Yes, Free Markets Would Improve Healthcare Results

John Stossel responds to critics of his last column.

Last week's column on my lung surgery struck a nerve. Many of you wished me well. Others said I deserve to die.

"He likes free markets?" sneered one Internet commenter. "In a truly free market, society wouldn't subsidize the cost of his smoking. In a truly free market, he'd be dead."

No, I wouldn't be dead. In a real free market, I would pay for my own care and that care would be cheaper and better because that's what market competition does.

Also, I've never smoked cigarettes. Some people who don't smoke get lung cancer, too.

The angriest comments were in the Washington Post: "Stossel should ask for his money back and the doctors should put cancer back into his lungs. That's what happens in a consumer-driven market, right?"

People can get very unhinged when libertarians argue that markets work better.

"HOW would that work? WHO would pay the nurses and the staff that keep a hospital running?"?

Who do they think pays now? Government and insurance companies paying doesn't make care "free." Government has no money of its own; it takes it from us. Such third-party payments just hide the cost.

"Is John Stossel's life worth more than the guy who collects my trash? … (T)urn health care over to his jackboot crew, only the rich will live to old age."

But it's the shopping around—including shopping by the rich—that fuels the innovation and discounting that extends everyone's lives, not just the rich. Charity will help the very poor.

"Let's see him negotiate the price of chemo vs. surgery when he's in the ambulance on way to hospital… Medical care is not amenable to usual market forces."

But it is. Patients wouldn't need to negotiate from the ambulance because such decisions would have already been made for them by thousands of previous patients, especially the 2 percent who pay the closest attention. Word would get around that hospital X is a rip-off but hospital Y gives better treatment for less. Doctors would advertise prices. Rating agencies would evaluate them for quality. Everyone will know more.

A hospital worker complained about this "customer mentality. A hospital is NOT a restaurant. It is not Burger King. You don't get to have it your way."

Why not? Must we just passively take what we're handed when it comes to medicine, even though we'd never accept that with hamburgers?

Medical patients tolerate indifferent service the way people tolerate waiting at the post office. The Postal Service, we were told, can't possibly make a profit, get it there overnight, etc. Then came UPS and FedEx. Competition showed what is possible.

"Stossel may think he's getting 'excellent medical care'," writes Cato Institute health care analyst Michael Cannon.

"But he doesn't know it, and neither do his doctors, because there is no market system to show how much better it could be. … In a market system, competition would push providers to strive to keep patients from falling through these cracks. … In our system, there is no such pressure on providers … because the real customer is government. As a result, few patients know how unsafe American medicine is."

Cannon warns, "Without that information, patients—even when they are smart, skeptical and wealthy like Stossel—are constantly consenting to inferior care."

A few extra-savvy consumers might be aware that my hospital got a "B" rating on The Leapfrog Group's Hospital Safety Score, and, says Cannon, it rates NewYork-Presbyterian "below average" in nine categories, including collapsed lungs and surgical site infections. "Did Stossel know about these safety measures before he chose NewYork-Presbyterian?"

No, I didn't.

I am grateful for my hospital's lifesaving technology and the skills of some of my caregivers. But it would be better if hospitals were as efficient as FedEx and most of what's offered by the private sector.

My local supermarket is open 24/7. They rarely make me wait, prices are low, there's plenty of choice, and they rarely poison me.

That's what competition brings—if people pay with their own money.

COPYRIGHT 2016 BY JFS PRODUCTIONS INC.

Comments

[Scarecrow & WoodChipper Repair]

This appalling misunderstanding of markets is frustrating as hell. People are so used to government "supervision" that they just assume it is necessary. Permit to build a deck? Permit to replace your roof? Permit to cut hair? It's all so ordinary that no one stops to ponder any of it.

I sometimes think if I were a magic genie, I would wave my hand and eliminate government in one country for a generation, so people would have a chance to see what life is like without that intrusive nanny breathing down everybody's neck. Not only would most stress vanish, the economy would rocket. In that one generation, not only would the natives learn what freedom is, but the rest of the world would learn how much worse off they are with their governments fucking up their lives day in and day out.

I bet 90% of the people would be deliriously happy at the freedom, and shudder in horror at the other 10%, who would spend their time sulking and pouting, banding together in socialist communes, trying to fool everyone else into joining and donating their money to sustain the freeloaders.

[some guy]

eliminate government in one country for a generation

My experiences with people indicate that government would immediately spring back up as groups of people try to take advantage of each other. They would form gangs, which would grow and compete (with violence) until you had a civil war or a government or both. It's human nature. All you can do is fight for the best government you can get while trying to convert people into liberty-lovers. Maybe in a few generations the desire to control others will be bred out of our species to the point that we can live without government, but I doubt it.

[sarcasmic]

Maybe in a few generations the desire to control others will be bred out of our species to the point that we can live without government, but I doubt it.

You know who else tried to change human nature through breeding?

[some guy]

Pierson's Puppeteers?

[Old Man With Candy]

Michael Hihndmost

[Swiss Servator]

*falls over chair, scrambles to rise and begin thunderous applause*

[Rhywun]

We're done here - shut it off for today.

[Set Us Up The Chipper]

+1 Puppeteers

[kbolino]

Maybe in a few generations the desire to control others will be bred out of our species to the point that we can live without government, but I doubt it.

If such a thing were possible, the resulting people--if they could still be called that--would no longer be human. Almost certainly, they would be chattel to the remaining humans.

[some guy]

Hm. I have no desire to control others. Are you saying that you do? Or are you not human?

[kbolino]

Hmm, I may be conflating two different things. You presumably don't want to be controlled, either. So then you would have to exercise retaliatory force against those who would control you. What is a battle if not a struggle for control? How do people who wish only to control themselves coexist with those who wish to control others?

[some guy]

Yes, I was assuming that self-defense does not count as exerting control over others, but rather control over yourself. I guess you went the other way where one who lacks a desire to control is a sheep willing to endure anything. Regardless I think we're in agreement that large numbers of people suck and will continue to do so for the foreseeable future.

[Citizen X]

That's why a lot of us who have no desire to control others collect guns.

[Rufus The Monocled Derp Slayer]

Yeh, that's exactly it. People have lost their sense of 'I ought to' and have simply grown accustomed to the 'government will' attitude.

It's apathy and it's appalling because, well, look at the retardation at work as Stossel explains.

I personally love the 'who will pay for' line. It's staggering their stupidity.

[Suthenboy]

"In that one generation, not only would the natives learn what freedom is, but the rest of the world would learn how much worse off they are with their governments fucking up their lives day in and day out."

Never change Scarecrow, never stop being an optimist.

*glances over at apologists for Venezuela

[BigT]

Venezuela is great! They are so well off, they can give all the government employees FIVE day weekends every week.

Woo hoo for Venezuela!!

[actually, it would be great if we could get our government to only work two days a week - less damage]

[UnCivilServant]

[actually, it would be great if we could get our government to only work two days a week - less damage]

Would I still get the same paycheck?

[Bobarian (Would Chip Her)]

Would I still get the same paycheck?

You are ready to leave the temple, grasshopper. Your journey to the darkside is complete.

You are a consummate government employee.

So listen up, crotch stain. Remember your training, and trust your instincts. You can do it! I believe in you! Bye-bye!

[AddictionMyth]

Good stuff, as usual. I actually think many of the fear mongers on health care are really just trying to protect their franchise on some niche so they don't have to face real competition. By keeping people ignorant you can play on their fears that they can't make smart decisions for themselves which is why government must step in. There is even an aspect of extortion - "If you vote for free markets then poor people will die in the streets from easily treatable conditions". Well meaning people fall for it.

[Catatafish & Woodchips]

It's a banner issue. "Universal health care is a human right" and all its attendant "poor people will die in the streets" otherwise cries are simply the tractor hauling a trailer full of other socialist causes behind it.

[A Cynic's Guide to Zen]

In sixty years, "Living until 90 is a human right!"

[buybuydandavis]

Who do they think pays now?

Mistaken premise - they don't think about who pays.

Wealth is simply pie that rich people hoard for themselves. Where it comes from, and how it is produced, are questions Progressives don't *allow* into their heads. They are masters of CrimeStop.

[Shirley Knott]

They also buy into the notion that the recipients deserve the money from the government.
Bear with me for a moment -- there are senses in which that's not entirely false.
We all have a sense of empathy that suggests that people in need ought to be helped.
The government is seen as helping.

The most successful route to beginning to change someone's mind on this is to argue, carefully and clearly, that even granted that person X "deserves" amount Y and since the government provides amount Y to X all is well, there's still the problem of transfer costs. May X does 'deserve' Y. But A, B, C, D, E..W do *not* deserve their high wages and cushy jobs to "facilitate" the transfer of money from Z to X. It's never amount Y, the amount we can agree for the sake of argument is actually "deserved". It's at least 3, and probably closer to 10, times Y to cover the transfer costs.
Markets work because all businesses have strong incentives to cut costs and do more with less.

