Current Events > what would happen if hospitals competed like other businesses

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Fam_Fam
11/20/18 9:39:16 AM
#1:


they look at how much it costs them to do business, and charge a markup that they feel is appropriate. For example, if it costs them $100 to take care of a person for a night including staff and meds, they charge, say, $150.

other businesses compete with them and offer lower prices to take their business. then prices fall to whatever is still profitable but people will be able to pay. Hospital B charges $140 to offer similar care to the customer, for example.

if it's more than people can pay, then they aren't profitable.

is there a way to make things work this way?
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averagejoel
11/20/18 9:53:46 AM
#2:


healthcare is a basic necessity. people should not be charged for it, and it should not be run like a business
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KiwiTerraRizing
11/20/18 9:55:24 AM
#3:


It would be an oligopoly. They would all set prices about the same place so there is no competition.
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Smashingpmkns
11/20/18 9:57:30 AM
#4:


KiwiTerraRizing posted...
It would be an oligopoly. They would all set prices about the same place so there is no competition.


This.
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Fam_Fam
11/20/18 9:58:17 AM
#5:


Smashingpmkns posted...
KiwiTerraRizing posted...
It would be an oligopoly. They would all set prices about the same place so there is no competition.


This.


why can't other businesses do the same thing?
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CapnMuffin
11/20/18 9:58:25 AM
#6:


Smashingpmkns posted...
KiwiTerraRizing posted...
It would be an oligopoly. They would all set prices about the same place so there is no competition.


This.

See: Gas Stations
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Antifar
11/20/18 9:58:26 AM
#7:


It's not a cereal aisle. Nobody wants to shop for the best price when they're in an ambulance. They're gonna go to the closest one.
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SaithSayer
11/20/18 10:00:14 AM
#8:


I always figured medical was so high so there would be money for studies and improvements and all of that.
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#9
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Smashingpmkns
11/20/18 10:02:58 AM
#10:


Fam_Fam posted...
Smashingpmkns posted...
KiwiTerraRizing posted...
It would be an oligopoly. They would all set prices about the same place so there is no competition.


This.


why can't other businesses do the same thing?


They do.
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HenryAllbright
11/20/18 10:09:17 AM
#11:


KiwiTerraRizing posted...
It would be an oligopoly. They would all set prices about the same place so there is no competition.


Why would you say that? I don't see that happening in other industries where there's a healthy amount of competition.
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SaithSayer
11/20/18 10:10:05 AM
#12:


HenryAllbright posted...
KiwiTerraRizing posted...
It would be an oligopoly. They would all set prices about the same place so there is no competition.


Why would you say that? I don't see that happening in other industries where there's a healthy amount of competition.

Well those other industries aren't about keeping people healthy.
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Bananana
11/20/18 10:12:16 AM
#13:


That would be a horrible idea in many ways
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#14
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Romulox28
11/20/18 10:15:15 AM
#15:


oh shit, i think im having a heart attack. quick, honey, make a spreadsheet comparing all the hospitals within the state so we can find one with the most competitive cardiac surgery prices
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Fam_Fam
11/20/18 10:25:09 AM
#16:


Romulox28 posted...
oh shit, i think im having a heart attack. quick, honey, make a spreadsheet comparing all the hospitals within the state so we can find one with the most competitive cardiac surgery prices


1.) you'd be dumb if you only went by cheapest price
2.) you could have plans ahead of time that people could look up, i.e. people would have to plan!
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SaithSayer
11/20/18 10:26:49 AM
#17:


Anyone that's planning for their eventual heart attack COULD just change their lifestyle.
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Romulox28
11/20/18 10:54:57 AM
#18:


Fam_Fam posted...
Romulox28 posted...
oh shit, i think im having a heart attack. quick, honey, make a spreadsheet comparing all the hospitals within the state so we can find one with the most competitive cardiac surgery prices


1.) you'd be dumb if you only went by cheapest price
2.) you could have plans ahead of time that people could look up, i.e. people would have to plan!

