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What I learned from reading a thousand emergency room bills

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Re: What I learned from reading a thousand emergency room bills

#571

Post by Broken_Hippo »

ThomPete wrote: post #557
Broken_Hippo wrote: post #475

Earlier quoted context omitted.

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. I really don't understand why it being a big country would make things difficult. Any sane person would adjust the needs dependent on state and smaller. Norway's population is about the same as Indiana's, but is more sparsely populated - so some of the same problems as the…

That's because you haven't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations. Healthcare systems like the scandinavian are established over decades as the young needs to pay for the old until they get old themselves and have to get covered by the young. This kind of system is more or le…

*That's because you havne't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations."

I'm American. The first one is easy enough to consider. I can drive to Sweden in the same or less time than it would have taken me to get out of Indiana. I know it is big. I just don't see how that is an excuse. It isn't like you can't customize health care to a geographic area so it serves the needs of the people best. There are multiple ways to do that.

And that bit about immigration? That's propaganda 101 in school. Trust me, I'm aware. I fail to see how that is an issue. Most folks in the US aren't new immigrants: They are at least 2nd to 3rd generation. Even if I take the higher numbers I saw - around 25% - most folks are still just Americans. I don't really see how that affects anything. Don't most folks still want healthcare? Do immigrants avoid health care? Don't most of these families have at least one working adult paying into the tax system?

And of course it would be expensive - the current system is expensive. But it isn't efficient now, and that can easily be changed. Just because you haven't seen a proposal you'd be happy with doesn't mean it can't work. Most of the proposals I've seen in the US are more focused on preserving health insurance companies instead of focusing on getting health care ot everyone.

Re: What I learned from reading a thousand emergency room bills

#572

Post by pfisch »

bumby wrote: post #505
pfisch wrote: post #465

Earlier quoted context omitted.

If no one is priced out and you are operating in the free market then you need to raise your prices. Repeat until you maximize profits.

Does it have an end goal of maximizing profits, though? Couldn't the goal of price discovery be to find the point where supply = demand, without necessarily maximizing profit? Granted, this ignores the human trait to increase consumption when removed from directly paying all associated costs (e.g., my behavior at Golden Corral)

No, this doesn't really work because other people will ultimately run you out of business with their compounding profit and reinvestment advantage.

Re: What I learned from reading a thousand emergency room bills

#573

Post by m-i-l »

WalterBright wrote: post #371
UnpossibleJim wrote: post #26

Earlier quoted context omitted.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

A free market police system cannot work, because the police use force against people, which is not allowed by the free market. Worse, the police aren't going to arrest people who pay them.

Following the current government's cutbacks to the state-run police, residents in one part of London (which is incidentally the "one of the safest ... seats in the United Kingdom"[0] for the current government) have funded their own private police force[1]. This is apparently working out well for them. The issue is that it furthers the division between the rich and the poor, with proper protection from crime becoming available only to the wealthy.

[0] https://en.wikipedia.org/wiki/Kensington_and_Chelsea_(UK_Par...

[1] https://www.theguardian.com/public-leaders-network/2018/feb/...

Re: What I learned from reading a thousand emergency room bills

#574

Post by bumby »

pfisch wrote: post #572
bumby wrote: post #505

Earlier quoted context omitted.

Does it have an end goal of maximizing profits, though? Couldn't the goal of price discovery be to find the point where supply = demand, without necessarily maximizing profit? Granted, this ignores the human trait to increase consumption when removed from directly paying all associated costs (e.g., my behavior at Golden Corral)

No, this doesn't really work because other people will ultimately run you out of business with their compounding profit and reinvestment advantage.

Doesn't that imply they compound profits by either 1) raising prices and thus reducing demand for their product in the presence of non-profit maximizing suppliers or 2) creating efficiencies to increase profit margin at an equal-or-lower price?

In situation one wouldn't the advantage go to the non-profit motivated supplier and in situation 2) doesn't it ultimately benefit the customer with lower prices?

Re: What I learned from reading a thousand emergency room bills

#575

Post by ThomPete »

Broken_Hippo wrote: post #571
ThomPete wrote: post #557

Earlier quoted context omitted.

That's because you haven't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations. Healthcare systems like the scandinavian are established over decades as the young needs to pay for the old until they get old themselves and have to get covered by the young. This kind of system is more or le…

*That's because you havne't considered how big the US is and you haven't considered that the US is mostly a land of immigrants not a land of people who lived their almost all their lives for several generations." I'm American. The first one is easy enough to consider. I can drive to Sweden in the same or less time than it would have taken me to get out of Indiana. I know it is big. I just don't see how that is an exc…

You are missing two important things here.

Homogenous and small.

These countries are homogenous which also means politically. You will be hard pressed to find any real fundamental political differences between parties in the scandinavian countries.

They are all on the left side of Sanders.

Furthermore, it matters quite a lot that you are dealing with a fairly limited population who all suffers from more or less the same issues because they genetically are alike.