[Shirley Knott]

Governments fail to do well because they have nothing but (literally nothing but) perverse incentives to raise the costs and do less with more. As soon as there's a shortfall, it comes out of Y, the money intended for X. It *never* comes out of the free riders A---W.
And that's the heart and soul of the difficulties we find ourselves in.

We don't have to, and shouldn't try (because it's basically impossible) to shift anyone from full-on statist/looter to a full-on supporter of markets.
We can't succeed by arguing that X does not deserve Y in some abstract sense. That sense is usually expressed in that vile word "should". 'Someone' "should" see to it that X gets Y, and if that means taking it from Z, so be it.
We can make progress by starting people thinking about transfer costs and perverse incentives.
We can make progress by documenting the actual costs versus the actual end-stage recipients of the transfer.
No one likes paying the taxman. They like even less paying for his support staff and accountants.

[BigT]

Zzzzzzzz.......

[straffinrun]

The angriest comments were in the Washington Post

The glee with which those "Ha, ha! You got cancer!" comments were made is all the more despicable given Stossel's overall nice guy character. Good luck, John.

[Inigo Montoya, Micro-Aggressor]

This.
It shows their true nature, for all their squawking about their opponents lacking empathy. I certainly don't wish that kind of thing on them. It's amazes me these people don't all start their own cinema chains, they project so well.

[SatanicBunniesOfDeath]

That cinema line is pretty good.

[Ceci n'est pas un woodchipper]

The Washington Post commenters are pretty vile people. And I'm fully aware of the irony of my saying that on the Reason boards.

[B. Woodrow Chippenhaus]

At least we pride ourselves on our villainy.

[UnCivilServant]

Mere villainy?

Sir, I aspire to supervillainy.

[Catatafish & Woodchips]

(Mos Eisley Cantina song begins playing in the background)

[Swiss Servator]

*shoots Gredo first*

[A Cynic's Guide to Zen]

Commenting is serious business, especially around these parts.

[Suthenboy]

The WaPo is a lefty rag. The left appeals to the worst aspects of human nature: envy, greed, the desire for punishing others. Thus the WaPo readers are the worst kinds of people.

No surprise here.

[chufracrak]

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[Steve G]

Yeah, kinda funny when you consider the price trends of elective medicine vs the not. No reason why the market forces that drive lasik surgery down from thousands of dollars per eye to a few hundred couldn't do the same for an MRI that you don't have to wait weeks to get.

[UnCivilServant]

I don't hare you for being sick.

I hate you for splitting an article so that about one paragraph lands on page two.

[kbolino]

I don't think Stossel gets to pick the split, any more than he got to choose to be "Reason Staff".

[UnCivilServant]

Unless he comes here and tells me who to hate for it instead, he ets the blame.

[Brochettaward]

My local supermarket is open 24/7. They rarely make me wait, prices are low, there's plenty of choice, and they rarely poison me.

THAT'S BECAUSE THE GOVERNMENT IS THERE TO MANDATE THAT THERE IS ONLY AN ACCEPTABLE LEVEL OF RAT FECES AND CHEMICALS IN IT, SHITLORD.

Also, I missed the memo that libertarians were wearing jackboots now. Why didn't any of you tell me? What do I even come here for?

[dantheserene]

I'm concerned I may not have the leg length to make jackboots really work for me. I don't even wear cuffed pants.

[Brochettaward]

It sounds like we are going to need a full uniform. Something in tan or black?

[Bobarian (Would Chip Her)]

White hoods before Labor Day.

[hpearce]

I strongly recommend that people explain the free market as a market based upon freedom of association; and that the only reason to oppose these markets is a dis-approval or opposition to the concept of freedom of association for state-mandated ones instead.

Your political "liberal" friends "should" like that.

[kbolino]

I don't know what your point is, except to say that self-described "liberals" generally aren't, but that's hardly news. The core principles of libertarianism, like freedom of association, non-aggression, and self-ownership, don't hold broad appeal to mainstream "liberals" or "conservatives".

[some guy]

The core principles of libertarianism, like freedom of association, non-aggression, and self-ownership, don't hold broad appeal to mainstream "liberals" or "conservatives".

... or "people" in general.

[hpearce]

The vast majority of people don't want to be labeled/consdiered as non-supporters of the concept of freedom of association IMHO.

[kbolino]

I do not think your opinion, while humble, is an accurate reflection of what "the vast majority of people" want. Even if we constrain ourselves to the United States, where things like blasphemy and apostasy are not widely held to be criminal acts punishable by death, most people support government regulation of markets and businesses. The only real question is, to what degree.

[hpearce]

Then the next step is IMHO to show/state that liberalism is based upon the concept of freedom of association (see WIKI) and that any so-called "liberal" not supporting it is a fake political "liberal"

[kbolino]

They're already self-selecting as "progressives" and "socialists". Shaming them by playing definitional games isn't going to accomplish anything.

[SimonJester]

I disagree about the value of free association. It is my opinion that most Americans, lib to cons, don't value free association, because they want to be able to force OTHERS to deal with their group. Liberals hate free association because TEH GAYZ CAKES! and Conservatives hate free assocation because TEH WAR ON CHRIZISMAS!

You are NOT free to only associate with whom you want, and there are legal repercussions if you decide not to associate with others based on race, sex, origin, veteran status, religious belief, etc.

[hpearce]

The point is that many people fail to have a moral/political principle for their support of free markets other than practical ones like "free markets work ...socialism doesn't"

Tying it to freedom of association (a generally considered liberal concept) provides that and a good retort to fake political "liberals"

[kbolino]

How do you convince a utilitarian with a deontological argument? If someone's starting premises are "do what works best" then arguing about principles is talking past them.

[hpearce]

I never said it works ALL the time, but I would then point out that where freedom of association doesn't rule, then state-mandated ones do ! AND that a society based upon state-mandated associations is a FASCIST one.

[kbolino]

Of course, but that's irrelevant in a majoritarian polity. If the people generally agree that "fascism is okay, so long as it works" then what?

[hpearce]

In that case, as far as I am concerned, they had better NEVER refer to themselves as liberal again. And you give-up on people who actually believe in fascism as just that. Authoritarian non-liberal fascists.

[generalisimo14]

Rothbard warned of the use of the utility argument. While true, what if another theory appears that has better utility, but required soylent green to be made of dissenters (like Dune's synchronized worlds)? This would pass utilitarian muster but not moral/ethical. We also ceded the moral high ground when relying on utility. Take a page from Saul Alinsky, and use whatever argument will move others to your cause, keep as many tools in you war chest as possible to fight for your cause. Be willing to be incremental and not pure, for perfection is a heavenly goal and not of our realm. Our enemies revel in our philosophical purity, as it has allowed them to win battle after battle. Guerilla warfare for liberty, sounds very American doesn't it!

[Anarcho-Woodchipper]

Sounds good in theory but these are the same mouth breathers who argue that someone *HAS* to bake a gay wedding cake... a gayke? A cake that is gay? Something something butt stuff sugar...

[hpearce]

And that is because conservatives almost NEVER provide a good rationale for being against anything other than practicalism.

It's time more people did.

Ever hear the typical conservative argue the minimum wage ? "It doesn't work" or "it causes unemployment" as if had that not been the outcome these conservatives would be all for the minimum wage which many in fact do claim to support.

[some guy]

"Let's see him negotiate the price of chemo vs. surgery when he's in the ambulance on way to hospital... Medical care is not amenable to usual market forces."

This is such a stupid argument, not only for the reasons Stossel gives. It assumes you have no prior relationship with your health service providers, which is almost never the case. It assumes that actual emergency care makes up a significant amount of total care, which it doesn't. These people have never taken the time to think through their arguments.

Who has time to negotiate plumbing rates when your basement is flooding? Or electrician rates when your power is out? Maybe we should nationalize plumbers and electricians.... and mechanics and late night restaurants. Any industry where someone might need their goods or services during an "emergency"... nationalize it!

[LynchPin1477]

Then we can stand back and wonder why emergencies seem to be on the rise.

[Hamster of Doom]

If the plumber refused to give you a quote until the work was completed, gave you a quote and then blew several thousand dollars past it, charged one customer 400% more than another customer for the same repair, or refused to let another plumber set up shop in your town until the new plumber had gotten a Certificate of Need from the other plumbers in town showing they thought there was adequate business to share with the new plumber, they would be arrested for price-fixing, gouging, and racketeering.

[Hamster of Doom]

Arrested might be wrong. *slurps down more coffee* Sued into oblivion, certainly.

[BigT]

Might get a visit from the local pipefitters.

[R C Dean]

Nobody goes to the hospital in an ambulance for cancer treatment, for starters.

Trust me: this I know. I oversee our emergency coverage contracts, which we have with specialties that actually are needed in the ED - ortho, cardio, etc. We don't pay for emergency cancer coverage. Because we're not stupid.