1. my father had open heart surgery, his bill was $110k, so i will say that price is probably a factor for many people
2. is this a serious statement
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Fam_Fam
11/20/18 11:05:14 AM
#19:


Romulox28 posted...
Fam_Fam posted...
Romulox28 posted...
oh shit, i think im having a heart attack. quick, honey, make a spreadsheet comparing all the hospitals within the state so we can find one with the most competitive cardiac surgery prices


1.) you'd be dumb if you only went by cheapest price
2.) you could have plans ahead of time that people could look up, i.e. people would have to plan!

1. my father had open heart surgery, his bill was $110k, so i will say that price is probably a factor for many people
2. is this a serious statement


1. prices would be different if people competed. there's no way the surgery actually requires 110k in costs. even if you include equipment / all the staff / rent for the space he was taking up for however long he was there. it's ridiculous and wouldn't be that cost. and when i say you don't go for cheaper price, you wouldnt travel an extra 3 hours to save $5, that's just stupid, even if money is tight.

2. Yes, you can make plans for what hospital you'd want to go to in an emergency, or which you'd want to avoid around your city, if something happened.
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Questionmarktarius
11/20/18 11:08:51 AM
#20:


Fam_Fam posted...
For example, if it costs them $100 to take care of a person for a night including staff and meds, they charge, say, $150.

Close.
They charge $300, because insurance "negotiates" down to $120, and medicaid only pays $80 via fiat, according to numbers I just made up.

When you charge a dollar, but only get payed sixty cents for some reason, you're going to charge $1.67 next time.
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Cj_WlLL_VVlN
11/20/18 11:09:18 AM
#21:


The price of Healthcare would go down, quality would go way up, people wouldn't be nearly as beholden to insurance companies and those that chose to get it would have competitive rates.

The free market is the most efficient way for something to run but liberals (and really conservatives, but on other issues) don't want to solve problems. They want to throw money at an inefficient solution that makes them feel good like universal Healthcare. Same reason they support ridiculous programs like rent control and minimum wage.
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HenryAllbright
11/20/18 11:31:17 AM
#22:


Cj_WlLL_VVlN posted...
The price of Healthcare would go down, quality would go way up, people wouldn't be nearly as beholden to insurance companies and those that chose to get it would have competitive rates.

The free market is the most efficient way for something to run but liberals (and really conservatives, but on other issues) don't want to solve problems. They want to throw money at an inefficient solution that makes them feel good like universal Healthcare. Same reason they support ridiculous programs like rent control and minimum wage.


This.

When there's competition, problems get solved. You guys could sit here all day and dream up all these ridiculous scenarios that you're only thinking of because our current system is the only one you know, but every one of these problems will either get solved or minimalized when there is competition pressuring hospitals to ensure that their customers have a good experience in terms of quality and price.
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pikachupwnage
11/20/18 11:38:34 AM
#23:


Romulox28 posted...
oh shit, i think im having a heart attack. quick, honey, make a spreadsheet comparing all the hospitals within the state so we can find one with the most competitive cardiac surgery prices


Well yeah for Heart Attacks, Stroke and the like it wouldnt mean as much.

For shit like Hernias, Cancer, Knee replacement Surgery, etc. that is important but not a get treatment In like an hour tops or you are gonna drop dead/suffer severe brain/heart damage it will certainly help. People can and sometimes will pick and choose based on price or perceived quality.

If In Townsville Mr Surgeon #1 charges 10K to fix a hernia and has a good reputation but Mr Surgeon #2 charges 8K and also has a good reputation who is gonna be doing more surgeries?
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Balrog0
11/20/18 11:48:09 AM
#24:


pikachupwnage posted...
Well yeah for Heart Attacks, Stroke and the like it wouldnt mean as much.

For shit like Hernias, Cancer, Knee replacement Surgery, etc. that is important but not a get treatment In like an hour tops or you are gonna drop dead/suffer severe brain/heart damage it will certainly help. People can and sometimes will pick and choose based on price or perceived quality.


that's the issue; there's very little evidence that consumers know anything about health care and lots of evidence that they really don't know anything about health care. hospitals would start paying a premium for good bedside manners and compliance with patient requests rather than medical knowledge or skill.

anyway this would all be predicated on hospitals refusing care to poor, dying people so that's one thing that you'd see more of
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s0nicfan
11/20/18 11:54:13 AM
#25:


Hospitals do compete. They advertise all over the place and highlight that they're #1 in this, or fastest in that, or have "the best patient care." One hospital near me advertises that they don't have a meal plan... you just ask for food and they bring it to you, whenever.