And again keep in mind the Scandinavian countries have budgets which means that you can't always get the treatment you want/need even if you had the money.

Again I am not saying the US system is good it's obviously not.

But a single-payer system in the US just isn't realistic or attractive for that matter.

The problem in the US is the price, but that price is held up artifically not because of the market. So we need to remove the things that make the price go up that hight. That IMO would be a much better approach than trying to mimick scandinavian countries as great as they are for their population (but definitely not without it's problems)

Re: What I learned from reading a thousand emergency room bills

#576

Post by vec »

bumby wrote: post #564
vec wrote: post #539

Earlier quoted context omitted.

If maximizing profits (or, more precisely, maximizing expected value) isn't a terminal goal for all involved parties then it isn't a free market.

I see your point if the term profit is defined in a general sense, but with the exception of "corporations as people" caveat there's plenty of everyday examples where people are trying to maximize outcomes other than capital (sometimes at the expense of capital). I'm not sure that makes it any less of a free market

It does. There's no free market for soup kitchens for the homeless, for example.

There exist entities who are willing to provide soup kitchen services below operating costs in perpetuity (i.e. charitably, for free). The price for services is kept artificially low ($0) by constant infusions of capital from outside the market (charitable donations), which prevents for-profit vendors who don't receive constant cash infusions from being able to compete on a level playing field. The resulting market is thereby warped by the distorting influence from non-market forces, preventing it from operating efficiently. It's not "free", in the technical sense.

This isn't necessarily a bad thing, to be clear. The charitable funding system may well provide better aggregate social outcomes than a free market would for any number of reasons, not the least of which being that one of the freedoms that "free market" implies is the freedom for vendors to decide that some of their potential customers are more trouble than they're worth to serve.

Re: What I learned from reading a thousand emergency room bills

#577

Post by WalterBright »

m-i-l wrote: post #573
WalterBright wrote: post #371

Earlier quoted context omitted.

A free market police system cannot work, because the police use force against people, which is not allowed by the free market. Worse, the police aren't going to arrest people who pay them.

Following the current government's cutbacks to the state-run police, residents in one part of London (which is incidentally the "one of the safest ... seats in the United Kingdom"[0] for the current government) have funded their own private police force[1]. This is apparently working out well for them. The issue is that it furthers the division between the rich and the poor, with proper protection from crime becoming…

Those aren't police forces. From my reading of the articles, they do not have the power to arrest people, serve search warrants, evict people, etc. They do do detective work and security work.

Re: What I learned from reading a thousand emergency room bills

#578

Post by taysic »

normal_man wrote: post #498
ams6110 wrote: post #483

Earlier quoted context omitted.

You have gone from a hypothetical to concluding that people in the US die because they can't afford cancer drugs. If your dad was over 65, he would be on Medicare. If he was younger than 65 and impoverished (income between 0 - ~150% of poverty level) he would be on Medicaid or another state plan for low income people. If he's above 150% of poverty level he probably has health insurance available at work or thru ACA.…

It's entirely possible to have health coverage and still be financially ruined by a health emergency due to deductibles and pre-existing condition loopholes.

Yet some people believe going to a freer market route would dramatically decrease costs

Re: What I learned from reading a thousand emergency room bills

#579

Post by taysic »

bumby wrote: post #574
pfisch wrote: post #572

Earlier quoted context omitted.

No, this doesn't really work because other people will ultimately run you out of business with their compounding profit and reinvestment advantage.

Doesn't that imply they compound profits by either 1) raising prices and thus reducing demand for their product in the presence of non-profit maximizing suppliers or 2) creating efficiencies to increase profit margin at an equal-or-lower price? In situation one wouldn't the advantage go to the non-profit motivated supplier and in situation 2) doesn't it ultimately benefit the customer with lower prices?

I think the point is if one company is making outrageous profits it’s trivial for a competitor to undercut them. The food industry for example rarely makes more than 2% in profit because it is so competitive.

Re: What I learned from reading a thousand emergency room bills

#580

Post by taysic »

Broken_Hippo wrote: post #475
ThomPete wrote: post #165

Earlier quoted context omitted.

The problem is that neither models work and both have shortcomings. In the US model healthcare is a profit center which allow those who can afford to get help and those who can't various sub-optimal variations of help. In the ex. Scandinavian model healthcare is a cost center and there is a set budget each year which the providers need to function within. This means that prioritization needs to happen and various ill…

Of course the problem is that the US is such a big country with huge immigration and scandinavian countries arent so it's always hard to compare. I really don't understand why it being a big country would make things difficult. Any sane person would adjust the needs dependent on state and smaller. Norway's population is about the same as Indiana's, but is more sparsely populated - so some of the same problems as the…

Another thing to keep in mind is the Scandinavian countries are resource rich with comparatively low populations - Norway has oil, Sweden has timber and iron ore, Finland has timber, etc. These helps build excess in their budget
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