This isn't a price transparency thing either. This is about having created a culture where every doctor in the country is constantly hustling, committing borderline fraud.
Sociologically, the idea that doctors and medical care workers are always looking out for what's best for their patients helps to mask the idea that they might be doing so from a health perspective but are ignoring any other consideration. And so bringing in a friend who's also a surgeon so he can get a little kickback doesn't really raise any ethical alarms.
But this isn't the fault of the libertarians.
Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now... the AMA and other quasi-unions won't stand for it. They'll negotiate.
And, as usual, our politicians will sell us down the river.
If you want to fix this (and every other problem), the answer is simple (though not particularly libertarian): outlaw all health insurance. Make everyone pay for their own care. Make them pay out of pocket.
In such a nation at that, none of these shenanigans could continue. Not that I expect anyone reading this to get it. You cry "But NoMoreNicksLeft, how could that man afford $117,000 out of pocket!"
And the answer is that he couldn't. The doctor (if he billed after the fact) might sue, but winning a lawsuit doesn't make someone magically capable of paying. If the doctor insisted on payment up front, then the man would just forgo his particular service (which, since he was unaware that he needed it and it sound like bullshit... wouldn't have mattered).
There aren't enough rich people who can afford to pay the current prices out of pocket for 100% of the doctors to continue to bill/earn what they do currently. Maybe just enough for 1% to continue like that... the other 99% are going to have to shape up, and in a hurry.
They can't hold out prices where they are now (we can't pay that out of pocket), nor can they spitefully punish us and refuse to do it at lower prices. They have bills to pay just like the rest of us, they have mortgages, they need to buy groceries, etc.
Nor will they decide to become plumbers and HVAC repairmen so that they don't have to give away their surgeries for less.
But again, this is lost on anyone I've ever explained it to. You all think it will result in millions of deaths and untold suffering.
> Laissez faire market philosophy fails
Bullshit. There hasn't been a laissez fair in the healthcare industry in the United States in 100 years.
I honestly can't tell if your comment is satire. We know from looking at other countries what a functional and effective health care system looks like. You're suggesting we do the opposite. It's almost beyond belief.
If you want to fix this (and every other problem), the answer is simple (though not particularly libertarian): outlaw all health insurance. Make everyone pay for their own care. Make them pay out of pocket.
In such a nation at that, none of these shenanigans could continue. Not that I expect anyone reading this to get it. You cry "But NoMoreNicksLeft, how could that man afford $117,000 out of pocket!"
And the poor couldn't afford healthcare anymore. Even if it is a well-justified $10,000 surgery. Most people cannot pay this out of their pocket.
In the Western European countries where healthcare does actually work and is affordable for everyone, it is strongly regulated and continually fine-tuned to find and eliminate spots where the system is abused. E.g. for years in the Netherlands doctors would prefer some expensive medicines when there are cheap alternatives, because their manufacturer gave them nice bonuses. The state outlawed such practices. Moreover, in cases where it is shown that there are medicines from different manufacturers with an equal amount of relevant substances, insurance companies now only prescribe the most affordable one.
Anyway, I have lived in two countries where there is strongly government regulated healthcare (The Netherlands and Germany) and never had any qualms about the systems. I have also seen people close to me with small health problems to various forms of cancer, and for no one this was ever a financial problem. Luckily.
"And the poor couldn't afford healthcare anymore. Even if it is a well-justified $10,000 surgery. Most people cannot pay this out of their pocket."
A free market healthcare system assumes people would be getting back at least 7.5% of their salary every year, if not more.
"Anyway, I have lived in two countries where there is strongly government regulated healthcare (The Netherlands and Germany) and never had any qualms about the systems. I have also seen people close to me with small health problems to various forms of cancer, and for no one this was ever a financial problem. Luckily."
As someone who has sold both pharmaceuticals and medical devices to European hospitals/health agencies, I can tell you that the dirty secret behind all fully socialized systems is rationing. There is literally a quota of, say pacemakers, for example, that can be purchased in Germany every year.
A free market healthcare system assumes people would be getting back at least 7.5% of their salary every year, if not more.
That doesn't work for various reasons:
- People will spend the money and won't have enough savings to save their medical bill.
- There is an economic crisis and people use their savings for covering their mortgage payments.
- Most importantly: for some people the medical bills will be higher than they could set aside at that point in their life or at all in the case of a chronic condition or e.g. a form of cancer that is very expensive to treat.
There is literally a quota of, say pacemakers, for example, that can be purchased in Germany every year.
Germany apparently has quota, but they are budgeting and adjusted to the need. Again, I know of no cases in my wider circle of family, friends, and acquaintances where they could not get some important medical condition treated and with nearly full coverage of insurance.
