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

(+) Yeah! (+)

Balrog0 posted...

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

i never said people don't need to know anything but cost. it's good if people as knowledgable as they can be, and then make decisions based on what they believe to be the best based on what is offered, and on cost. same as any other service / good.

and all systems have tradeoffs. I'm saying that increasing competition and taking money out of private insurance companies hands can make health care more accessible, and then hospitals can work towards giving good service at a reasonable cost.

Balrog0 posted...

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

The core issue with healthcare is that we want to pay for a Yugo but get a Cadillac, which just leads to everyone getting a bus pass instead.
So, why not just start with handing out a bus pass to everyone?

what argument can I present to you that I haven't presented a billion times already? I can only go over the different kinds of public health care so many times
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Balrog0 posted...

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.

I guess I'm just curious as to how the numbers add up. I mean, is 100% of every $1 we are taxed for public assistance going to go straight toward helping a poor person pay for something? Are we adjusting the figures to compensate for the differentiation in efficiency between government assistance and private assistance?
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Balrog0 posted...

what argument can I present to you that I haven't presented a billion times already? I can only go over the different kinds of public health care so many times

The inevitability of a public health system is shitty care with a private "concierge" system right over the top of it. Just cut out the awkward time period between "utopian idealism" and "it's become haves and have-nots all over again anyway".

Questionmarktarius posted...

The inevitability of a public health system is shitty care with a private "concierge" system right over the top of it. Just cut out the awkward time period between "utopian idealism" and "it's become haves and have-nots all over again anyway".

so are you admitting you just have ignored me this whole time? There's no basis for thinking any public system collapses into the Beveridge system except that that system is particularly odious to Americans due to the direct employment of doctors by government. But plenty of countries have public health systems that are as old as the NHS and they haven't moved towards it, while the NHS has actually moved towards more privatization of its functions
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Balrog0 posted...

what argument can I present to you that I haven't presented a billion times already? I can only go over the different kinds of public health care so many times

I think it's just hard to make the comparisons either way because so many tiny little details would wind up being changed if society went from one system of doing things to something vastly different. That's why I don't mind the comparisons to the VA or the DMV, because ultimately they are the best examples we have in terms of seeing how services get extended to the public through means of government without little to no competition.

But I would admit that a more detailed, specific conversation about the workings would be more beneficial. It's just, like I said, really hard to iron out all the details of how much it would cost, the problems, etc.
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HenryAllbright posted...

That's why I don't mind the comparisons to the VA or the DMV, because ultimately they are the best examples we have in terms of seeing how services get extended to the public through means of government without little to no competition.

the best example of public health care in this country is obviously medicaid and medicare which follow the model of a national insurance system
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Balrog0 posted...

HenryAllbright posted...

That's why I don't mind the comparisons to the VA or the DMV, because ultimately they are the best examples we have in terms of seeing how services get extended to the public through means of government without little to no competition.

the best example of public health care in this country is obviously medicaid and medicare which follow the model of a national insurance system

I've never used Medicaid or medicare services before, but I hear a lot of people complain about them?
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Balrog0 posted...

But plenty of countries have public health systems that are as old as the NHS and they haven't moved towards it, while the NHS has actually moved towards more privatization of its functions

That's actually an argument for "VA for everyone".

HenryAllbright posted...

That's why I don't mind the comparisons to the VA or the DMV, because ultimately they are the best examples we have in terms of seeing how services get extended to the public through means of government without little to no competition.

But, the VA does have competition: the private system. No veteran is forbidden from going to a private doctor.

That's where the bus analogy works: It's cheap, sometimes even free, and available for anyone to use. Most people, however, would rather just use private transportation.
Or, we can attempt to buy everyone Cadillacs. Good luck with that.

Questionmarktarius posted...

That's actually an argument for "VA for everyone".

how? seriously look at this objectively and without trying to grind that ax. explain yourself for once and be specific instead of using silly analogies.

Questionmarktarius posted...

That's where the bus analogy works: It's cheap, sometimes even free, and available for anyone to use. Most people, however, would rather just use private transportation.
Or, we can attempt to buy everyone Cadillacs. Good luck with that.

but since you insist on talking about things this way, lets extend the analogy

the government subsidizes drivers indirectly by keeping gas taxes low but continuing to increase funding for highways and roads, which causes more and more lanes to be built and maintained using general fund money or bonds. that means you and I are paying for it even if we don't use it.

what you're saying is that, instead of letting poor people have access to a free car, we should give them bus passes. but you're not saying we should do much to change the situation where government spending unfairly biases people to use cars instead of buses, through the financial incentives they give drivers over public transit riders -- think about it, people say public transit systems are failing when farebox collections don't recoup costs, but literally no car has ever recouped the costs of its trip with respect to the public dollars that are necessary to maintain that infrastructure. In other countries, where car drivers pay their costs, people drive less and use public transit more.

But you're not talking about taking away our massive subsidies for drivers, you're just talking about setting up an alternative system for poor people. And you've yet to explain why except through this analogy which I've hopefully now refuted or at least put into doubt.

tangentially, it's crazy to me how easily you 'libertarian' types can switch between 'consumer behavior is a result of bargaining between different parties and represents the least bad trade off from their perspectives' and 'people do this so that means they prefer to do this' without even slowing down to think about the implications of what you just said
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That's why all analogies are bad, if you think about them too hard.

It's kinda like... ohshit I almost did it again.

Ilishe posted...

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.

your second sentence directly contradicts your first, unless I'm missing something here
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