Re: Health care is turning into a consumer product

#286

Post by rkk3 » Mon, Jan 10, 2022, 7:14 PM UTC

BorisEm wrote: post #249

rkk3 wrote: post #158

Earlier quoted context omitted.

> the pile of trash that the US healthcare is There are significant problems but whose Vaccine did you take for Covid-19? Pfizer (Us), Moderna (US), Johnson and Johnson (US)...

2 of the 3 vaccines you mention were not fully developed in the US despite what you insinuate. Johnson and Johnson was developed by Janssen which is based in the Netherlands and Belgium [1]. And as others have pointed out, Pfizer was developed by BioNTech in Germany [2]. [1] https://en.wikipedia.org/wiki/Janssen_COVID-19_vaccine [2] https://en.wikipedia.org/wiki/Pfizer%E2%80%93BioNTech_COVID-...

Yeah we live in a globalized world, corporations are global entities and companies from other countries made meaningful contribution. They still were predominately developed, tested, manufactured and distributed by US companies... thats why BioNTech had less than a billion of revenue last year to Pfizer's 7.5B Operating Income. You wouldn't have it at this scale without the so-called 'trash' US healthcare system.

Re: Health care is turning into a consumer product

#287

Post by vorpalhex » Mon, Jan 10, 2022, 7:15 PM UTC

netizen-936824 wrote: post #255

nightski wrote: post #233

Earlier quoted context omitted.

Yet we have cities with multiple ISPs which have incredibly cheap internet at blazing speeds. In my city we have 1Gbps fiber for $70/mo and the price goes down quickly as you reduce the speed. That's better than some areas of SF I think, and we only have 2 major ISPs here. Amazing what a little competition can do. The city was smart enough when the competitor moved in to install the capacity for more ISPs to utilize…

Just because there are a couple exceptions doesn't mean you can write off the rest of the country's experience as irrelevant or incorrect

We can ask why those areas with no competition are so, and it is due to overwhelming anti-market bias that makes it hard for other ISPs to compete or even outlaws it directly. Meanwhile cities that have setup one touch laws or fixed right-of-way have seen robust competition emerge.

One area where markets do poorly are where the cost of service exceeds profit, like rural areas. This is an area where government intervention in the form of subsidies can help, but these can also cement single ISP marketplaces if not managed well.

Re: Health care is turning into a consumer product

#288

Post by pg_bot » Mon, Jan 10, 2022, 7:16 PM UTC

dragonwriter wrote: post #230

pg_bot wrote: post #226

Earlier quoted context omitted.

It's not Eisenhower's administration that's to blame, it's FDR's. Employer based healthcare is a result of the stabilization act of 1942. Health benefits were offered as incentives to workers because employers could not raise wages.

> Employer based healthcare is a result of the stabilization act of 1942. Health benefits were offered as incentives to workers because employers could not raise wages. Employers can raise wages, and have been able to for some time, so that's not why we still have it. We still have it because of tax and other incentives, and because government keeps making policy decisions to protect, and even extend it (e.g., the AC…

I did not state that this is why we currently have employer based health insurance, just why it came into existence. Many consider this to be the "original sin" of US healthcare policy.

Re: Health care is turning into a consumer product

#289

Post by ch4s3 » Mon, Jan 10, 2022, 7:17 PM UTC

nopenopenopeno wrote: post #274

dragonwriter wrote: post #230

Earlier quoted context omitted.

> Employer based healthcare is a result of the stabilization act of 1942. Health benefits were offered as incentives to workers because employers could not raise wages. Employers can raise wages, and have been able to for some time, so that's not why we still have it. We still have it because of tax and other incentives, and because government keeps making policy decisions to protect, and even extend it (e.g., the AC…

Employers love employer-based healthcare because it gives them insane amounts of control over their employees’ livelihoods. And as a result, wage competition is far less influential. The fear of losing healthcare coverage a severe fear that people in other countries don’t have to worry about.

I think a lot of employers find it to be a giant headache. It’s expensive and tricky to administer and has nothing to do with your core competency as a business.

Re: Health care is turning into a consumer product

#290

Post by UnpossibleJim » Mon, Jan 10, 2022, 7:18 PM UTC

hitpointdrew wrote: post #276

cntainer wrote: post #44

It's interesting to see that "Health care consumes 18% of GDP in America" compared to ~10% in most developed countries. In my (non-american) opinion part of that difference comes from the fact that healthcare is already a consumer product in the US. Maybe not entirely, but much more than in Europe, where universal healthcare sponsored by the state is the norm. Another point is that US healthcare is considered the mos…

> the fact that healthcare is already a consumer product in the US I would strongly disagree with this. Healthcare in the US is currently a cartel system, not a consumer product/market system. If healthcare were a consumer product then: 1. It wouldn't be tied to or dependent on my employment. 2. Prices for medical treatment wouldn't be hidden/obfuscated by medical providers. 3. Insurance providers wouldn't be restric…

I only put this out there because I feel it needs to be, but we can't just put all of health-care into a single basket. Emergency medicine should be separated out of these discussions as there is no "Free Market" option, just as there is no real free market option for police or fire services.

For optional surgery or cosmetic treatment, sure. You can argue a free market option, but that's why I always think there should be separate baskets, for lack of a better term.