The problem isn't hospitals. It's insurance. They all compete on services rather than price because they're all going by insurance rates.
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Fam_Fam
11/20/18 11:56:07 AM
#26:


s0nicfan posted...
Hospitals do compete. They advertise all over the place and highlight that they're #1 in this, or fastest in that, or have "the best patient care." One hospital near me advertises that they don't have a meal plan... you just ask for food and they bring it to you, whenever.

The problem isn't hospitals. It's insurance. They all compete on services rather than price because they're all going by insurance rates.


yes, so im saying let hospitals deal with taking in money and setting prices, and fuck the insurance companies, who are garbage
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uwnim
11/20/18 11:56:11 AM
#27:


Hospitals wouldn't really compete much. There tends to be too few in a general area. General practitioners could compete, but the tend to not publicize prices and the insurance system makes it hard for people to freely choose who they want to see.
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Balrog0
11/20/18 11:56:54 AM
#28:


s0nicfan posted...
The problem isn't hospitals. It's insurance. They all compete on services rather than price because they're all going by insurance rates.


Also, they mostly don't compete at all -- at least at the consumer level -- because most people on private insurance have it through their employer.
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Fam_Fam
11/20/18 11:57:38 AM
#29:


Balrog0 posted...
pikachupwnage posted...
Well yeah for Heart Attacks, Stroke and the like it wouldnt mean as much.

For shit like Hernias, Cancer, Knee replacement Surgery, etc. that is important but not a get treatment In like an hour tops or you are gonna drop dead/suffer severe brain/heart damage it will certainly help. People can and sometimes will pick and choose based on price or perceived quality.


that's the issue; there's very little evidence that consumers know anything about health care and lots of evidence that they really don't know anything about health care. hospitals would start paying a premium for good bedside manners and compliance with patient requests rather than medical knowledge or skill.

anyway this would all be predicated on hospitals refusing care to poor, dying people so that's one thing that you'd see more of


consumers know pretty much nothing about anything they buy, other than cost, and people telling them that its good or bad.
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Balrog0
11/20/18 11:58:18 AM
#30:


Fam_Fam posted...
yes, so im saying let hospitals deal with taking in money and setting prices, and fuck the insurance companies, who are garbage


that's how hospitals used to work and they weren't sustainable. even today you see lots of rural hospitals shutting down because of high uncompensated care costs. the problem is doctors aren't supposed to let people die without treating them, even if they can't pay

so I'm not being facetious, I'm very serious when I say your proposal would require letting folks just die.
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HenryAllbright
11/20/18 12:01:16 PM
#31:


Balrog0 posted...
pikachupwnage posted...
Well yeah for Heart Attacks, Stroke and the like it wouldnt mean as much.

For shit like Hernias, Cancer, Knee replacement Surgery, etc. that is important but not a get treatment In like an hour tops or you are gonna drop dead/suffer severe brain/heart damage it will certainly help. People can and sometimes will pick and choose based on price or perceived quality.


that's the issue; there's very little evidence that consumers know anything about health care and lots of evidence that they really don't know anything about health care. hospitals would start paying a premium for good bedside manners and compliance with patient requests rather than medical knowledge or skill.


But that brings up a whole other point about maximizing utilization. Maybe healthcare doesn't need to always 100% be about maximizing quantity of life. Maybe some people are willing to trade in what's best as far as their health goes for what makes them have a better quality of life. Odds are there will be options. There's nothing wrong with differentiation of goals among various patients.

anyway this would all be predicated on hospitals refusing care to poor, dying people so that's one thing that you'd see more of


They would be more affordable, so in turn you would actually see more poor people seeking care. If society actually cared about helping poor people afford medical care, they could donate money to services that help cover their bills. Let society have their values reflecting naturally rather than through means of laws.
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Balrog0
11/20/18 12:02:55 PM
#32:


Fam_Fam posted...
consumers know pretty much nothing about anything they buy, other than cost, and people telling them that its good or bad.


That's just not true. People know the difference between a good job mowing their lawn or a bad job. In fact, they get to decide that! Tons of consumption goods are that way. As long as you know if you like the pencil, it's a good pencil.

