The real drain on the system is Medicare and Medicaid. Government programs that have been riding on the back of the free market for years. The problem has always been cost shifting and providing health care to people who have never paid in.

If it werent for employer insurance the whole scam would go belly up within a year.

It is your doctor’s choice whether or not he takes your insurance. Want to see him or her? Pay cash. Don’t rely on a third party payer, taking a big cut of the cost themselves in return for your freedom from doing the math.

Insurance,in my opinion, shouldn’t cover regular office visits. Anymore than car insurance should cover oil changes.

A doctor is just a businessman who trades in something you want to buy. Please don’t make it my problem or the government’s problem by trying to demand that the government reduce your costs, at my expense.

"My question is how do we fix this? Is there a way to untie healthcare from the workplace? "

Really? Yes! Quit lying about national health care being "insurance" and switch to a credit model!

That should look familiar.

Why would you make a law against raises? Does someone understand the logic?

The staying with one employer thing is mostly a myth. Even back in FDR's time most people didn't stick with one employer. So that doesn't have anything to do with this conversation.

A more human effective solution than Rad's recommendations, stop exempting health care benefits from taxes. Obamacare drove up the price of insurance (even for group plans). It appears to be near the breaking point. So raising the costs a little more may be enough to collapse the employer based system and push everyone into the individual market. At which point most will just pay cash.

Nicole, it was one of FDR's many wartime economic "reforms". He took advantage of the situation (never let a crisis go to waste!) to pretty much turn the U.S. into a command economy. One can argue that wartime made a certain amount of this necessary. But FDR was obsessed with "war profiteers" and wanted to maintain an image of watching out for the little guy.

But the effect, for middle-class people, was that the only way to get a raise was to change jobs. Employers found this frustrating, because they couldn't compete with offers for higher-paying jobs that their employees received from other companies. Providing health benefits was a way around that problem.

NicoleK, this was during world war 2. Everything was rationed, including jobs. The law against raises was put in place to prevent employers from poaching workers from other possibly war necessary companies. The rationing laws went away with the end of the war. But some things like employer based health care stuck around. Rent control in New York and other places is another WW2 hold over that should have gone away a long time ago.

Why would you make a law against raises? Does someone understand the logic? ~ NicoleK at December 19, 2018 6:54 AM

Nixon imposed wage and price controls in order to try and blunt the runaway inflation leftover from the Johnson administration.

Nicole, it was one of FDR's many wartime economic "reforms." ~ Ben at December 19, 2018 7:10 AM

Not just wartime. FDR monkeyed with wage and price control measures throughout his administration. Read The Great A&P wherein FDR's administration tried to throttle A&P's price-cutting, arguing that higher grocery prices were good for the consumer and for the economy. This was during the Great Depression.

FDR believed strongly in Keynesian economics - wherein a controlling authority, the government, could and should monkey with the economic levers to achieve the ideal economic outcome.

Even Keynes admitted there were limits to what that controlling authority could accomplish, but FDR and his administration never accepted the existence of any limits.

I’ve long been intrigued by a system of private individual, high-deductible catastrophic insurance, as that’s what I generally got between jobs. With the option to purchase a plan with a lower annual deductible for those who do have chronic, pricey health conditions.

Two things to solve for:

1. Doing that with no lifetime cap (or a cap that wouldn’t get wiped out by a cancer diagnosis).
2. Making sure those who want to be responsible and get insurance aren’t denied for preexisting conditions. Or that the high-risk pools don’t suck as much as they used to. My husband was attacked on the street (knocked in the head) when he was in college. This was considered a pre-existing condition by every major insurer and they all denied him coverage on the individual market (he’s self employed). Our attempts to get him into the state high risk pool were met with a waiting list and some weird catch-22s. And I’m not entirely sure he belonged in a high-risk pool anyway, as all he wanted was catastrophic coverage (his “condition” requires no ongoing care). Obamacare kicked in before he got into the pool anyway, so he bought high-deductible coverage on the exchange until we got married and he got covered by my employer. Cousin was in a similar situation due to a long-ago hit-and-run he was the victim of.