[JoWaDat889]

Lets jsut roll with it man.

http://www.Complete-Privacy.tk

[Ceci n'est pas un woodchipper]

A hospital worker complained about this "customer mentality. A hospital is NOT a restaurant. It is not Burger King. You don't get to have it your way."

This is the fundamental problem with the health care system in our country (and most others). They know you have no choice, you're making a decision under extreme duress, and you're dealing with a subject in which you're not particularly knowledgeable, let alone expert, and so must take a lot of information on faith, at least in the short term. It's also why hospitals get sued so often; it's the only way to get their attention.

[Lee G]

They know what's best for you along with their government masters. Submit to their authority and let them help you already.

[some guy]

you're making a decision under extreme duress

The vast majority of healthcare is provided by appointment. People have plenty of time to do their research and shop around for about 98% of their healthcare. And you can easily research ERs in your area long before you need one. It's all about planning, which is something few people seem to do.

[kbolino]

It's all about planning

This is the part many don't seem to understand. Yes, in an emergency situation, you will be "at the mercy" of the people caring for you. Which is why you should be empowered to make binding legal statements of intent--like living wills, DNR orders, etc. except broader and less contestable--as well as establish contracts of care and service beforehand, so that when you are deprived of faculty in an emergency situation, there is little left to chance and guesswork.

You don't "shop around" for emergency care when you're in an emergency. You do so when you're not.

But people want care without having to pay for it, and they want to set the terms of the arrangement without giving the other party any bargaining power.

[some guy]

But people want care without having to pay for it, and they want to set the terms of the arrangement without giving the other party any bargaining power.

Yes, it all comes back to wanting to control others.

[B. Woodrow Chippenhaus]

It's all about planning, which is something few people seem to do.

Hey, I'm a busy guy, what with waiting around for my welfare check to arrive and all.

[LynchPin1477]

Doctors have been on a pedestal for I-don't-know-how-long (100, 200 years?). They are almost like a modern priest class. And they don't like to be questioned.

Well, some of them. There does seem to be a move towards more humility and patient-focused care.

[R C Dean]

This is the fundamental problem with the health care system in our country (and most others).

You're right, but not for the reasons you say. Health care is run for the convenience, primarily, of physicians, and for the benefit of third party payers. We call patients "meat-based billing units" for a reason.

They know you have no choice, you're making a decision under extreme duress,

This is true only for true emergencies, which are actually fairly rare.

you're dealing with a subject in which you're not particularly knowledgeable, let alone expert, and so must take a lot of information on faith, at least in the short term

This is typical of most transactions in our economy, like buying a car, a house, a computer, etc.

It's also why hospitals get sued so often; it's the only way to get their attention.

There is a grain of truth to this. Hospitals don't get sued for bad customer service, they get sued for bad outcomes. However, only angry patients sue, and they're usually angry because of bad customer service.

[Rufus The Monocled Derp Slayer]

Good luck to John. He's a helpful voice for libertarian thought in the mainstream. It's too bad about the 'gotcha' attitude in the WaPo comments but should we be surprised?

[A Cynic's Guide to Zen]

Surprised by misanthropy?

[GOML!]

I hear "healthcare is a right" nonsense all the time. Healthcare is a service. Nothing is a right that requires the labor of another person. If you believe healthcare is a right, then you believe in forced labor, i.e. slavery.

[Lee G]

The magic of government washes away the taint of involuntary servitude.

[sarcasmic]

Wanting to keep what is yours is greedy, selfish, and evil.

Wanting to use force of government to take what is not yours is altruistic, selfless, and good.

[LynchPin1477]

So may people really do assume that "free market" means some sort of Darwinian, ultra-individualistic, cut-throat survival of the fittest (richest). Why they don't conclude otherwise when they look at the market for cars, or smartphones, or clothing, or food, or movies, or music, or any number of things, really is beyond me. I mean, I can understand someone saying "there won't be enough charity to help everyone who needs it", but people assume that the world will look like that movie Elysium if we make health care look just a little more like the market for flat screen TVs.

[Alice Bowie (is back)]

I think you make your own point.

There appears to be a reason why healthcare (emergency/expensive healthcare) doesn't seem to exists in the free market. You can continue to blame the bleeding hearts. But the bleeding hearts alone didn't seem to stop things like LASIK. Why? Because LASIK isn't life-death.

[LynchPin1477]

Most healthcare isn't life or death. I've never had to make a life or death decision with regards to my medical care. My grandfather passed away last year after a few years of declining health but even then, there were no emergency life or death decisions that needed to be made.

I don't see why the very small fraction of healthcare decisions that have to be made under emergency situations should dictate what they rest of the system looks like.

[kbolino]

There appears to be a reason why healthcare (emergency/expensive healthcare) doesn't seem to exists in the free market.

Yes, there is a reason. That reason is that it's illegal. Try making an arrangement for emergency care that doesn't involve an insurance company or the government, and you will be pointed to laws and court cases that make it practically impossible to do so.

[Migrant Log Chipper]

Who is the new Alice sock? Tony, Tulpa, amsoc.......?

[JimBob7]

What would you expect from the Washington Compost writers or readers? Logic? Understanding? Really?

[Jackand Ace]

As I stated last week, I wish you the best. The comments made to you are disgraceful. I have received similar here on these pages.

I only say that as far as Presbyterian, you are receiving some of the best health care available in the country. I say that knowing first hand, as a family member had a double lung transplant there. The Leapfrog ratings you speak of are being challenged in another instance, where Stony Brook received an F.

I once asked my brother what he thought the total bill of his health care there was, and he said probably close to $1M dollars. He then said he wonders what happens to similar people with no insurance. It wouldn't be the health care he received.

Here is hoping you are back on your feet soon.

[LynchPin1477]

/applauds civility of usually ideologically opposed commenter

[Brochettaward]

/mumbles that Jackand Ace is still a cunt

[kbolino]

I have received similar here on these pages.

No, you have not. You have been a called a liar and a fool, but both are true, and neither is a wish of ill will.

[Jackand Ace]

Actually I was told that I should get cancer and die. But thanks anyway.

[kbolino]

There are 11 pages on this site that a match a search for the terms "jackandace" and "cancer". None of them involve anyone wishing cancer upon you.

So, provide a link or STFU.

[kbolino]

Dammit, your stupid handle. What the fuck does it even mean and why is there a space?

[Swiss Servator]

Constant barrage of short jokes, sure...failed urban planner jokes...Venezuela jokes...

[kbolino]

I have been through 5 pages of these results and no one wished you cancer.

Liar.

[R C Dean]

He then said he wonders what happens to similar people with no insurance.

Odds are very good that they are covered by Medicaid or Medicare. If they really have no payer at all, then the odds are still very good that they get exactly the same care, with a non-profit hospital writing off the cost.

And, yeah, good on ya for this comment, Jack. When the revolution comes, I'll kill you . . . second. Maybe third.

[B. Woodrow Chippenhaus]

I once asked my brother what he thought the total bill of his health care there was, and he said probably close to $1M dollars. He then said he wonders what happens to similar people with no insurance. It wouldn't be the health care he received.

I wonder how much of that $1M went to pay for a full time administrative staff that can navigate the labyrinth of laws and regulations imposed by government, how much went to pay for tests that the doctor knew were unnecessary for a diagnosis but necessary to cover his ass in a possible civil suit should something unforseen happen, how much went to pay for the inflated costs of medications due to the regulations and R&D requirements they had to meet, etc., etc.

[Notorious UGCC]

Stossel has cancer? Prayers and best wishes.

[Domestic Dissident]

Like I said a week ago, somehow it seems like it's always the John Stossels and never the Dave Weigels of the world that things like this happen to. Life is so cruel and unfair sometimes.

[Alice Bowie (is back)]

Two things that are 100% true of healthcare in America:

1. Third Party Payment is what hides costs. It allows providers to be, let's say dishonest about cost. Since the Patient (consumer) doesn't know the cost of service, the provider goes batshit. And, the Third Party doesn't have the resources evidently to do anything about it.

2. Healthcare service (especially life-saving and emergency care) is inelastic. People will pay (or claim that they will pay) whatever it costs to heal their child, loved one or themselves.

For routine Medical care that is not expensive, let's have a free market.
For expensive life/death emergency and cancer-like diseases in which most people go broke, let's have A Single THIRD PARTY payer that is non-profit and can work with the providers so that the medical providers are compensated for the cost and can make a high-level of income.

- Money is FAKE. We made it up. We print more when needed (for wars/bank bail-outs/etc.).
- What is not FAKE is the suffering of someone who is sick and can't pay.
- What's lousy is that people chose not to have insurance and go to emergency rooms to leach off the people that contributed to the system.

A simple, single payer system which monitors costs and pays a handsome profit to the providers.
Let's beef up Medicare and let's provide emergency/life-saving services for all.

[Swiss Servator]

CUBA HEALTHCARE LIBRE'!

