And, if you want to talk care and outcomes, let's pick the most grim of diagnostics: Cancer. Japan's 5-year survival rates are among the highest in the world, and the highest in particular cancers such as colon and rectal cancer. And, FYI, the US isn't #1 in survival rates for all cancers. It's spread evenly through the G8.
And, the most free of supposed free markets and tax-friendly wonderlands, Singapore, also puts price controls on procedures, with similarly successful outcomes. So it isn't a cultural or "economic" thing, it's a government thing. It always will be. An adult just needs to come in, put their foot down similar to what Tommy Douglas did in Canada, and declare either we all buy in to a government-run healthcare system, or we buy in to the government completely regulating the market much like it does the stock market or agricultural industry. States will have no say, no quarter, or feedback. They can choose to secede from the union to opt-out of the program.
And, while I love me some comment karma, I know that my position is tantamount to heresy on this board, so, get your dismissive hand cocked and ready to wave me away :D
What would happen to the food market were it not for the generally high supply of food? It wouldn't be pretty.
Because of that, some sort of non-market intervention is simply unavoidable. As are the inefficiencies that go along with price controls and other similar endeavors. Ugly stuff, this healthcare business.
Not necessarily. Suppose you have a deadly condition. Your information is extremely limited as non-professional. Would ... you can pay all your money now for the cure your doctor offers or you can wander over to an unknown provider for the best price? The quality of unknown providers is ... unknown and your doctor is known. And he knows he's got by the genitalia and will charge accordingly since with even a thousand unknown providers, your real choices are very limited.
Just as much. Presently, no American hospital publishes its price list. I believe there's no regulation about this. Why hasn't "the market" impelled these providers to publish their prices.
you don't have time to shop around for services while unconscious in the back of an ambulance.
It is true that some people will choose badly when left to their own devices, but that's better than forcing the same dumb rule on everyone. Each of us is an end in ourselves. So long as we do not violate the negative rights of others, we are responsible only for our own lives, not the lives of our brothers.
No man is an island. Neither you, nor anything you create is created in isolation.
Dependencies are ever-present and failing to understand this leads to failed ideas such as "true free market" not unlike the idea of "true communism".
In reality the very fact that you are alive to write your words is a testament of other peoples effort including your parents to guard you against the many many dangers in this world.
Ultimately you don't own the right to anything, not even yourself.
It's an agreed upon right not a natural law.
I agree that there are some times too many regulations. But claiming what you do here is simply wrong in a very unfortunate Ayn Rand way.
You turned cause and effect upside down. You think the free market for food "works" because food supply is "abundant"? Think again. The supply is high because it's market is "free" (not really but fairly) globally and (sorta) works.
Healthcare can be broken up into a lot of smaller markets, and for a lot of those the free market works just fine. The market for coffee in the cafeteria of the hospital works fine as a free market. Do you know what percentage of healthcare cost pertain to the cost of the actual treatment itself? (hint: it's a very small part)
The Japanese system is not without its problems. More importantly, the "price fixing" approach to health insurance simply isn't going to happen in the US. What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat.
Why wouldn't it? Would there be riots in the streets? Roving gangs of healthcare-affiliated hooligans throwing rocks, burning patient effigies? Doctors lining up to leave the country en masse for a freer medical marketplace or just throwing dirt in the eye of medicine to go be a quant trader at a hedge fund?
The more important question is: Why hasn't that happened worldwide, in places where there truly _is_ universal/free/government healthcare?
"What parts of it do you think we really can adopt? Because nobody is going to fix US healthcare by fiat."
And, nobody but the rich and upper-middle class will be able to afford healthcare by Market. We can already see that today, with over 50 million uninsured Americans, up from 37 million just two years ago. How many will it be next year?
My objection to your point is twofold:
(1) It is total wishful thinking.
(2) It's wishful thinking in the face of pragmatic solutions that could resolve the problems we have now without utterly restructuring the market for health care.†
I'd also appreciate it if you wouldn't attempt to frame any critique of your comments in terms of "you're either with me or against health care reform". As you can see from a casual glance at this vast, Reddit-like thread, few opponents of health care reform would dare poke their head up on HN these days. I'm not an opponent of reform.
† Recap of my wish list: mandatory guaranteed-issue private high-deductable health insurance, an exchange-type system that fosters 5+ insurers in every major market (up from the 2 we have today), and broad adoption of cost-cutting services like telemedicine-issued scripts and nurse-practitioner clinics.
Funny mental picture though :D In my head they're wearing those stereotypical nurse hats and brought their own stretchers to carry off the wounded / exhausted / weaponry.
I can imagine a scenario where the age for Medicare was lowered slowly over time to cover more and more people. (Unlikely, but not beyond the realm of possibility).
Everything has a price, but that seems a little lopsided.
I generally trust a self-correcting free market over a government bureaucracy to solve such problems, but in this case it seems the fundamental problem is that there just isn't enough margin for for-profit insurance companies to prosper without turning the screws on either doctors & staff, patients, and/or taxpayers.
In fact, forcing US hospitals and doctors to publish a price of any kind would be a simple improvement.
It is amazing with all the other twiddling that this approach never appears - at least not much.
Hospitals are private, and both they and doctors negotiate every two years to set prices for everything from MRIs to stitches. The insurance industry is also private, but they have a public-run insurer for Japanese poor. AFAIK, taxes are taken just for the public-run insurance, to which only a small percentage of Japanese apply, but for private insurance (which the rest are mandated to have), it's paid through premiums per month, which is on average about $250/mo per family (and employers pay for almost all of that).
The government is getting a pat on the back for removing essential services because the masses aren't taking notice; we've fanboy-ed our system while ignoring its degradation of the fundamentals. Our current system is not a positive guideline to success.
A Macleans article about the state of our system: http://www2.macleans.ca/2011/01/25/our-health-care-delusion/
Bulk billing is so much more convenient for everyone that you'll see signs advertising it on the outside of doctors surgeries, thus the cost of care is kept down. On the other hand, the doctors are free to charge what they want. Sounds like a fair way to do it.
And the funny thing is, Singapore and Japan both are rather well-off nations, not much different wage and price wise than the US. Biggest difference is medical cost...
The problem with comparing global stats like cancer survival rates is their weak correlation with the health care system. For example, the reason why colon/rectal cancer survival rate is high is because Japan is basically the only rich country where those cancers are the most common one (in other rich countries, prostate, breast, lungs usuallly come first for the concerned sex). There is also the issue of "free-ride", where most western countries benefit from research being done in the US and a couple other countries - which is not so easy to quantify either.
Designing good indicators is incredibly hard, and for that reason alone I think it will always be a political question first, and an economical one second (i.e. economics can help making a decision, but it won't give you the decision).
Incidentally, as near as I can tell, a hospital in Japan is equivalent to a clinic or doctor's office in the US. They also seem to be open weird hours. (example http://www.youtube.com/watch?v=Mi31MJrRjhE)