Medical care isn't that way. What's a good comparison consumption good in your opinion?
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Questionmarktarius
11/20/18 12:04:40 PM
#33:


HenryAllbright posted...
They would be more affordable, so in turn you would actually see more poor people seeking care. If society actually cared about helping poor people afford medical care, they could donate money to services that help cover their bills. Let society have their values reflecting naturally rather than through means of laws.

Charity hospitals used to be a thing, before government meddling started in.
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Balrog0
11/20/18 12:05:31 PM
#34:


HenryAllbright posted...
But that brings up a whole other point about maximizing utilization. Maybe healthcare doesn't need to always 100% be about maximizing quantity of life. Maybe some people are willing to trade in what's best as far as their health goes for what makes them have a better quality of life. Odds are there will be options. There's nothing wrong with differentiation of goals among various patients.


this is already the case? My point is that the kind of things people are willing to pay for are not associated with better health outcomes. Plenty of people refuse service on the basis of how it would impact their lives...

HenryAllbright posted...

They would be more affordable, so in turn you would actually see more poor people seeking care. If society actually cared about helping poor people afford medical care, they could donate money to services that help cover their bills. Let society have their values reflecting naturally rather than through means of laws.


Okay, as long as you admit you value this associational freedom more than you value the lives of poor people I have no real issue with your argument here. I have different priorities but at least it's honest.
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HenryAllbright
11/20/18 12:06:54 PM
#35:


Balrog0 posted...
Okay, as long as you admit you value this associational freedom more than you value the lives of poor people I have no real issue with your argument here. I have different priorities but at least it's honest.


But the cool thing is that you totally still have the means in which to help poor people obtain health care. Your priorities can still be executed. Just don't interfere with mine. (I mean that in a philosophical way).
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Fam_Fam
11/20/18 12:07:24 PM
#36:


Balrog0 posted...
Fam_Fam posted...
consumers know pretty much nothing about anything they buy, other than cost, and people telling them that its good or bad.


That's just not true. People know the difference between a good job mowing their lawn or a bad job. In fact, they get to decide that! Tons of consumption goods are that way. As long as you know if you like the pencil, it's a good pencil.

Medical care isn't that way. What's a good comparison consumption good in your opinion?


people don't know a good watch from a bad one, who knows what goes into it? you just get told a rolex is good. who can tell you why its worth thousands more than a $50 seiko watch? and what difference do those differences make?

Same thing with computers. many, many people don't know shit about the quality of the parts in there. they just see bigger numbers and think things are better. can they tell you why? and what the bigger number actually means?
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Ilishe
11/20/18 12:07:30 PM
#37:


averagejoel posted...
healthcare is a basic necessity. people should not be charged for it, and it should not be run like a business


I agree. If you want special treatment, then you have to pay.
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Balrog0
11/20/18 12:08:30 PM
#38:


HenryAllbright posted...

But the cool thing is that you totally still have the means in which to help poor people obtain health care. Your priorities can still be executed. Just don't interfere with mine.


It's true, in that not literally every single poor person would be unable to get care. Many more would die now, though. So they do actually run against each other, I'm sorry to say.
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HenryAllbright
11/20/18 12:09:23 PM
#39:


I don't understand "people should not be charged for it". Who do you think is going to pay for a universal healthcare system? Whether you pay directly for the services you get or a system is funded through paying taxes, you still have to pay for it until doctors decide to start working for free.
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Questionmarktarius
11/20/18 12:10:59 PM
#40:


Balrog0 posted...
HenryAllbright posted...

But the cool thing is that you totally still have the means in which to help poor people obtain health care. Your priorities can still be executed. Just don't interfere with mine.


It's true, in that not literally every single poor person would be unable to get care. Many more would die now, though. So they do actually run against each other, I'm sorry to say.

Just to toss a chair into the crowd...

"VA for Everyone"
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Balrog0
11/20/18 12:11:15 PM
#41:


Fam_Fam posted...
people don't know a good watch from a bad one, who knows what goes into it? you just get told a rolex is good. who can tell you why its worth thousands more than a $50 seiko watch? and what difference do those differences make?


I'm not sure what your point is. I've watched I, Pencil, dude. I'm not saying that consumers need to be experts on the supply chain management required, the exact specific technical details of the product, etc.