[generalisimo14]

Alice,
In a truly free market, price communicates what people value (see Mises "Human Action"). Coercive interference, of any kind, simple skews the price mechanism and results in a loss of utility. Any scheme that is other than free market, overrides the VALUES of the individuals for that of the arbitrary and coercive state. You may not understand, or have been exposed to Mises, but his praxeological derivation of his economic theory is the best to fit observation to date. Your belief in the state is based on faith, not reason. Faith is wonderful when confined to personal and private decisions (free will), not when foisted on others by coercive violence. History has far too many examples of this. Liberty is the answer.

[kbolino]

They wouldn't be able to "leech off the people that contributed to the system" if it wasn't for EMTALA.

If you don't want to suffer, make more of that "fake" money and pay the people who would alleviate your suffering.

You are not entitled to a comfortable life.

[Alice Bowie (is back)]

This has nothing to do with a comfortable life. Life is truly precious. We're not talking about a BMW here. We are talking about keeping someone alive and healthy. Could be your own loved one.

"Medicare for All" would had been a better solution than EMTALA.
EMTALA was put in place by Reagan. Not exactly a bleeding heart liberal.
What failed with EMTALA is that there is no funding towards the provider. The Provider MUST offer emergency car and swallow the costs. The Provider should at the least be able to file claims via Medicare.

[sarcasmic]

The Provider should at the least be able to file claims via Medicare.

They can. It's called "Uncompensated Care." Look it up.

[kbolino]

It doesn't matter what you're talking about, if you want it done and you can't do it, then you have to pay for it.

And it doesn't matter who signed EMTALA into law. What matters is the effect it has.

[LynchPin1477]

Life is truly precious

I agree. But that doesn't imply that your preferred healthcare system would be the best for safeguarding life.

[Domestic Dissident]

People like you invented this lousy, rotten, corrupt system, and then you have the unmitigated nerve to say that the problems with your system are our fault and that only you can fix them.

Nobody should have to be a slave so that you can live a few weeks or months longer. Screw you, lady.

[sarcasmic]

It's the magic of good intentions. They have good intentions. They want everyone to have free medical care. Their goal is noble. Therefore any unintended consequences must be the fault of someone else, like those icky libertarians who want rich people to profit from the sick.

[kbolino]

Screw you, lady.

That's a man, baby.

[Alice Bowie (is back)]

From what I read about "Uncompensated Care", doesn't sound like anyone is being a slave. Especially medical providers.

And the system is definitely lousy, rotten, and corrupted as it exists today.

Create a non-profit third-party payer system for expensive care.
Leave a free market for all other medical care.

Look at Lasik. I believe that with the existence of a free market and consumers that are able to pay, more and more medical care will go the way of Lasik and less will be burdened on the expensive stuff.

Where I think we went wrong is that EVERYTHING is covered by third party.
When I was a kid, there was something called "Major Medical". Major Medical should be universal...not every minor doctor visit.

[kbolino]

The slaves are the taxpayers.

And "major medical" was destroyed by HMO. Yet another law in the pursuit of "better" care that delivered exactly the opposite.

[Alice Bowie (is back)]

The taxpayer is the benefactor of the care.

Even Ayn Rand used Medicare for her lung cancer towards the end of her life.

Perhaps you are referring to the richer tax payers that will never use medicare as they are rich enough to pay themselves? In the US, we don't means-test medicare. They use medicare.

So, perhaps you are referring to the foreign taxpayers?

[kbolino]

The taxpayer is the benefactor of the care.

No shit, that's exactly what I said. However, it's obvious you mean beneficiary and not benefactor.

But that's a lie. Some taxpayers will never be net beneficiaries. If every taxpayer was a net beneficiary, then the whole system would collapse. That's what you want to have happen, but most people are not so suicidal.

Your whole system depends on forcing some people to pay more than they will ever use. And given that we tax income and have capital controls, it is indeed slavery. No one can live here without paying into your pocket and no one can leave without paying into it even more.

Even Ayn Rand

doesn't fucking matter, any more than Reagan or anyone else. Stop blaming everything on Emmanual Goldstein and defend your fucking arguments.

[Rhywun]

monitors costs

You do know where this leads, right?

[kbolino]

I really don't think he cares. He wants his pony, and all the consequences be damned. If grandma dies in an NHS-like waiting line, well at least she had "access" to care.

What they hate above all else is that someone else can have better access with more money. You will be brought to heel and if they have to run a wrecking ball through the economy ("Money is FAKE"), so be it.

All of the rest is just lies. They don't want universal care, they don't want better care, they don't even want affordable care. They just want the people they don't like to suffer more.

[Alice Bowie (is back)]

They just want the people they don't like to suffer more.

By offering Major Medical to all American?

I guess if I had the choice of someone's child just dying of Bone Cancer and Donald Trump having to pony up an addition $1,000 per year. You are right, I want Donald to suffer from having that $1,000 less.

[LynchPin1477]

False choice

[kbolino]

Even if I take what you say at face value, it's contradictory.

You say you want emergency care for all then complain about free riders.

You say money is fake but then you say other people should have to give it to you.

[LynchPin1477]

Third Party Payment is what hides costs...the Third Party doesn't have the resources evidently to do anything about it

It doesn't have to be that way. The point of insurance is to pool risk so as to insulate any one individual against the full cost of a catastrophic event. That's a good thing. And in a more competitive market for insurance, insurers would have incentives to keep costs down.

The problem is that insurance is expected to pay for everything, and that there isn't much competition between insurers.

Healthcare service (especially life-saving and emergency care) is inelastic. People will pay (or claim that they will pay) whatever it costs to heal their child, loved one or themselves

And as I pointed out above, most healthcare spending is not life-or-death. And that which is usually doesn't happen in emergency, heat-of-the-moment situations.

[LynchPin1477]

let's have A Single THIRD PARTY payer that is non-profit and can work with the providers so that the medical providers are compensated for the cost and can make a high-level of income

Your first point claims third party payers are the problem, and your solution is to create a single third party that will have even more power than the current multiple third parties?

Money is FAKE. We made it up. We print more when needed (for wars/bank bail-outs/etc.)

Being "made up" doesn't make money fake. Printing more has very real consequences.

A simple, single payer system which monitors costs and pays a handsome profit to the providers

So a system we don't know how to create?

[R C Dean]

let's have A Single THIRD PARTY payer

A monopoly.

that is non-profit

Still a monopoly.

and can work with the providers

Monopolies are famous for working with people who have no options.

[Mainer2]

http://www.wsj.com/articles/si.....1461167875

The WSJ published letters responding to an editorial about patients rating their doctors. It's interesting how the people opposed to the idea present hypotheticals. While the CEO of eMerit has actual data:

Our organization supported Mr. Isaac's hypothesis until 2011. We believed that patient reviews were even worse than no information. So, we studied it. We obtained a list of the best and worst surgeons based on proxies for patient safety and clinical outcomes. We were blinded about which surgeon was on which list. Then we went to the Internet review sites to see what patients wrote about these doctors. When we unblinded the results, we learned our assumptions were wrong. The best surgeons had the best online reputations; the worst surgeons had the worst online reputations. The correlation was strong.

[Crusty Juggler]

Troll bait!

[Alice Bowie (is back)]

I'm surprised Stossell didn't go the Memorial Sloan Kettering Hospital Next Store.

That's the CANCER place.

I am a patient of NY Pres (Weil-Cornell) for Diverticulitis. I was treated all last year and they were pretty good with me.

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[Tonio]

Wishing you a good outcome, Mr. Stossell. My thoughts are with you.

[HazelMeade]

Many of you wished me well. Others said I deserve to die.

God, I fucking hate leftists. They are gross, evil cunts with poisoned souls. I hope they all die in a fire.

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[Observer22]

Mr. Stossel, first let me say that I am very sorry you were diagnosed with lung cancer, and I wish you a speedy return to good health.

Second, I fully agree with your conclusion that hospitals are not run for the benefit and convenience of patients. I also agree that free-market forces would improve the situation. The issue is two-fold: 1) information to help patients make informed medical and financial decisions is not readily accessible to patients; and 2) it is impossible to negotiate treatment and pricing while laid out flat on your back in a hospital bed.

So what can we do to help those of us who believe that free market forces are the best avenue for forcing change in healthcare delivery, and who practice what we preach by selecting high-deductible insurance plans and diligently shopping for our healthcare services? Healthcare is the only thing you buy without knowing the price. It's like the passage of the Obamacare legislation: you have to buy the service to see what it will cost. And it's equally as mysterious to try to get objective information on the quality of a healthcare provider. The best I have been able to do is ask colleagues to recommend a doctor.

Right now, my basic approach to healthcare has been to try not to get sick, but obviously that is not going to work in the long-term. I'll look forward to hearing your opinions on more effective strategies to become a better healthcare consumer.

[Alice Bowie (is back)]

I'll look forward to hearing your opinions on more effective strategies to become a better healthcare consumer.

