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Prices Prices Prices
Vox’s Own Goal on the Single Payer Pivot
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  • S.C. Schwarz

    You expect serious policy analysis from Vox? They’re just another liberal propaganda outlet.

  • Andrew Allison

    I’m confused. Other than retaining the overhead and profits of private insurance, how does does all-payer rate-setting differ from single-payer rate setting? On a tangential subject, isn’t the fundamental problem that the demand for health care is very elastic, namely that lowering the cost of obtaining health care, whether by subsidizing premiums (ACA) or care (Medicaid) significantly increases the demand. It seems pretty obvious from all the more-or-less successful single payer systems operating around the world that even providing bare bones care to the entire population is barely affordable. By extension, providing the standard of care to which the insured have become used to everybody is completely unaffordable. Simply put, it’s a typical socialist problem: cake for some and bread for the rest, or bread for everybody. Churchill put it rather more trenchantly: Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.

  • FriendlyGoat

    Price transparency is the key and you will not get it without government coercion. Thirty-five years of empty talk and wheel spinning have proved this beyond a reasonable doubt. The medical business community IS NOT going to do this by itself.

    • f1b0nacc1

      You have said this many times, and while I believe it to be an honest point, it really doesn’t make a lot of sense. Price transparency, while highly desirable, is not in and of itself crucial to real competition. There is very little price transparency in the computer market (hardware or software) for instance, and we see quite a bit of competition and huge drops in prices against massive gains in productivity. Observed value-add vs price provides a much better metric, and here we can see quite a bit of room for transparency, particularly through the action of third parties, not necessarily the government. I don’t necessarily disagree that price transparency wouldn’t be a good thing (in fact I think it would be an excellent development), but it doesn’t necessarily require government intervention for it to occur. In point of fact the intrusiveness of governmental regulations like HIPPAA make it far more difficult to obtain real transparency than might otherwise be the case. A non-governmental third party ‘certifying body’ could for instance provide such a service (think of it as a Consumer’s Union for medical coverage), and those providers that didn’t participate would be at an automatic disadvantage. Insurers might find such services quite useful, and in fact a model for this sort of thing could be Underwriters Labs.
      The Medical community isn’t likely to undertake reforms as long as they are protected by licensing requirements and can engage in rent-seeking with local governments. Introduce real competition, and encourage third-party observations and actions by stakeholders other than providers, and you will see changes.

      • FriendlyGoat

        Nothing against Consumer Unions, but without government coercion, I think MOST providers (not a few) would simply refuse to participate, citing their right to keep “proprietary” information secret and possibly citing phony “concerns” about patient privacy. Given how much of our medical bills have been borne by employers in the non-medical business community, if non-government price transparency was easy to get, we’d already have it. Instead, without government, we got all these “networks” where insurers and providers have secret pricing contracts and citizens are left out of the loop.

        How crazy is THAT? We didn’t have enough backbone to pass decent laws about pricing, so they screwed us for a few decades. Citizens ARE government, when they decide to be. We are late, late, late controlling the game in the way we should. The providers’ product is not that much better in this country than others, so why are we paying double year after year after year after year?

        • f1b0nacc1

          Oddly enough we don’t disagree entirely on this. Some providers WILL refuse to participate, but they will find themselves in a bit of a quandary when the insurers (who are paying for this nonsense) will start to demand more transparency in order to lower their own costs. The consumers aren’t even relevant here, it is those paying the bills that matter. As for the insurers colluding with the providers, some will continue to do so, but as it becomes increasingly difficult to maintain profitability, some will inevitably jump ship (see basic game theory), and that will be the beginning of the end.
          As for the value of the product, if you do an apples-to-apples comparison (without cherrypicking data…forgive the puns), there is a huge difference in the quality of health care. I don’t like the prices either by the way, but I am not foolish enough to believe that if you simply impose a mass of regulation (which the providers and insurers are in an excellent position to avoid, think of regulatory capture as the model) that you are going to change anything for the better. Healthcare, like it or not, is a product, and unless you choose to enslave the producers of that product, they ultimately will sell it for what they choose to. Change the incentives, and you change the game…

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