Two things to solve for:

Health insurance, like fire insurance, homeowner insurance, etc. is a pool of money from which expenses (claims) are paid. Premiums are set in expectation of the amount that analysts project will be paid out over time.

The problem with pre-existing conditions is that many people with them don't attempt to buy insurance until they find that they have that expensive medical condition. To have enough money in the pool to cover pre-existing conditions, we need to get people in the prime of health to buy insurance.

Until we can compel or influence healthy people to buy insurance, we're going to need to find ways to cut costs to a level that the pool can afford to cover; that often means denying those with newly discovered conditions from joining the pool after the discovery of an expensive medical condition.

Employer-based pools mean pools made up of people healthy enough to work and ambitious enough to work - often meaning people with less sedentary habits (although with work being mostly sedentary these days, that assumption is out the window). They also mean pools in which employers pay at least half the premiums, giving insurance companies some assurance of getting paid.

Severing health insurance from employment means increasing the take-home pay of employees, but with no guarantee the employees will spend that windfall on health insurance. And if they don't, they'll still get care from emergency rooms and hospitals - forbidden by law from denying a minimum level of care to the uninsured, a bill the pool of insured must pick up.

The self-employed who are looking for insurance coverage for major expenses like cancer are out of luck with Obamacare, which dictates that everyone gets full coverage - coverage which can cost them thousands every month in premiums.

Two years ago, I looked at getting a policy for self-employment and found that, with the cheapest policy, I would spend well over $200,000 before coverage kicked in - between the monthly premiums, the deductible, and out-of-pocket expenses. And the premiums would run over $100,000 per year to insure two of us.

You may have missed the real gotcha with Obamacare Conan. When I bought one I found out that the doctors they advertised as accepting the plan actually didn't. I could get all the coverage (after deductible) at a hospital. They all took it. But I couldn't see any doctors or nurses at the hospital since none of them took it. And since they then knew I has insurance that they didn't accept I couldn't even pay them cash.

Though part of that is my age. Talking with others if you are around 55 or so then Obamacare works really well. Insurance costs went down and doctors are quite available. My problem is I'm under 40. So I was expected to pay for all those 55+ people and get nothing for it. Hence the death spiral as people like me dropped insurance.

I know artists who got health insurance via a group rate for artists who joined the association. A group can negotiate a discount. Such group coverage was banned by Obamacare. Group coverage outside of a job had been available to many associations (Doctors, Dentists, artists, others).

Staying with one employer has everything to do with pensions but nothing to do with health insurance. If you change jobs they just want proof that you had insurance at your old job (or take a physical) in order to sign you up.

"Such group coverage was banned by Obamacare. "

I was going to mention that. I think that aspect of Obamacare was overturned by the set of changes to the law last year. It was one of the things that demonstrated to me that Obamacare had no intention of actually doing what it promised -- if it did, then it would have encouraged such ad hoc group buys, rather than banning them.

Health insurance is screwy anyway. It really isn't insurance in the dictionary definition of the word. Not like, say, fire insurance -- odds are that your house will never burn down in your lifetime. Because the risk is unlikely to occur, premiums can be cheap; most policies will never have to pay out. On the other hand, if you live long enough, it is practically guaranteed that you will need expensive medical treatment at some point. So health insurance needs to be treated as more of a savings plan. As such, the employer-funded model is just about the worst possible solution.

Step 1 is to give individual and group policies the same tax treatment as employer policies; the individual should be able to pay their premiums with untaxed money. Step 2 is to actually use the Commerce Clause for its intended purpose, and eliminate all of the regulations that prevent policies from being sold across state lines.

Step 3 is to disincentiveize free riders. I admit that I have no idea how to do this in a manner that most people won't find reprehensible.