The most effective strategy to being a better healthcare consumer is :

- Be very very rich and able to pay for the best care available
- Be very very rich and able to pay for the care your insurance company doesn't cover
- Be very very poor and get whatever the system will pay
- Be middle class and get whatever the system will pay once your insurance company weasels out.

These are the suggestions for today.

We can always try to push for a new solution like:
- Free Market
- Single Payer
- Something else

Right now, the established providers are very happy with the current system. It's the new-bees that are not happy with it.

[R C Dean]

Right now, the established providers are very happy with the current system.

Actually, health care providers one and all pretty much hate the current system.

[Alice Bowie (is back)]

The problem is that the only opinion libertarains will offer the the one in which people that can't afford healthcare will be screwed.

Unlike food, healthcare isn't abundant. And I believe that the AMA and the providers, themselves, are the reason why we don't have abundant healthcare.

Rand Paul said something interesting: "Republicans have to be more 'live-and-let-live' in order to win elections in Today's America".

I believe libertarians should be more compassionate ( and not just to the rich) to move into the political space.

It's ok to have vouchers ($$$) and special treats to those of us that are the most productive and resourceful.
But we all can afford to help those that are terminally sick. We have the resources.

[R C Dean]

The problem is that the only opinion libertarains will offer the the one in which people that can't afford healthcare will be screwed.

Err, no. The libertarian solution leaves ample room for charity care, which in a wealthy society like ours is more than adequate to ensure that poor folks aren't screwed.

You know who screws poor people? Medicaid administrators, who exercise a lot of control over how much care they get, based solely on trying to keep the Medicaid budget under control.

[Alice Bowie (is back)]

The libertarian solution leaves ample room for charity care,

I respectfully disagree Mr. Dean.

In the financial science of "Trickle down economics", the only thing that trickles down is any additional costs.
Surplus rarely, if ever, trickle down. They are kept as profit. Proof of this is the surplus cash capital many of the American Corporations and the wealthy hold.

[kbolino]

The surplus does not "trickle-down" for free. You still have to fucking pay for it.

The difference is that what used to cost $5000 now costs $500, what used to cost $500 now costs $50, and so on. That puts things that were previously in the realm of unaffordable luxuries into the realm of commonplace comforts.

Money that sits in one place has no effect on the economy. Nobody with wealth or capital and sense sits around all day counting it. They invest it, which enables people with less wealth and capital to produce more.

There is not enough money sitting in reserves to pay for all of what you want. Not by a long shot, and certainly not for very long. And if you went after it, the things you claim are more important than money would cease to be produced.

The accumulation and exploitation of capital is absolutely essential to the provision of any "basic needs" that people have, and moreover to the continual improvement of the state of the art such that we aren't stuck living to the standards of our ancestors, or worse.

[Alice Bowie (is back)]

Maybe a $50 shirt is now $5. Correct.
The Television definitely came down in price as well.

All of this came the lost of many jobs and the decay of good paying jobs.

You can always argue that if the Cell Phones weren't made in Asia, people in the public housing projects wouldn't have cell phones.

But isn't it better to have a more full-employment economy paying $50 per shirt than having high (Real) unemployment and under-employment and barely being able to afford a $5 shirt?

[kbolino]

But isn't it better to have a more full-employment economy paying $50 per shirt than having high (Real) unemployment and under-employment and barely being able to afford a $5 shirt?

Yes, it is better to have unicorns than horses, but one of those things exists. There are still $50 shirts. Go and buy one. You'll probably have to buy a few thousand $50 shirts to affect employment numbers, though.

Cheap consumer goods don't make people unemployed. Unrealistic expectations of what they should be paid do, whether those expectations come from their own demands or the government.

There is no magic money tree from which higher wages will be paid if prices go up. If everybody is spending all of their money on shirts, how the fuck are they going to pay for healthcare?

[kbolino]

Don't believe me? Go get treated in India or Mexico. You will pay a fraction of the price that you would pay in the United States. But you're also more likely to develop complications. Just like the same treatment done decades ago in the US, but at greater expense. The cost of care has gone down, way down, such that people can live better lives than ever before.

There Ain't No Such Thing As a Free Lunch -- You want it, pay for it.

[R C Dean]

You disagree that the libertarian solution leaves ample room for charity care?

Why doesn't it? People are free to provide and fund it.

And, we know from decades of experience that they will do exactly that. Around half (probably a little less) of the hospitals and health systems in this country are non-profit, and they spend billions every year providing charity care.

Your theory that people are purely financial robots is refuted by reality.

[kbolino]

The problem is that the only opinion libertarains will offer the the one in which people that can't afford healthcare will be screwed.

As opposed to your option, where those without connections to the healthcare bureaucracy are screwed by the capriciousness of bureaucrats? As far as I know, you're not a medical professional, and you're probably not a net taxpayer either, so how can you promise something you can't deliver?

Unlike food, healthcare isn't abundant.

It is actually extremely abundant. There are hospitals, doctors' offices, pharmacies etc. all over the place. There's half a dozen different drug stores within walking distance of my house. What isn't abundant is specialized care requiring trained professionals and expensive equipment.

But we all can afford to help those that are terminally sick. We have the resources.

Then do it. Are you complaining that you don't give enough to help others? How the fuck is that my fault?

[cynicalretiree]

I worked in hospitals for 30 years. it is staggering the quantity of low wage earners who were not always eligible for continued treatment.when you ignore people who are denied treatment, like the free market did before ACA, you have populations with communicable diseases.infectious, communicable diseases spread to everyone.
this writer's fantasy is based on privileges of higher wage earners who never suffered disadvantages.. the disadvantaged poor, are also human beings unless you classify them as Lower Cast, like they do in India.if you ignore them to satisfy free market economy, worse diseases bounce back at everyone.
if you ignore present health care needs of low wage workers,the disadvantaged, the unemployed and the unemployable, they end up in emergency rooms with increasingly expensive conditions. if we keep ignoring them, we are less than civilized.

[kbolino]

No one was being ignored. People who didn't have the means to pay for costly treatment didn't receive costly treatment, unless they qualified for Medicaid or Medicare.

There is no magic money tree. If you consider it such a problem, then give more of your money to remedy it.

[R C Dean]

People who didn't have the means to pay for costly treatment didn't receive costly treatment, unless they qualified for Medicaid or Medicare.

No, they most likely got it as charity care from a non-profit health system.

[kbolino]

Until the government effectively eliminated charity hospitals, anyway.

But somebody had to (willingly) pay for it.

[generalisimo14]

There are so many people who think just like you. I see the poverty, disease, and suffering of others and I'm convicted to act. You and I, and many others, give of ourselves without thought of compensation for the benefit of others in need. This empathy is humane and socially responsible. So, I can agree with you to a point, and this is where we diverge. I see it as a greater harm to force others to my will, because if you can justify it for this instance then you have justified any other well intended tyranny. I see the righteousness of a philosophy of liberty. I see the utility of liberty. You are emoting, not reasoning. You are patently wrong in your assumptions and conclusions about the free market. WE ARE THE MARKET. We supply and demand. We express our values through the delegation of our capital. We, if free to do so, can choose to solve these problems as well as possible through our elective choice. Not only is state intervention less efficient, resulting in ALL of our wealth declining, but it is also less moral in that theft from some for the benefit of others is not charity, it is theft.

[generalisimo14]

Additionally, for the libertarian, there is no class or caste, there are only individuals, and each individual has the same rights as all others. Mutual respect, equality under the law, and liberty; which is what libertarianism is about. To give privilege to one group above others is what defines castes and class. You are advocating for the very thing you claim to abhor. Liberty is the answer.

[R C Dean]

when you ignore people who are denied treatment, like the free market did before ACA,

Welp, I've worked in hospitals for twenty years (and still do), and I can tell you this is completely and utterly wrong.

[cynicalretiree]

instead of focusing on cigarette smokers, how about looking at middle aged unemployed men with diabetes and/or heart conditions, wife with arthritis, and one of their kids who has asthma.
in addition, free market hospital care results in 1: cutting hours and time of the most valuable staff, the registered nurse, 2: stagnating the wages of RN's who are directly responsible for clients' progress.
we will never Fix health care to everyone's liking. free market hospitals are rarely the research hospitals where the progress in treatments are discovered. free market hospitals advertise as locations where progress began, but that's just free market advertising.

[kbolino]

free market hospital care results in 1: cutting hours and time of the most valuable staff, the registered nurse, 2: stagnating the wages of RN's who are directly responsible for clients' progress.

Do you know what "free market" means?

Why would an enterprise that competes on quality of care cut the wages of the most valuable staff?

What you are describing is what socialized medicine delivers: rationing and cuts.

