Originally published at: https://boingboing.net/2019/06/19/us-health-care-plan-perfectly.html
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Most of it makes sense when viewed within a particular frame of reference and in relation to real-world pressures, however the entire thing is a monstrosity that defies comprehension and dwarfs any person or organization that attempts to deal with it.
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More like this:
“I’m in insulin shock and need to consume that candy bar, RIGHT NOW!”
< fill in the rest of the tweet as above >
We often describe the American Health Care System in terms of choice (like buying candy), when in fact it’s more like a situation of immediate need (like needing medicine). Unregulated marketplaces only work for luxury items. Health care is a lot of things, but it is rarely a luxury.
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Or, alternatively:
“While you were unconscious, we sold you this candy bar you needed to survive…”
or
“How much is that candy bar?”
“Agree to buy it and find out!”
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Actually, most health care consumption anywhere is not emergent. And US healthcare is far FAR from unregulated.
Agreed. Republicans always say stuff like “all we have to do is unleash the power of the marketplace to get prices under control.” But one of the core definitions of what makes a fair marketplace is that both the buyer and seller are there voluntarily and have access to roughly the same information. When was the last time you wanted to be in the hospital or knew as much as your doctor about your ailments, relevant treatment options, their costs and long term outcomes. Also, people are regularly brought to this market unconscious and have a bunch of purchasing decisions made for them.
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And if you go down to Mexico or up to Canada to stock up on $0.50 candy bars you’re a criminal.
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It captures some of the how, but none of the why.
I’m confused. is he a millennial who’s also a dad, or the dad of a millennial?
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The US Health Care system is certainly less regulated than almost every other country’s system. It’s probably less regulated the the candy industry.
But that wasn’t really my point. My point remains that health care is not a luxury (like candy). It’s a necessity, and it should be regulated like a necessity.
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Everything in America that can be treated like a profit center is treated like a profit center. Just because huge profits can be made from ordinary people’s desperation doesn’t mean it should be, of course. But that is not a consideration for legislators or business managers in modern America.
Where health care is treated like the necessity it is, corporate greed is brought under control. Health care providers still make a comfortable amount of money, but they’re not allowed to grow grossly rich on the illness of ordinary citizens.
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“But one of the core definitions of what makes a fair marketplace is that both the buyer and seller are there voluntarily and have access to roughly the same information.”
That has never been a definition or even a feature of a marketplace. Information asymmetries are the norm in markets. And people buy potentially life-threatening things that they don’t understand all time (e.g., building construction, automobiles, the law). Instead, in well-developed markets people are offered ways of dealing with those ubiquitous information asymmetries (e.g., proxies, ratings, functioning price systems).
If US healthcare marketplaces are not well developed, the question should be, “Why not?”, since there is nothing categorically unique about healthcare in markets.
Another scenario I’ve dealt with:
“That will be $3500. Show us your membership card.”
“I don’t have a membership card.”
“Oh, in that case, it’s $200. We wanted that club we thought you were a member of to pay $3500.”
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You’re wrong about that - it’s been mathematically demonstrated that a “free market” is only possible when both sides of a transaction have the same information about every aspect of the transaction. When there is an imbalance of information, it is not a free market transaction.
This is pretty much irrelevant to the major objection to putting healthcare in a capitalist market, which is that healthy citizens are central to the good functioning of a society, and it benefits the society as a whole to have healthy members. So health care should be run like law enforcement or garbage pickup - for the common good, rather than for the profit of the few.
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More like:
“You need this candy bar”
“How much?”
“Not sure. $300 - $5000 depending on membership. But knowing all the ins and outs of each membership policy is not my job. You do owe me $30 right now for coming in to talk about the candy bar. If we consider the candy bar as a drug, you might pay $25, $50 or $100 depending on whether your membership considers it a tier1, tier2 or tier3 candy. Of course, they might not cover it at all.”
“Is it considered a drug.”
“Well, no. The candy bar will have to be administered to you in a special room in a special building by specially trained people.”
“I do have a really good membership.”
“Oh, that definitely helps. But your membership will only pay if the special building is on their approved list.”
“That should be easy to find out.”
“And the person administering the candy bar also has to be approved.”
“Okay”
“And their might be other people involved in the procedure that you don’t have any control over that may or may not be on the list even if the special building and main person in charge are.”
“Sigh. Anything else?”
“Yes. Since it’s January 3rd your membership probably won’t reimburse you for any candy related expenses until you paid a certain minimum by yourself. But you’ll be paying your membership’s negotiated rate. Probably.”
“Probably”
“Well, I’m the candy specialist with a decade of training and in my expert opinion, you need this candy bar. But your membership’s candy committee may decide differently, in which case all bets are off.”
“So, you’re saying I need this candy bar and there is no way you can possibly know how much it will ultimately cost me.”
“Yes, and yes. See the receptionist about the $30 and please don’t hesitate to call us if you have a problem and think you might need candy.”
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Todays comic!
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“The US Health Care system is certainly less regulated than almost every other country’s system. It’s probably less regulated the the candy industry.”
That simply is not true. Even comparing to Western Europe, US healthcare is in some ways regulated more heavily. Citizens across Europe have more ready access to some things that are legally restricted in the US. And if candy purchases were made to be provided through third-party financing, it would very much resemble US healthcare.
A great deal, even most, of healthcare consumption is not “necessary” by most people’s standards. But even where necessary, “necessity” and “regulated” are independent concepts. One need not imply, and usually has nothing to do with, the other.
Some are even grandparents.
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“it’s been mathematically demonstrated that a “free market” is only possible when both sides of a transaction have the same information about every aspect of the transaction”
That isn’t, and could not possibly be, true. No 2 people have the same information about every transaction. You are claiming that markets in anything have been mathematically proven to be impossible.
Information asymmetries exist (and almost always do exist), but they don’t and never have prevented markets from functioning to the benefit of both parties. If US healthcare markets are not well-functioning, you must look to something other than information asymmetries.
" Everything in America that can be treated like a profit center is treated like a profit center."
There are profits at the expense of others, and profits as a share of the benefits provided to others. Profits incentivize malice in the former, but beneficence in the latter. The problem isn’t profit, but how it is obtained. And where the former exists, you can usually be sure there is a gun involved somewhere.
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