Health insurance is screwy anyway. It really isn't insurance in the dictionary definition of the word. ... So health insurance needs to be treated as more of a savings plan. ~ Cousin Dave at December 19, 2018 12:39 PM

At some point in his presidency, George W. Bush proposed a health insurance reform utilizing personal Health Savings Accounts that would accumulate unused balances. He even proposed a government subsidy for those who could not contribute to their own accounts. However, then-Speaker, Nancy Pelosi, declared it dead on arrival, before anyone even had a chance to flesh out what such a reform might look like.

Cousin Dave has it partly right. But employer-provided health care was not just a result of the wartime command economy. It was during WW2 that the income tax code was changed to allow corporations a deduction for providing group health plans to their workers. Take that out of the tax code and we probably would never have seen employers in the health-coverage business, at least once wartime wage controls ended.

Both workplace health insurance and Medicare have driven up the price of health care by making payment indirect so that the costs aren't visible to those making the decisions. That's part of the reason it all costs so much, and it would be a good idea to stop expanding both. Another major part is predatory malpractice lawsuits, which has a well known and obvious answer: loser-pays.

But most of all, we need to do away with the ObamaCare rule to ignore preexisting conditions, which is designed to destroy the insurance industry by adverse selection. (The right way to enable high-risk people to get coverage is the same way it's done in the fields of car insurance and homeowners insurance -- create an assigned-risk pool.)

"To have enough money in the pool to cover pre-existing conditions, we need to get people in the prime of health to buy insurance."

No, we don't, and the reason for this is in the plan at my link above. You haven't noticed that what we have is not "insurance", either. My link is there because the topic is too long to post every time this comes up.

That link isn't monetized.

Insurance,in my opinion, shouldn’t cover regular office visits. Anymore than car insurance should cover oil changes.

Not quite the same thing. Regular office visits, at least in theory, find and treat conditions so that they don't become catastrophic and require expensive care. Oil changes do nothing to prevent accidents; if you never change your oil and your engine seizes up as a result, your auto insurance doesn't cover that.

Isab Says:

"Government programs that have been riding on the back of the free market for years."

Many people make this mistake.

Healthcare is not a "free market".

For a "free market" to function as per free market economic theory, the goods in question must by definition be elastic.

Price elasticity of goods is a necessary component of any free market system.

Things like health care display price inelasticity precisely because when your life is on the line you do not actually have a free choice to decline the good or service in question.

Goods and services that are price inelastic need to be tightly regulated and monitored precisely because you cannot expect the market to operate as you might expect for a good or service that behaves elastically.

This is why you have parasites on the system capture the market for epi pens and then jack up the price by 600%... that sort of thing doesn't happen with iphones because people will just refuse to buy them.

However, when you are dealing with a device that will save your childs life if they are ever stung by a bee... they can essentially charge anything under the sun... there is no price someone wouldn't pay to save the life of their toddler.

Free market economics only works when dealing with goods and services that show close to perfect elasticity... the theory itself demands this.

I agree. End the non-portable employer health insurance PPP. I'm tied to mine, unfortunately, because, guess what, it beats the hell out of the Obamaocare exchanges.

“Not quite the same thing. Regular office visits, at least in theory, find and treat conditions so that they don't become catastrophic and require expensive care.”

Unfortunately this has proven to be a red herring. About 90 percent of doctors visits are for things that will resolve with no treatment at all, and treating the sniffles with anitibioltics has led to their dangerous overuse with all sorts of dire consequences to public health.

Oil changes are maintenance. So are regular doctors visits. What you need insurance for is the big stuff. The unforeseen catastrophic medical issue that will destroy your retirement if you have to pay for it, or force you into bankruptcy if you can’t.

Radwaste is correct. Medical insurance isn’t really insurance at all, as it currently exists. It is just cost shifting with big profits going to the middle men. And a lot of insurance scammers are getting rich off of the third party payer system.

Regular office visits, at least in theory, find and treat conditions so that they don't become catastrophic and require expensive care. ~ Rex Little at December 19, 2018 6:39 PM

Regular office visits as preventative medicine was the theory behind HMOs. And it turned out that paying for regular office visits caused people to go to the doctor for minor ailments that they once would have handled with home remedies - increasing the expense of the program beyond what the premiums could pay for.