[PaulID]

I can prove that markets work for medicine my doctor doesn't take any form of insurance he charges by the minute and he is usually busy though I have never had a long wait to see him he works a broad range of hours Monday through Saturday and will in a real emergency see someone on a Sunday he does house calls though they are more expensive the most I have ever paid to see him was around 140 dollars and that was for both me and my wife and included her thyroid blood tests, if we had gone to any of the doctors that take insurance just one of her tests would have been 300 dollars these fools that say that markets don't work need to try it because we have not had a free market medical solution for decades.

[Alice Bowie (is back)]

That's the longest sentence I've seen in my life.

The Free Market for Doctors works anywhere you have an abundance of rich people.

All of my Doctor friends DON'T TAKE INSURANCE. They don't need to. There's enough cash-paying patients.

Once you leave the City, Doctors depend on medicaid/medicare/insurance patients.

[kbolino]

The Free Market for Doctors works anywhere

Period.

We don't have a "free market for doctors" and haven't for at least a hundred years. The AMA is a legally sanctioned cartel.

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[Haha, charade you are]

Yet another example of leftists showing their true colors. Such ugly, hatred, comments uttered by the people who are supposedly the more caring and compassionate.

Get well soon, John.

[Gwen]

Back at the turn of the 20th century, "fraternal" organizations -- groups like the Elks, the Shriners, the Moose Lodge, and hundreds of others like it -- negotiated contracts with local doctors to treat their membership. The members were exhorted not to abuse the privilege, and paid a small amount per year in exchange for care from that physician. It wasn't waiting X days or weeks to get into a crowded hot zone of a waiting room, to get shuffled into an exam room to wait 40 minutes for the doctor to come in, give you a cursory examination, write you a prescription or an order for tests, and shuffle you back out to the front desk to get your receipt, total time about 9 minutes in front of the doctor. It was generally a house call, the doctor took as long as was necessary, and you got the best care he could give.

This was, of course, destroyed by legislation lobbied for by doctors who didn't like that they had to compete, and only got such small amounts. They wanted higher amounts and didn't want to have to justify it with anything so crass as "good care".

[kbolino]

The doctors' and other medical workers' professional associations definitely played a part in getting to where we are now. But at every turn, they rode the wave of popular sentiment to do it. If the voters had realistic expectations and held their elected politicians' to realistic standards, then the AMA etc. would have no power to grant themselves privileges.

[Jerryskids]

Those organizations also functioned as mutual self-help societies, their regular meetings included lecturers that preached on clean living and hard work and self-improvement being the keys to a better life. They acted as a peer-pressure group to enforce social norms of good behavior. If you drank too much, gambled away the grocery money, didn't take proper care of your wife and kids, didn't show up at the meetings, you were sure to have a few people sitting you down for a little talk about how a man is supposed to act. And if you got hurt on the job, there would be a group making sure your temporary loss of a paycheck wouldn't cripple your family - but the amount of their pecuniary concern might be directly related to just how much you drank and gambled and beat your wife and let your kids go hungry and how much you participated in helping out the organization and its efforts to establish the norms of clean living and hard work and self-improvement.

[SovereignMary]

John Stossel - I wish to say that I hope that you have a very quick and full recovery. Keep up the great and enlightening commentary!

[Mustang]

Ex-felon article links to the John Stossel article. Wish you the best John, but I want to read about ex-felons.

[Florida Hipster]

Me too

[Charles Easterly]

Here you are, gang.

If that works, put me on the payroll.

[SovereignMary]

People did not need health insurance for regular and affordable doctor office visits and treatments for colds and other mundane health issues years ago. Individuals and families only took out health insurance to cover what was once affordable health insurance for hospitalization.
Then along came the unlawful, costly and abusive middle-man Big Brother Federal government with its rules, regulations, restrictions, mandated paper work, newly created federal bureaucracies and frustrating interference between doctors and patients.
It also seems that once businesses and industries got on the bandwagon with supplying health insurance coverage for their employees then the health insurance providers, hospitals and nursing homes found numerous means and loopholes to jack up erroneous costs, expenses and billings which also included unnecessary as well as non-existent medical care.

[Jerryskids]

If you want to make an omelet you gotta break a few eggs.

If you want eggs, there's the Department of Agriculture and the health department that require licenses and permits and registrations, the local zoning board to permit the chicken house, plus of course the occupational licensing and registration for taxes and Labor Department and OSHA to deal with, plus you gotta pay for somebody to write the rules for building and operating a chicken house and somebody to inspect the building and operating of the chicken house. Then you have to ship the eggs to the wholesaler and the retailer and that involves additional layers of licenses and permits and registrations and taxes and fees plus the DoT for the trucks and the EPA for the refrigerators and Customs if you're using an imported pencil to fill out all the forms.

And that's not even considering that if you want an omelet you're going to need cheese which involves cows and milk and about twice as much regulatory oversight as eggs - and you don't even want to think about what it takes to get ham into that omelet. All in all, it's a wonder omelets don't cost about eighty bucks.

[bpuharic]

In 1965 childhood leukemia had a survival rate of 5%. Today it's 95%. The system you hate is a success except conservatives wish to deny it to the middle class and the poor

[kbolino]

And what the fuck does that have to do with things like Medicare?

HMO and ACA didn't do jack shit for childhood leukemia.

[bpuharic]

Govt money paid for research. Govt money paid for hospitals. Govt regulations gave us testing so we'd know which medicines worked and which didnt....etc etc

[Suell]

Thanks to the small bit of free market that is allowed in healthcare, bitch.

[MikeP2]

What a stupid comment. I don't know any conservatives who wish to deny care to anyone. The only question is who pays for it.
Would you pay $200k for chemo for a 90 year old life long smoker? $400k, $800k? At some point a value/benefit decision needs to be made if the taxpayers are footing the bill. A rich man may pay out of pocket for that treatment.....that doesn't mean society is then obligated to pay for the poor to have the same treatment. There has to be a line drawn somewhere....that is the argument. Any liberal who claims there isn't a line is delusion at best.

[bpuharic]

And yet when Obama proposed this, sarah palin called it death panels...

[colorblindkid]

"My local supermarket is open 24/7. They rarely make me wait, prices are low, there's plenty of choice, and they rarely poison me."

Brilliant.

[bpuharic]

Comcast is open 24/7 as well. Ever dealt with them?

[kbolino]

Comcast is most definitely not "open 24/7". You will not have a technician come to your house at 3 in the morning.

If you don't like Comcast so much, then stop using their service.

[bpuharic]

Comcast is a monopoly here. You seem not to know about it

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[bpuharic]

"Charity would help the poor?" Proof? Well...none. None at all. "Word would get around?" Proof? Well...none. None at all. The great assumption of the failed faith in free market fundamentalism is that information is both perfect and free. As anyone who's studied thermodynamics can tell you, that is scientifically wrong. Maxwell's demon must be paid for. And yet the fiction libertarians continue to push is that there is no cost to information.

So this precious fairy tale is nothing more than myth...a fable for people unwilling to face the harsh reality that libertarianism is just another recipe to make the rich and powerful moreso. Children who believe in Santa are cute. Adults who believe fiction should guide policy are delusional.

[kbolino]

Of course information isn't free. Who the fuck argued otherwise?

The problem isn't the cost of information, it's the inability of someone other than you to know what's best for you.

The only fiction is that the government cares about you.

[bpuharic]

He the fuck,argued otherwise. Who's going to,get it? The government, by REGULATION? The fiction the right pushes is that govt is a dictatorship and hides info apart from crony capitalism much beloved of libertarians.

[generalisimo14]

Oh friend, I'm actually pleased to see that someone has been treated so well by government, that they would come to "hostile territory" and take such a stand. Most government is well intended, and for the greater good. That only works if they are genuinely benevolent, like the philosopher kings of Plato (fiction!). The issues we are pointing out are systemic and borne out of rigorous logical deduction and experimentation (Read Mises, Hayed, Rothbard). A system of centralized planning is less efficient and just than one not as centralized (see communism).You are holding onto dogmas, not reason.

[bpuharic]

Me ses and hayek are objective? Hardly

[generalisimo14]

Respectfully, you are economically illiterate. Your reference to thermodynamics is evidence of this. Physics and the physical sciences are blessed with having cardinal measurable quantities to render into theory. Economics is a system of only ordinal values being scaled and compared. Econ is about human action, not hard physical laws (accepted theory, more correctly). There is a great body of literature that explains this, however, it is not favored because it is not useful to those who would rather use "economic science" for their gain (I mean the state and crony capitalists, who use intervention for gain).

[bpuharic]

When i was at Carnegie Mellon, Herbert Simon won the Nobel Prize in economic cs for his work on information and its role in decision making. Ilya Prigogine won a Nobel in chemistry for his work in thermodynamics and information theory including its application to economics.

There's and old saying that it's better to be silent and thought a fool than to speak and be known as a fool. You should never speak again

[jerbigge]

In a free market there would be no prescription laws (or drug laws in general). The patient would be the decision maker and the doctor the adviser. However the doctor would not have the ability to deny the patient the medicine that the patient has decided to take. This makes a really big difference to the patient. Most likely the patient will make his or her decision upon the basis of what they consider the most important, life span versus comfort. They may well decide to use a medication that may shorten their life, but will give them a degree of comfort and ability to do things that they would not have otherwise.