I'm saying that if the goal of health care is to improve health outcomes, we have good reasons to doubt that would happen because of pressure from consumers for better health care.

Watches are status symbols. The point of them is to look good or signal something about yourself. Not comparable at all.

So like I asked before, what's an actually good comparison?

Fam_Fam posted...
Same thing with computers. many, many people don't know shit about the quality of the parts in there. they just see bigger numbers and think things are better. can they tell you why? and what the bigger number actually means?


No, and we have tons of inefficiencies in computer technology because of it. Qwerty is inferior to Dvorak and we use it just because we use it and always have. Is that the kind of medical system you'd like? When we treated health care that way we were using leeches and bleeding people and people paid for it because something was better than nothing.
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HenryAllbright
11/20/18 12:12:17 PM
#42:


Balrog0 posted...
HenryAllbright posted...

But the cool thing is that you totally still have the means in which to help poor people obtain health care. Your priorities can still be executed. Just don't interfere with mine.


It's true, in that not literally every single poor person would be unable to get care. Many more would die now, though. So they do actually run against each other, I'm sorry to say.


I get that no system is perfect, but there is quite a bit of opportunity to assist poor people, especially if competition has resulted in much lower prices. The poor people won't need as much financial assistance to get care if the prices are lower, and your average person who does make decent income will have more money left over to donate to poor people if they aren't paying as much for healthcare.

Of course, whether they do donate or not is up to them. I think a bit of social pressure can go a long way, though.
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HenryAllbright
11/20/18 12:13:57 PM
#43:


Questionmarktarius posted...
Just to toss a chair into the crowd...

"VA for Everyone"


lol

that's really not that far-fetched. A DMV comparison would have been a solid choice, too.
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Balrog0
11/20/18 12:14:14 PM
#44:


HenryAllbright posted...
I get that no system is perfect, but there is quite a bit of opportunity to assist poor people, especially if competition has resulted in much lower prices. The poor people won't need as much financial assistance to get care if the prices are lower, and your average person who does make decent income will have more money left over to donate to poor people if they aren't paying as much for healthcare.


Empirically speaking, for every $1 of public assistance you offer in medical care, you crowd out 1 cent of private charity. If you're relying on prices falling to replace public assistance, then you'd need to bring costs down to literally less than 10% of their current levels for it to be even marginally feasible to make up through private charity.
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Fam_Fam
11/20/18 12:15:07 PM
#45:


Balrog0 posted...
Fam_Fam posted...
people don't know a good watch from a bad one, who knows what goes into it? you just get told a rolex is good. who can tell you why its worth thousands more than a $50 seiko watch? and what difference do those differences make?


I'm not sure what your point is. I've watched I, Pencil, dude. I'm not saying that consumers need to be experts on the supply chain management required, the exact specific technical details of the product, etc.

I'm saying that if the goal of health care is to improve health outcomes, we have good reasons to doubt that would happen because of pressure from consumers for better health care.

Watches are status symbols. The point of them is to look good or signal something about yourself. Not comparable at all.

So like I asked before, what's an actually good comparison?

Fam_Fam posted...
Same thing with computers. many, many people don't know shit about the quality of the parts in there. they just see bigger numbers and think things are better. can they tell you why? and what the bigger number actually means?


No, and we have tons of inefficiencies in computer technology because of it. Qwerty is inferior to Dvorak and we use it just because we use it and always have. Is that the kind of medical system you'd like? When we treated health care that way we were using leeches and bleeding people and people paid for it because something was better than nothing.


our system now is horribly inefficient, and costs are ridiculous for what you get. Health care is basically a luxury nowadays.

And yes, there will always be shitty doctors, even in the current system, but we have ways of relaying that information, and reading up on techniques that people are using. it's not a complete crapshoot.

and i'm saying we SHOULDN'T do things the way we always do them, we should change them so that people aren't buying into a shit system that is built for profit of insurance companies. they don't have patient quality of life high in their priority lists. it's all about money for them. and we should put a stop to that.
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Balrog0
11/20/18 12:17:00 PM
#46:


Fam_Fam posted...
our system now is horribly inefficient, and costs are ridiculous for what you get. Health care is basically a luxury nowadays.