And oil changes do sometimes reveal things that need to be repaired on automobiles before they become major problems - oil leaks, tire issues, etc.

However, auto insurance is about insuring the driver and not about automobile maintenance, so that analogy falls apart pretty quickly.

"Healthcare is not a "free market".

For a "free market" to function as per free market economic theory, the goods in question must by definition be elastic."

Well over 90% of health care spending is non-emergency care. I think the actual number is around 96-98%. That care is elastic. So your argument is invalid Artemis.

For a "free market" to function as per free market economic theory, the goods in question must by definition be elastic. ~ Artemis at December 19, 2018 8:08 PM

Price elasticity is not, by itself, the defining characteristic of a free market.

Plenty of relatively inelastic goods are traded on a free market, gasoline, water, tobacco, etc. Very few products are perfectly inelastic.

The freedom for the supplier to set the price and freely dispose of his goods makes a market free. Likewise, the purchaser being free to seek the best price.

A product unable to command a price that covers its cost of production (or a service its cost of provision) disappears.

The suppler that cannot supply the desired product or service at a price a purchaser is willing to meet goes out of business. The purchaser unwilling to meet the lowest asking price must do without.

The healthcare market is not free not because of price inelasticity of healthcare, but because the price is set by a third party (government or insurer) with little consideration of the cost. Let's say the third party will pay $X for a certain procedure. If that procedure costs $(X+1), then the supplier must make up the difference elsewhere or forego providing the procedure. The third party has little to no incentive to increase the amount paid for it. If the procedure costs $(X-1), then the supplier charges $X and pockets the difference.

In addition, free markets depend upon information to function properly.

For example, in the market for electronics, the consumer reads periodicals, talks to friends, and educates himself on the various options available and makes a semi-educated purchase decision. He doesn't have to understand the engineering behind the product to be informed of the benefits and costs of a particular product.

In the market for healthcare, the consumer mostly leaves it to his doctor to provide that education, feeling the subject too intimidating or too urgent and with too many variables for him to educate himself.

If the consumer does attempt to educate himself outside the confines of his doctor's office, he is bombarded by pseudo-science and quackery (e.g., Jenny McCarthy) and left potentially more ignorant than he was before; sometimes that ignorance has fatal consequences.

Too often politicians, insurers, and medical practitioners tell the healthcare consumers to leave it to them and create a wall of data (ever try to read your health insurance forms?) to screen their practices from the prying eyes of the actual patient. And, often, that is done with not only the patient's consent, but his demand to forego informing him in favor of treating him.

For healthcare to be a true free market, it must feature the consumer, not the insurer or the government, making informed purchase decisions, weighing the costs and benefits of each option.

I would cut out the bit about "In the market for healthcare, the consumer mostly leaves it to his doctor to provide that education, feeling the subject too intimidating or too urgent and with too many variables for him to educate himself." Conan. As you point out the vast majority of customers are ill equipped to deal with electronics or other technological goods. Instead they used informed proxies. In health care so what if the consumer is informed? He still isn't paying. It isn't that the topic is too intimidating or urgent. It is that the consumer isn't paying and there is no benefit to being informed. Why waste resources on an act that gets no benefits?

In health care so what if the consumer is informed? He still isn't paying. ~ Ben at December 20, 2018 7:55 AM

That was my point Ben. The third-party is paying and setting the price, not the purchaser/patient nor the supplier.

And the purchaser/patient is content to allow the insurer to set the price and the doctor to make the decision. He wouldn't purchase a stereo that way, but he's okay with purchasing medical care that way.

Even if he's not perfectly informed about stereos, he makes an effort to become better-informed. Not as much with medical care. An informed consumer controlling the purse strings (including any associated trade-offs) is the way to a true free market in healthcare.

Conan Says:

"Price elasticity is not, by itself, the defining characteristic of a free market."

I agree with you.