Oddly enough lawyers will glad do pretty much what the client wants, even if the lawyer is aware that you probably don't have a case. Doctors on the other hand tend to view their patients in much the same way as your vet might if you were a dog. They make the decisions, you don't.

This may be the reason there are so many malpractice lawsuits against doctors. If you are angry over how your doctor treated you, and there is a lawyer eager to file a lawsuit against that doctor for you, why not "get even with the bastard"?

Perhaps if doctors treated their patients as beings with legal rights, perhaps there wouldn't be so many lawsuits.

[bpuharic]

Another failing of the free market. Unless you have an MD, a PhD in biochemistry, etc, you're not qulaified to make such decisions. That's WHY we delegate AGENTS to act for us. The libertarian argument keeps failing

[generalisimo14]

So a wise specialist (you pick the specialization) should have power to tell you what to do with your own body? That is perverse. Perhaps you mean that the specialist is paid to consult, so the patient/consumer can make an informed decision. Libertarians build their philosophy around property rights, your body being the most sacred property you own. You should have the right to dispose of your property as you see fit, as long as you do not impinge upon the right of other in doing so.

[bpuharic]

Ever hear of division of labor and its effect on efficiency? So you'll get a PhD in aeronautical engineering so you can determine which plane is safest...an MD so you know which medicines are safe...a PhD in mechanical engineering so you know which cars are safe...a PhD in electrical engineering so you know which electronic devices are safe

Golly this libertarian stuff has some strict requirements!

Of course its more logical to let regulatory agencies like the FAA do it. We haven't had a plane crash in 10 years.

[Suell]

Stoss,

I don't know if you read the comments here, but if you do then please use as fuel all those dumb ass comments on WaPo. We are looking forward to more articles on the shit healthcare situation in this country. Keep it up. You friggin rock dude.

[don quixote]

Karl Deninnger references an article and says that doubling every 10 years, government health spending will collapse the economy but could fixed by enforcing current law:

"In 1940, entitlement payments ...disability ...Social Security to Medicare, amounted to just over 20% of annual government spending...Today ...has swelled to nearly 70%...

Medicare and Medicaid (combined) are roughly double the outlay of Social Security and yet they are funded at a rate of less than 1/4 that of Social Security via taxation. ... [Medicare & Medicaid in] Fiscal Year 2005, for example, spent a total of $652 billion. Fiscal Year 2015 spent a total of $1,297 billion, or close to a clean double in 10 years. ... That's a 7.2% growth rate which far exceeds alleged inflation... we're definitely overpaying by more than twice for medical care; we are in fact probably overpaying by as much as 80% across-the-board.

...then one wonders why there haven't been thousands of criminal indictments and lawsuits alleging racketeering and extortion filed against the administrators and doctors in all the other hospitals. If we stop this right now the Federal Government would immediately and permanently run a roughly $400 billion a year surplus....and the federal debt would slowly be retired at a rate of about a trillion dollars every three years."

http://market-ticker.org/akcs-www?post=231295

[bpuharic]

Private medical care expense has been increasing faster

[don quixote]

And why not, if the government & croney collusion acts to put a floor on prices? If it instead enforced existing laws, then the price floor would disappear and jailing of the first racketeers would encourage price competition. But even though (only) Trump said he'd enforce laws against the Medical Industrial Complex, it seems unlikely to happen... because he seems to have developed confusion about the "rule of law" in general.

[bpuharic]

Of course it's obvious libertarianism has failed in that it can't account for the cost of technology in medical costs. Thus proving my point it's a fantasy

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[Eman]

"Doctors would advertise prices"

assuming someone doesnt pass a law making it illegal to mention the important differences. theyd probably end up advertising who has the freshest flowers in the waiting room.

[timbo]

The best thing would be to just have the government pay the doctors and have all services at the same price. That way, customers would not feel envious when someone got better care for better service provided.

People seeking profits is what makes our healthcare system so bad. Why should someone be paid more money than me for providing a much wanted service that takes an incredible amount of skill and brains to perform adequately?

[timbo]

This is such 1 percenter logic. Free markets are what got us into all of this trouble with the rich going to poor people's houses and stealing their stuff.

Of course free healthcare would work because no one would have to pay for it. The quality would be better than it is now because these evil profiteers would not be trying to make money and would just do it out of kindness.
Every single person in the healthcare industry would thus make more money because minimum wage laws would guarantee their happiness.

Once there were no costs associated with people's labor, then we could get down to making everyone the same and healthcare would be affordable because no one would expect compensation for their labor or services.

[Johnimo]

We can only assume that you're being facetious. Either that, or you're one of the most ignorantly uneducated boobs ever. The society you recommend exists a mere 90 miles off the coast of Florida. We all know how many folks have been risking their lives on rafts trying to break in to the Communist paradise that's Cuba.

[JeremyR]

Good luck with the lung cancer. My mother had it and pretty good insurance (she worked for the library) and was treated like crap by the health system (i guess in part because while her insurance was good, it wasn't great).

Anyway, while a free market would probably be better (I don't think anything could be worse than what we have now), at the same time, I'm not sure you can have a free market in medicine.

Firstly, drugs. You'd have to have free access to drugs without a doctor prescribing them. Can people self proscribe? And what about things like anti-biotics? Overuse of them means that bacteria becomes resistant

Secondly, for a true free market, you'd have to get rid of patents on everything from medical devices to drugs. As a side effect, this would hurt research, but you can't have a truly free market with patents.

Thirdly, training. You'd have to let doctors and nurses be doctors and nurses without certification.

Is any of that ever happening? No. Not ever. So there will never be a free market in medicine. I'm not saying socialized medicine is the answer, but let's be honest - almost every 1st world country has it, yet spends about half as much on health care as the US does. Somehow they manage to do it.

[EscherEnigma]

There's a big assumption here that people don't pay for their healthcare. If that were true, medical debt wouldn't be the #1 leading cause for bankruptcy in America.

That said, what's stopping hospitals and doctors from advertising their prices? They may be unwilling to advertise iron-clad prices, but they could certainly say "for procedure X, with insurance Y, the average cost to the patient is A with a standard deviation of B." Face it, in most areas there isn't *that* large of a pool of insurers.

Then again, for many people there really *isn't* room for competition. There is exactly 1 hospital within a hundred miles of my town. If you need emergency medical care? That's where you're heading. If you need specialist care and can't afford the out-of-town trips (whether it's due to direct cost, having a car, or can't afford the time-off from work during business hours for a day trip), then you don't have options. And for non-metropolitan areas, I don't think that's an unusual case.

There's lots to be said about the Free Market. But the first step is that people have a realistic ability to shop around, and that requires both (A) information and (B) availability. There's nothing stopping doctors/hospitals from sharing sufficient information already, and there's nothing about the Free Market that will realistically improve availability in most of the US.

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[Tweak]

"As a result, few patients know how unsafe American medicine is"

There are people who'd jump on this so quickly with counter-arguments involving the value of the DEA, USDA or the FDA and how they are somehow inherently noble where the private sector isn't...or something. Yeah, right. Results matter.

But nevermind that for now.

What's even more abhorrent than people's misunderstanding of free markets and the consequences of government monopolies is their behavior toward another human being who's sick and deserves quality treatment just as much as any Sander's supporter. That's typical tribal leftist behavior though: "I only give a rat's ass about you if you agree with my economic and social philosophies, and if you express anything to the contrary that may threaten my world view then I'll treat you like shit." The fact that they feel so threatened by another's ideals somehow turns them caustic in every other area of their thinking and behavior and it then becomes impossible for people like this to be civil, despite the fact that they purportedly "care so much about another's well-being."

Sorry, I just have no tolerance for that.

Anyway, keep fightin' the good fight!

[DrZ]

I wonder what it is in the wiring of the liberal brain that only allows them to believe that the government is the only agency that can run a healthcare system?

Why does the left believe that medicine can never operate in a free-market system?

A few things need to happen and they are not going to be trivial, not because of the effort, which would be considerable, but because of human inertia:

- Insurance companies must be able to see anywhere. Get rid of state insurance commissions.
- Amazon-like gather places where medical services are put out for display along with user comments. The internet holds wonderful potential for ordinary people to discuss prices and results. Insurance would also be sold in this environment.
- Tort reform which adds to the cost of medicine.
- Either get rid of tax advantages completely, or give these advantages to everyone, preferably in a tax-free HSA account. This means getting federal and state governments out of the health insurance business. It also means getting the employer out of the business too. The employer contributes to individual HSAs.
- No first dollar cost sharing. No co-pays, no deductibles, first dollar comes out of pocket. This contributes to creating better medical services/drug shopping.

In short, the consumer, the patient, needs to be the buyer of most services. It is up to the patient gathering information and working with his chosen doctor to decide what is best, not the federal government.