In the nineties, we had inefficiencies in The Netherlands that sometimes resulted in long waiting lists. These issues have been resolved at the beginning of the century... Through government interference.
You might also want to check on research, which shows time and again that countries with universal insurance outperform the US, both on quality and cost per citizen. E.g.:
There is a frequent misperception that
trade-offs between universal coverage and timely access to specialized services are inevitable; however,
the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while
maintaining quick access to specialty services.
> Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now...
I disagree with you 100%, and halfway think you're joking. This is one area where more government is the clear answer. How many other countries have to set a working precedent?
You seem to make this out to be an outcome of "borderline fraudulent" doctors. That you'd call out "every doctor" as committing borderline fraud shows your lack of understanding for the system as a whole, much less nuance. Do you think the high price is because doctors are looking to make enormous profits? I'm sure that's true for some, but in general that just is not the case. Who percentage of doctors do you think get fabulously wealthy, anyway? Most do fine, but after student loans are factored in it isn't the key to wealth that you think.
The high price is driven by many things, and you've focused on the one of the smallest. Your proposal is chaos, and it would turn healthcare into even more of a privilege for the wealthy than it is now (nevermind for the moment the unpredictably of care pathways that cannot be agreed to upfront).
> I disagree with you 100%, and halfway think you're joking.
This is because you don't have very well practiced thinking skills. The best you can manage is to be shocked at the idea, and then to refuse to think it through. Worse, you then turn around and believe that whatever dumbass projection your small mind can come up with is some sort of reasoned extrapolation of the idea.
You're barely able to anticipate how other singular individuals can and will react. Imagining millions of other people's reactions in aggregate is simply beyond your capabilities.
If everyone has to pay out of pocket, and if you're a doctor selling health care... you can either sell it at a price they can afford or you can starve. Most doctors I know don't like to starve, it conflicts with their beliefs that they're well to do.
No bank is going to loan someone $500,000 for a liver transplant either, they're not even going to loan you $20,000 for an appendectomy.
Nor can the doctor lower prices to 90% of what they are currently... when people talk about the incredibly high prices, they're not saying "it needs to be 90% of what it is now". When I say "lower" we're talking about significantly lower, something where you could hope to afford it.
But you can't see that. You're just too dim.
> You seem to make this out to be an outcome of "borderline fraudulent" doctors.
And this particular issue raised in the link, that's what it is. Some guy he never heard of shows up while he's out of it on painkillers, and then sends a $120,000 bill weeks later. The insurance company caves, pays the whole thing, letting him (and others that are aware of it) that they can continue to do this.
It's not a price transparency thing. That happens when either the company providing the service can't know beforehand how much it will cost, or refuses to estimate. But after the bill comes in, no one, not even the customer, is going to say "this price is absurd". Instead, they say "dammit, it really does cost about that much, but it hurt me because I couldn't prepare for the price".
They're saying "This price is absurd, it's unfair, and no one can even tell me what it is I'm paying for if I pay this bill".
That's fraud.
Worse, I believe that for the most part, the doctors don't even see it as fraud. They feel like they're doing what they have to earn the income they deserve, and that this is no big deal.
> shows your lack of understanding for the system as a whole
No, it proves my understanding. Fuck, you can't even be bothered to explain how it's wrong, you're just doing the "don't you dare besmirch their good name". Which might be a moving argument, if we were talking about someone specific. We're not.
And the industry itself, and this practice in particular, is rotten. It stinks.
> Do you think the high price is because doctors are looking to make enormous profits?
Fuck no, and that's horrible. These doctors aren't driving gold-plated Ferraris and buying 2000ft long mega-yachts. In some cases they feel forced to do this. In some cases, they're paying so much on the new building for their practice or whatever, that if they didn't do this they'd go under. In others lifestyle creep has them paying what they feel are reasonable prices so that the wife can go to the resort spa once a month and the kids get their cheese-tasting lessons and all that snooty shit, and it constantly costs them more even while they feel like they're treading water.
This can't be justification for any reasonable person.
> Who percentage of doctors do you think get fabulously wealthy, anyway?
They don't have to, fool. This can happen even while they feel like they're just a bit into the upper part of the middle class.
> The high price is driven by many things
None of which you understand. You're incapable of it.
I understand it perfectly, and I've proposed a single simple solution for it (even if it is politically unviable).
> The high price is driven by many things, and you've focused on the one of the smallest.
Yes, I have. I've found the one tiny piece that if removed, the entire logjam goes away. It all unravels with this. Outcomes would be better for everyone (well, except all the health insurance workers who would be unemployed).
> Your proposal is chaos,
Possibly. But we've already seen what your non-chaos looks like, and it's strangling everyone.
> Bullshit. There hasn't been a laissez fair in the healthcare industry in the United States in 100 years.