Price elasticity is a necessary but not a sufficient condition for free market economics to function according to the theory.

Just like you cannot have a free market that is composed primarily of monopolies.

For a market to actually be free a number of features must be present.

Conan,

Just to be clear, I am talking about the free market as defined by economic theory... just like the behaviors of an ideal gas are defined by the ideal gas law.

The point I am getting at here is that many folks rail against regulation and intervention in the market on the grounds that a free market is the most efficient.

However this market efficiency requires several features that are not present when the goods or services we are talking about are price inelastic.

Applying free market economic theory to inelastic goods gets you into the same territory as applying the ideal gas law to molecules that have significant attractive forces between them.

In such a system it is inappropriate to talk about free market theory, you need something more sophisticated and you also require outside intervention to obtain desirable behavior... for example, not demanding the deed to your house to supply you with insulin.

One cannot simply rely on the good nature of their fellow citizens to constrain greed, where competition does not exist and goods/services are inelastic free market theory does not do the job.

Conan Says:

"Even if he's not perfectly informed about stereos, he makes an effort to become better-informed. Not as much with medical care. An informed consumer controlling the purse strings (including any associated trade-offs) is the way to a true free market in healthcare."

Again, this doesn't necessarily work with health care because in many scenarios you are in a captured market.

The next time you are rushed to the emergency room please let us all know how much time you have to do research to be a fully informed consumer to handle the time sensitive and life threatening issue you are dealing with.

There are no analogies here to stereos... you can wait on a stereo, you can do your research, you can compare prices.

When an ambulance rushes you to the hospital you would be crazy to ask for a list of prices and then shop around at nearby hospitals as you are bleeding out.

Healthcare simply is not the same kind of market as consumer electronics because many purchase decisions in health care are for lack of a better term made under duress.

Imagine if every time you made a consumer electronics purchase that there was a real risk of you getting shot if you decided to shop around... that is what it is like to have a life threatening injury and being rushed to a hospital... you don't have the luxury of shopping around and using your power of consumer choice. In many cases you have to take the services available to you or risk the very real possibility of death.

"However this market efficiency requires several features that are not present when the goods or services we are talking about are price inelastic."

What we're disputing is that medical services are inelastic. As Conan pointed out, most medical services are non-emergency services. You mentioned the Epi-pen. There's two things about that, though. The first is that you don't go to the drug store and buy an Epi-pen after you've been stung. You buy it beforehand, when you first find out that you are allergic to bee stings. At the time you buy it, it isn't an emergency, and you have time to price shop. The second thing about the Epi-pen is that regulation (the FDA) created the opportunity for price gouging, by dragging its feet on approval for competing products, and depriving the consumer of choice.

(I was going to write something else about shopping for products where specialized expertise is required to shop intelligently. But the analogy I wanted to use wasn't making sense. I'll think about that some more.)

I will say this much for Artemis' position: A big issue with trying to shop intelligently for medical services is the industry's lack of transparency. If you want to know what an airline's accident and fatality rates are, you can find that; the FAA publishes the raw data and there are lots of places that compile and analyze it. If you want to know what a particular hospital's rates of patient deaths or staph infections are, you probably can't get that information unless you have insider connections.

Cousin Dave Says:

"The second thing about the Epi-pen is that regulation (the FDA) created the opportunity for price gouging, by dragging its feet on approval for competing products, and depriving the consumer of choice."

That is a gross oversimplification of the issues at play.

There are real and significant risks to deregulating medical devices and interventions.

The principle reason why Thalidomide was a massive problem overseas and not in the United States is because of careful regulation and oversight.

Again, this isn't like a faulty stereo component.

Lives are at stake.

At the end of the day there should exist no "opportunity" to price gouge for inelastic goods that are required to save lives. At some level it becomes no different than extortion.

If you want to deregulate then the only viable solution is to make the board of directors criminally responsible if people are killed by their negligence.

If all you have is fines then it just becomes the cost of doing business.