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[Uncle Jay]

RE: Yes, Free Markets Would Improve Healthcare Results

Yes, free markets would improve healthcare costs and results.
But that's not what it's about.
It's about controlling the unwashed masses with healthcare.
Just ask Hitler or Stalin.
Just look how well it worked out for the German and Soviet people.

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[Brochettaward]

A sane Michael Hihn post. Next I'm going to see a unicorn.

[Rufus The Monocled Derp Slayer]

Canada's lack of equipment is an abject embarrassment.

BUT WHO WILL PAY FOR IT?

Retards. One and all.

[kbolino]

Obama agreed there's a problem when his grandmother gets a costly hip transplant, when she was ALREADY terminal cancer, and died a few months later.

But it's not a problem if grandma is paying for her own care. She may have wasted that money, but it's hers to waste. The problem is that no amount of messaging is going to convince someone of the flip side as well; if grandma had a curable or treatable illness but no money to pay for the treatment, and no one willing to foot the bill for her, then she doesn't get treated.

At some point, you are going to have to accept that, despite the now-ancient poll you keep trotting out, there is not a hidden majority of people who secretly believe in libertarianism. Most people when pressed will not accept that the government shouldn't be, at the very least, the payer of last resort.

The only outcome which stands a chance in hell of seeing the light of day is a technocratic but not particularly libertarian one in which the government takes a far too active role but much less than it does now. The real problem, which you don't seem to understand, is that such a solution will not last more than a decade. People and politicians will clamor for more to be done, and we'll either end up more or less back to square one, or worse yet, in a fully socialized system.

[kbolino]

Ultimately, it's not the Libertarian Establishment's fault that most people want the government to take an active role in the health sector. In the public discourse, the acceptable options extend from "partially privatized, but with the VA and Medicare" to "fully socialized".

[LynchPin1477]

We spend a quarter-million to extend a life by six months or less

If people were paying more out of pocket, then we probably wouldn't do that quite as much. It wouldn't go away entirely, but there would be more cost-benefit analysis going on.

How many readers know that Medicaid eligibles had HIGHER uninsured rate than in the private market.

I did, but I'm having trouble understanding why you are bringing this up. Do you think this is a problem for libertarians? Something we don't have an answer for? Or something we should be focusing on more?

[Lord Humungus]

*unicorn flies overhead with a sparkling rainbow trailing behind*

[Pompey]

It all goes haywire if he's disagreed with. do it, you know you want to.

[Pat (PM)]

How would you SELL liberty, to someone who needs persuading?

I'd incessantly badger people who I already ostensibly agree with by copying and pasting the same trite bullshit over and over again on a poorly-frequented blog comment section and pat myself on the back for once placing 4th in a 4 way election for local insurance commissioner as if it somehow afforded me some level of credibility. But that's just me.

[sarcasmic]

How would you SELL liberty, to someone who needs persuading? Just in general.

That's a good question. I mean, how do you convince a slave who has been asking permission and obeying orders their entire life that they can actually make their own decisions about their own life? I dunno. I guess it would be a hard sell. Some people are comfortable in chains.

[Scarecrow & WoodChipper Repair]

You can't, as long as there's a coercive government in the picture. One of my pet peeves is the idea of the rational voter not caring because they know their individual vote is unlikely to decide an election. No, it's deeper and simpler than that: people have one vote to stand for every political choice. One vote has to stand for abortion, gun control, trade policy, foreign policy, the degree of CIA/NSA/FBI spying, air force vs navy vs army, FDA, FCC, nuclear power vs coal vs fracking -- everything. Only delusional people think any specific candidate has the perfect combination of policies for their tastes. Most voters instinctively know that they really are voting for the lesser evil, and all choices are so evil as to make any choice pretty bad.

As long as government is redistributing everybody's money, no one wants to be the first to give up their benefits. Life with coercive government becomes a battle for benefits, to make sure you get your fair share before others get more than you do, and since no one can actually tally up benefits because they are so complicated, it simply becomes a battle for more and more at everybody else's expense.

IFFFF everybody could vote on everybody giving up benefits simultaneously, and if everybody actually knew that would happen, I think people would vote for it -- but then there's defined-benefit pensions and other accrued future benefits, which no one thinks it would be fair for anybody to lose after having paid into them.

[Catatafish & Woodchips]

Ouch.

[Citizen X]

Oh snap!

[generalisimo14]

First, Mr. Stossel, my best wishes and prayers to you and your family, I pray we celebrate your health in the near future.
After scanning the thread I see two things I wanted to note. First, Mr. Hihn, I enjoyed your comments and look forward to seeing more contributions in the future. Second, it is obvious that we libertarians/Libertarians need to rebrand our message in a way that is amenable to the masses. I give to various organizations that support the cause of liberty and I see a lot of effort going into education, but not a lot of branding. Businesses don't spend money on marketing because it doesn't work. They do it because it offers a return that is quantifiable and necessary in light of competition. The market of ideas works in the same manner, and we need to have a focused effort to rebrand our message so that it is more widely accepted. I engage many people about liberty and have learned that Americans love liberty, even if they actively or unknowingly work against it. Most are well intended, most consider themselves honorable, and most are ignorant of economics. Why not adopt whatever means attain the end. Let's sponsor a NASCAR for the Rs, and we'll get a Hollywood type for the Ds, then we need to plaster the "libertarian chic" everywhere possible for the guys and Mr. Stossel in a Speedo for the girls. I jest but not really. How can we package this beautiful message so that it gets the widest dissemination?!? Ideas?

[Seguin, the Mighty Monoclops]

That wasn't just a burn...it was Hihncineration.

[Bobarian (Would Chip Her)]

Hey now! Don't forget to come on late at night and corpse-fuck some dead threads so it looks like you won some of those arguments.

[Lee G]

They don't recognize the chains as such. To them it's government benevolence of the paternal and maternal types.

[kbolino]

There's reason they bleat "government is us". To imply otherwise would be to reveal the nature of the beast.

[CatoTheChipper]

The same losers who yearn for "government benevolence of the paternal type" also screech about the oppression of the patriarchy.

I suppose they really just want their slavemasters to be women?

[A Cynic's Guide to Zen]

"The Proletariat have nothing to lose but their chains!"

[dantheserene]

"they really just want their slavemasters to be women"
I think I saw a website about that once...

[neoteny]

as long as there's a coercive government

Life with coercive government

As John Hasnas wrote in his essay about the ethics of lobbying:

"[...] government action is coercive action. Legislation and regulations are not optional. They are not suggestions that private parties may decide to obey or not as they see fit. They are mandatory prescriptions backed by the government's threat to use force to achieve compliance."

[IceTrey]

Im a free market it wouldn't cost a quarter million.

[DOOMco]

Hes talking about you.

[DOOMco]

You're becoming unhinged.

[generalisimo14]

MH, Thanks for the thoughtful and civil response. Economic illiteracy is a key factor in this discussion also.

[generalisimo14]

You are right, on the surface which is all most people see, about salesmanship not policy being key. Few voters dive to the pelagic of classical liberal philosophy and far less arrive at the abyss of Austrian economics. So to attack the 59% you cite as fertile libertarians, if not in name, then in ideas, how best to do this. In the short term, the L party's ability to field a national debate participant is key. I've made a personal decision that Petersen is the guy for this job. Currently the R party is shattering; mostly the conservative factions are being marginalized by Trump and his populist demagoguery. Petersen's pro-life and constitutional stance is welcome planks to an R conservative and to Americans in general. He is also not as quirky as Johnson (viewed as pothead), or as racy as McAfee. 15% is what we need to have an L stand next to Clinton and Trump on a national venue.
So you understand electoral politics. Please enlighten me, seriously, about your thoughts to bring the message of liberty to a broader audience.

[Ship of Theseus]

generalisimo14 is clearly Michael Hihn. Or his son. Or grandson.

[generalisimo14]

clone...

[generalisimo14]

I'll engage when he/she is civil. Otherwise I'll avoid. There's some god stuff on these threads.

[generalisimo14]

good 😉

[bpuharic]

How many MRI's existed then? You, like all right wingers, think non xtians should be under control of xtians. Sorry...the 1st prohibits that. And private charity could not keep up with the cost of technology. Your argument is so incoherent it's not even wrong.

So if you're willing to live with medical technology of the 1940's go for it!

And medicare recipients, BY DEFINITION, are older and sicker than those with private care. oops!

As to medicaid...the income cut off in Alabama, for example, is $9500. Know any poor people who make more than that?

The US govt spends more because our free market system is inefficient compared to socialized medicine, as the facts show.

So everything you posted is wrong or just plain propaganda

[bpuharic]

In the last 30 years the income of the 1% has tripled while middle class incomes went up 0%.. But the right really wants us to believe, on faith, the 1% are 300% more valuable than 30 years ago. Libertarianism is economic creationism

[don quixote]

Thanks Michael for the link.