I never said otherwise!

Fam_Fam posted...
And yes, there will always be shitty doctors, even in the current system, but we have ways of relaying that information, and reading up on techniques that people are using. it's not a complete crapshoot.


But I thought consumers didn't need to know anything but price? The way you're arguing about this seems more like you're trying to justify your conclusion -- which I thought was a discussion question? -- rather than actually trying to talk about it with me.

Fam_Fam posted...
and i'm saying we SHOULDN'T do things the way we always do them, we should change them so that people aren't buying into a shit system that is built for profit of insurance companies. they don't have patient quality of life high in their priority lists. it's all about money for them. and we should put a stop to that.


okay, and I'm saying that proposing an increase in competition sounds nice without any context, but if you put it in context, it starts to sound a lot less attractive and you notice that it might not address these issues the way you want it to
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HenryAllbright
11/20/18 12:17:24 PM
#47:


Balrog0 posted...
HenryAllbright posted...
I get that no system is perfect, but there is quite a bit of opportunity to assist poor people, especially if competition has resulted in much lower prices. The poor people won't need as much financial assistance to get care if the prices are lower, and your average person who does make decent income will have more money left over to donate to poor people if they aren't paying as much for healthcare.


Empirically speaking, for every $1 of public assistance you offer in medical care, you crowd out 1 cent of private charity.


Can you explain what you mean by this? Also, are you talking in terms of how our current system works? Just wanting some clarification.
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Questionmarktarius
11/20/18 12:17:39 PM
#48:


HenryAllbright posted...
Questionmarktarius posted...
Just to toss a chair into the crowd...

"VA for Everyone"


lol

that's really not that far-fetched. A DMV comparison would have been a solid choice, too.

The suggestion pretty much always gets hate-dogpiled, for generally weak reasons.
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Balrog0
11/20/18 12:18:35 PM
#49:


HenryAllbright posted...
Can you explain what you mean by this? Also, are you talking in terms of how our current system works? Just wanting some clarification.


https://niskanencenter.org/blog/social-insurance-not-charity/

If private charity is willing and able to step in and do a better job than K-12 then what is it waiting for? The same private dollars that would allegedly jump in when we shut down government schools could jump in today. Existing property taxes are hardly a budget constraint for the kinds of rich households, charities, and foundations that wed expect to fund something like this.

I can already begin imagining some plausible libertarian responses to this (again, of the but for regulation and crowd-out variety), but his point stands. The conventional libertarian argument has always been a bit hand-wavey, pointing to eras in history where, yes, government was smaller and mutual aid societies were bigger, but where poverty was nonetheless widespread and abject.

Consider Jonathan Gruber and Daniel Hungermans well known paper that estimates the extent to which the New Deal crowded out faith-based charity. Their central finding suggests that church spending fell 30% in response to the New Deal, and that government relief spending can explain virtually all of the decline in charitable church activity observed between 1933 and 1939.

Sounds dramatic, right? And it may have been, for the churches. But in absolute terms, church benevolent spending fell a mere 2.9 cents for every dollar that federal transfers increased. As Gruber and Hungerman write, from 1929 to 1932, the last year before the New Deal, annual church benevolent spending in the U.S. averaged about $180 million. This is a little less than 10% as large as the average annual New Deal transfer spending over the 1933-1939 period of $2 billion.

My naive interpretation of this result is that, were the entire post-New Deal/Great Society welfare state eliminated tomorrow, we should expect civil society to leave somewhere between 90-97% of social insurance spending unreplaced. And that is probably being generous, since the cultural and institutional capital needed to coordinate a private safety net does not emerge instantaneously, if it emerges at all.

---
But to you who are listening I say: Love your enemies, do good to those who hate you, bless those who curse you, pray for those who mistreat you.
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Balrog0
11/20/18 12:19:22 PM
#50:


Questionmarktarius posted...
The suggestion pretty much always gets hate-dogpiled, for generally weak reasons.


the reasons are incredibly strong, I'm actually kind of considering ignoring you if you keep bringing it up without actually justifying it

I like you the rest of the time
---
But to you who are listening I say: Love your enemies, do good to those who hate you, bless those who curse you, pray for those who mistreat you.
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