So as far as I am concerned we can either continue to regulate or make the highest ranking decision makers at pharmaceutical companies criminally liable for patient deaths and negative outcomes like birth defects.

Regulation is there to protect the companies because if they comply then they have limited or non-existent liability.

If we get rid of the regulations then liability needs to sky rocket and be proportionate with the risks. If the risk is death then the liability needs to be equivalent to a manslaughter charge for the folks making the decisions.

At the end of the day, folks who want to treat healthcare like any other business aren't properly understanding the important economic distinctions.

Cousin Dave Says:

"A big issue with trying to shop intelligently for medical services is the industry's lack of transparency."

It isn't just transparency, it is also the time sensitivity of decisions as well as the fact that in many cases decisions are made on your behalf without your approval while you are unconscious.

If you are suffering from a heart attack you don't have time to do research, you don't have time to shop around... you need to get to a hospital and the medical professionals then get to work.

If you are put under for surgery then you are in no position to be making "informed consumer choices".

Again imagine if you walk into a best buy and are subsequently drugged unconscious and later find yourself at home with a new television and surround sound system.

Healthcare isn't like any of the consumer product businesses folks here want to compare it to.

How do you propose we handle emergency care without insurance or regulation?... you just wake up on a hospital bed with a bill for whatever they decided to do for you?... or do you need to have a full emergency plan on you at all times detailing all contingencies and decisions in advance?

We can't just treat all medical care as if it is chronic low level issues where folks have a chance to become educated and make informed decisions.

The most expensive items are typically where you have no viable choices.

That is why I said I would cut that part Conan. I agreed with the rest of it.

"When an ambulance rushes you to the hospital you would be crazy to ask for a list of prices and then shop around at nearby hospitals as you are bleeding out."

This is not the majority of health care spending Artemis. Your claims are flat false.

The next time you are rushed to the emergency room please let us all know how much time you have to do research to be a fully informed consumer to handle the time sensitive and life threatening issue you are dealing with.

There are no analogies here to stereos... you can wait on a stereo, you can do your research, you can compare prices.

When an ambulance rushes you to the hospital you would be crazy to ask for a list of prices and then shop around at nearby hospitals as you are bleeding out.

~ Artemis at December 20, 2018 9:06 AM

Sure, let's use that one-in-a-thousand situation as the rebuttal argument.

Not every medical procedure involves an urgent demand and tight supply. Vasectomies, cosmetic surgeries, etc. can wait as the consumer comparison shops and seeks the best deal - although one should be wary of choosing a discount vasectomy or rhinoplasty.

And, in case you missed it, not every ambulance trip involves an unconscious patient. If the patient is conscious, he's asked for his insurance card and to what hospital he'd like to be taken. If not and a family member is available, that family member will be asked.

Yes, in an emergency, one has to pay the price of the provider - as one does in any shortage. When you don't have substitutes and demand is high, the supplier sets the price.

By the way, there is an analogy to consumer electronics. When the Super Bowl involves the local team, expect television sales to go up (7.7% according to the NRF) as consumers upgrade. As the sets fly off the shelves, supply tightens, prices rise and consumers don't spend a lot of time haggling. Supply is short and demand is high, so consumers must meet the price demanded by the supplier or risk going without.

A system in which the consumer has better information, a role in guiding the decisions being made, and a demonstrable financial consequence in the choice being made is closer to a true free market in healthcare. And until we get closer to a free market in healthcare, a few companies (healthcare providers and insurers) will set the prices with little incentive to lower them.

"The principle reason why Thalidomide was a massive problem overseas and not in the United States is because of careful regulation and oversight."

No, it was because the FDA dragged their feet. I've read a lot about that case. There were no brilliant FDA scientists saying, "This drug is dangerous! Don't approve it!" It was sheer bureaucratic molasses. They got lucky that time. What doesn't get the attention that Thalidomide got is the untold number of deaths that could have been prevented by drugs or devices that the FDA slow-walked.

