Mary Warner, in the previous post about healthcare:
I’m one of the millions of Americans already benefitting from Socialised medicine. I’ve been on Medicaid since last Summer. Before that, I’d gone a few years with no insurance at all, which was very difficult as I have pre-existing conditions and some expensive prescriptions. But even so, I’d much rather have the US scrap all mandated insurance, and abolish the most of the regulations we currently have, and try to return to an actual Free-Market system. We have far too much Socialism in this country already, and letting the Government into everybody’s private medical concerns would just let them continue to erode our freedoms even farther, I think. This could very well hurt myself, I know, possibly severely. But what’s right for society, and what’s most beneficial to oneself, are not necessarily the same thing.
You’re all going to gang up on me over this, aren’t you?
There shall be no ganging! For I am one, and therefore I shall not gang.
Look, I get that libertarians recognize – correctly – that the United States is not a classical free market when it comes to healthcare. But as many a writer has pointed out better than I could before: a perfect free market in healthcare cannot exist, because in order for a free market to operate properly, consumers and sellers need a perfect amount of information, or at least something close to it.
You can’t get that in healthcare, mostly because medicine is so complex that doctors actually have to specialize in sub-areas of it to have a realistic shot at doing their jobs properly – forget about you, the non-doctoring schmuck, being able to accurately determine which treatment is best for you, even if you spend whole days on the internet. You can’t do it; even doctors mostly have to make educated guesses for the serious stuff. And that’s before you get into the idea of effective cost. Do you feel confident taking the $1000 surgery over the $1500 surgery? Christ, I wouldn’t – but that’s not a rational decision based on the relative skill of the surgeons, it’s just the root assumption that the more expensive surgeon is the better one, which isn’t necessarily true and how could I tell?
(I’ve had people seriously inform me that they know how good hospitals are based on the politeness of the staff. I mean, polite staff are nice and all, but I will pick “staff more likely to save my ass” over “staff more likely to ask me if my pillow is fluffy” ten times out of ten.)
On top of that, it’s not a free market because for the majority of serious treatments, you don’t have the opportunity to refuse. If you need chemotherapy and it’s two thousand bucks, you are not going to sit back and say “well, I’m gonna wait for the spring sale.” You spend the money. And you spend it right away. Because you’re a captive to the necessity of care, and therefore you are not a rational, discerning consumer.
And on top of that, you need some form of regulation because, hey whoops, healthcare is really expensive. There are exactly two ways to lower this cost and neither one of them is “competition.” The first way is for government to mandate how much healthcare costs, typically by employing all the doctors, or alternately by telling doctors what they can charge. The UK goes the employment route; Japan, Canada, and most of Europe goes the dictating-prices route.
The second way is through massive risk-pooling. The concept of insurance is simple: everybody pays a little into a collective fund against the risk that something bad happens to them. If something bad happens to you, the people who did not have something bad happen to them’s money goes toward fixing your something bad. This way, everybody pays a little, rather than somebody going bankrupt because of the bad thing (and since that bankruptcy can have ripple effects, in the long run it’s better to help them anyway, so it’s basically win-win).
But that concept doesn’t work for health insurance, because unless everybody dies a tragic instantaneous death or is healthy as a horse till the age of 98 and then dies peacefully in their sleep, what happens is that eventually everybody will get old and need to access health insurance – and the old people who use health insurance the most are also the biggest drains on the system. Thus, the only way health insurance works is if the healthy, young majority subsidizes the old, sick minority, on the theory that eventually they too will be old and possibly sick and will want the young people of tomorrow paying their way. And so on, and so forth. But this only works if the young people pay into the health insurance system – which (beyond maybe catastrophic health risk insurance for those inevitable bus crashes) they have absolutely no selfish incentive to do, because they are young and healthy and don’t really need health insurance to cover their yearly physical.
Thus, the concept of mandated insurance and/or universal participation. This is the other way that every country in the world with a decent healthcare system lowers costs. It works, and so the right-wing in America is predictably shitting a brick over the idea that it be proposed.