True. But why did health care turn away from a completely free-market approach? Why does almost every other industrialized society now support some sort of single-payer system, at least for those who cannot afford private boutique care?
The answer is simple: as a society, we do not accept the results of a truly free-market health care system. 100 years ago, it was accepted that you could become ill at any point in your life, and very possibly die. Being rich was not really a lifesaver, because many if not most major disease categories were at that time untreatable, or the treatments available were palliative at best.
Now, we live in a world where we all know fully well that with enough access, many medical situations that used to be fatal are now treatable with excellent chances of full or near-full recovery. Steve Jobs gets a liver; Dick Cheney gets a heart. My wife's uncle just died of a heart condition similar to Cheney's. Somehow, there was no transplant available for him.
In this world, most people find it unacceptable that your health outcome is directly related to your wealth and social status. The world you suggest -- where everyone simply pays out of pocket -- would be socially regressive in a way that I believe is abhorrent to most civilized people, with the glaring exception of around 50% of the US voting public.
Insurance was developed as a reasonable fair-market way to ameliorate this issue of health care access disparity. If you can afford insurance -- in the US, this typically was through getting a decent job that provided a large risk pool and could therefore negotiate reasonable premiums -- you could at least theoretically rest assured that a major medical crisis would not totally bankrupt you.
But for those outside of the pool of large employers, the insurance companies started doing bad stuff (from a customer's POV) -- dropping the sick, refusing to cover previous conditions etc. In their defense, insurers had the problem that without some sort of mandate, people could just go uninsured until they got sick. So the individual market was destined to be over-represented by older, sicker people.
If you really believe in laissez faire, free-market medicine, you (as a society) have to accept the following:
* People who treat themselves like shit for years and get sick (obesity-related diabetes is a great example) can simply drop dead if they can't afford expensive care and medication.
* If some idiot on a motorcycle without a helmet spins out and breaks their skull, and is not rich, shovel his body to the side of the road, wait for him to die, and call sanitation to remove the body
* If your parents get old and sick, and they fucked up their retirement planning, slip them some clonazepam or watch them wither away painfully over a period of months or years. Be prepared for someone in the family to quit their job and become a nurse, or let Grandma wander around until she falls down and hopefully dies on the spot.
That was basically where everyone was throughout most of history. Only difference is, now we know it can be better. But in a ruthlessly free-market society, only the rich and well-connected would ever have a chance of getting the best possible care.
Healthcare didn't voluntarily turn away from a market approach. The US Government invaded the industry in a massive way and began manipulating and regulating it from top to bottom. That has only gotten worse over time.
Amen. The collective argument behind our current system forgets the history, namely that our current backasswards way of paying for healthcare originates with a reaction to wage controls during WW2.
This isn't a price transparency thing either. This is about having created a culture where every doctor in the country is constantly hustling, committing borderline fraud.
Sociologically, the idea that doctors and medical care workers are always looking out for what's best for their patients helps to mask the idea that they might be doing so from a health perspective but are ignoring any other consideration. And so bringing in a friend who's also a surgeon so he can get a little kickback doesn't really raise any ethical alarms.
But this isn't the fault of the libertarians.
Government has meddled in this industry and even with the ideas that the typical Americans think about for so long that this was inevitable. Nor can government fix it now... the AMA and other quasi-unions won't stand for it. They'll negotiate.
And, as usual, our politicians will sell us down the river.
If you want to fix this (and every other problem), the answer is simple (though not particularly libertarian): outlaw all health insurance. Make everyone pay for their own care. Make them pay out of pocket.
In such a nation at that, none of these shenanigans could continue. Not that I expect anyone reading this to get it. You cry "But NoMoreNicksLeft, how could that man afford $117,000 out of pocket!"
And the answer is that he couldn't. The doctor (if he billed after the fact) might sue, but winning a lawsuit doesn't make someone magically capable of paying. If the doctor insisted on payment up front, then the man would just forgo his particular service (which, since he was unaware that he needed it and it sound like bullshit... wouldn't have mattered).
There aren't enough rich people who can afford to pay the current prices out of pocket for 100% of the doctors to continue to bill/earn what they do currently. Maybe just enough for 1% to continue like that... the other 99% are going to have to shape up, and in a hurry.
They can't hold out prices where they are now (we can't pay that out of pocket), nor can they spitefully punish us and refuse to do it at lower prices. They have bills to pay just like the rest of us, they have mortgages, they need to buy groceries, etc.
Nor will they decide to become plumbers and HVAC repairmen so that they don't have to give away their surgeries for less.
But again, this is lost on anyone I've ever explained it to. You all think it will result in millions of deaths and untold suffering.
> Laissez faire market philosophy fails
Bullshit. There hasn't been a laissez fair in the healthcare industry in the United States in 100 years.