You have to understand how any U.S. federal bureaucracy works. For any given decision, there are only a few people who can say "yes", but hundreds who can say "no". Saying "yes" is a huge career risk. There is zero risk in saying "no". So nobody wants to be the person who says "yes". Everyone wants to be the person who says "no" -- you get to wear the mantle of Protector Of The Herd and you have a job for life.

New tech in the oil industry is very similar CD. The cost of a mistake is so high that it is worth more than anyone's job. So if you make a mistake and it costs rig time you are fired. Eventually everyone who is willing to take a chance is driven out of the industry. In the end there is one guy who is responsible for saying 'yes' to everything. And you can't fire him because once he is gone nothing more can be done.

Cousin Dave Says:

"No, it was because the FDA dragged their feet. I've read a lot about that case. There were no brilliant FDA scientists saying, "This drug is dangerous! Don't approve it!" It was sheer bureaucratic molasses."

You simply do not know what you are talking about.

As shown in the following article Dr. Kelsey of the FDA refused to approve of the drug because of her concerns about it's safety.

https://www.theglobeandmail.com/news/national/canadian-doctor-averted-disaster-by-keeping-thalidomide-out-of-the-us/article21721337/

Needless to say your opinion on this matter is not based on facts or evidence.

Conan Says:

"Sure, let's use that one-in-a-thousand situation as the rebuttal argument.
Not every medical procedure involves an urgent demand and tight supply. Vasectomies, cosmetic surgeries, etc. can wait as the consumer comparison shops and seeks the best deal - although one should be wary of choosing a discount vasectomy or rhinoplasty."

Catastrophic medical issues are the ones that are the most financially devastating in terms of health care cost and the primary reason people need insurance.

This entire conversation is about insurance so we cannot discount these as trivial events.

Let's talk about another issue that happens often within the medical field.

Emergency c-sections.

Are you really going to argue that a birthing mother is in any position to negotiate with her medical practitioner while in the middle of labor when they inform her that the delivery is not going as planned... that the baby is in stress... and that they need to surgically remove the baby immediately to ensure it's survival?

I can think of hundreds of scenarios where health care is dramatically different than just about any other consumer choice... but you really want to plant your flag on the hill that it is analogous to buying a stereo???

Needless to say, medical care in general is not a free market... it is only a free market for elective surgeries such as Vasectomies and cosmetic surgeries... but those are in fact the minority of cases... furthermore, insrance does not in general cover cosmetic surgery unless it is for reconstruction after a horrific accidenct such as being caught in a fire and having your face burned off.

You are in fact the one talking about corner cases and not the general case... and you aren't even discussing things that is typically covered by insurance.

Conan Says:

"By the way, there is an analogy to consumer electronics. When the Super Bowl involves the local team, expect television sales to go up (7.7% according to the NRF) as consumers upgrade. As the sets fly off the shelves, supply tightens, prices rise and consumers don't spend a lot of time haggling. Supply is short and demand is high, so consumers must meet the price demanded by the supplier or risk going without."

A television is price elastic Conan.

Medical intervention to save your life in the event of an emergency is price inelastic.

That is the fundamental different that you do not appear to fully appreciate.

Suppy/demand curves only work properly in a free market when dealing with goods and services that are price elastic.

If you are on the table in a hospital after having a heart attack and they have 30 minutes to save your life... what choice do you have if the medical practitioners demand your entire life savings as payment?

You either pay up or you die.

That is the definition of making consumer choices under extreme durress.

Yet you still want to compare these kinds of scenarios to how expensive TVs can get leading up to the superbowl?... the fundamental difference is that you can walk away from the purchase in that scenario and try again another time.

You cannot do that when your life is in the balance.

You are desperately clinging to an overly simplistic economic model to apply to all scenarios instead of understanding where it works and where it fails.

Free market economics only properly functions when certain conditions are met.

Healthcare does not meet those conditions.

Ben Says:

"This is not the majority of health care spending Artemis. Your claims are flat false."

The majority of health care spending is not elective in nature either.

You can't just discount emergency cases as unimportant in a discussion about health care and insurance.

Those are precisely the scenarios where unscrupulous individuals can take you for everything your are worth if there are no regulations preventing such outcomes.

If you want to make a proposal that comprehensively deals with health care in general I am all ears.

If this is just a conversation about vasectomies and boob jobs then it really isn't about health care.

Conan Says:

"And until we get closer to a free market in healthcare, a few companies (healthcare providers and insurers) will set the prices with little incentive to lower them."

Insurance companies have every incentive to lower the price of medical procedures... they are the ones who have to pay out on those bills.

How exactly do you think insurance works?

When a $20,000 hospital bill comes in and you are beyond your deductible... who exactly do you think is paying?

That being said, a public option would serve to lower insurance costs for the consumer... but the insurance companies themselves would love to reduce outgoing medical costs while charging you the exact same premiums.

"The majority of health care spending is not elective in nature either."

Actually, to a significant extent it is. You have flexibility on both time and type of treatment for the very vast majority of health care spending. A disappointing percentage of it is even unnecessary as well as harmful.

But as usual you will refuse to accept that you could ever be wrong about anything no matter how blatantly obvious it is. Oh well.

Heck, by your argument Artemis restaurants and grocery stores have to be state controlled. Eating is non-elective in nature. Obviously a free market in food is impossible. At least in Artie land.

Ben Says:

"But as usual you will refuse to accept that you could ever be wrong about anything no matter how blatantly obvious it is. Oh well."

How about you do us both a favor and try to present facts some time instead of just asserting things as fact.

This is where you constantly get yourself into trouble.

You and others have asserted that the vast majority of health care costs come from elective procedures (such that emergency cases are apparently negligible and should not be part of this discussion). Please present your data.

I will wait patiently while you do your research and collect your sources.

Ben Says:

"Heck, by your argument Artemis restaurants and grocery stores have to be state controlled. Eating is non-elective in nature. Obviously a free market in food is impossible. At least in Artie land."

This is a classic strawman argument.

Groceries exhibit price elasticity in a way that emergency medicine does not.

You clearly do not understand the constraints under discussion here if you so easily confused all of this.

The reason a free market can and does work for groceries is precisely because you have so many competing options.

What exactly are your competing consumer choices when you are on a surgical table suffering from a heart attack?

By the way... while several folks are here patting themselves on the back with regard to free market healthcare assertions... contributors at Forbes are more or less in complete agreement with my position:

https://www.forbes.com/sites/chrisladd/2017/03/07/there-is-never-a-free-market-in-health-care/#77ff9c511147

"In a free market, goods and services are allocated through transactions based on mutual consent. No one is forced to buy from a particular supplier. No one is forced to engage in any transaction at all. In a free market, no transactions occur if a price cannot be agreed.
The medical industry exists almost entirely to serve people who have been rendered incapable of representing their own interests in an adversarial transaction. When I need health services I often need them in a way that is quite different from my desire for a good quality television or a fine automobile. As I lie unconscious under a bus, I am in no position to shop for the best provider of ambulance services at the most reasonable price. All personal volition is lost. Whatever happens next, it will not be a market transaction."

But sure... keep living in the fantasy land that if you got hit by a bus you would be busy comparative shopping between multiple medical providers to negotiate for the best price.

Sometimes I think that free market economics has become a religion for some folks... true believers who just have faith that it always works in every conceivable situation.

https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/

There you go Artyboy. Emergency medical is only 2% of spending. I'll agree that is inelastic. The other 98% is why you are wrong.

But once again you won't accept that you could ever be wrong. No matter how obvious it is.

Ben,

Here was the request:

"You and others have asserted that the vast majority of health care costs come from elective procedures (such that emergency cases are apparently negligible and should not be part of this discussion). Please present your data."

You then present data showing that emergency care accounts for ~2% of spending (numbers I have seen are between 2 and 5%).

The problem is you haven't answered the question.

Health care costs are broken up into 4 categories:

1 - Elective care
2 - Semi-Elective care
3 - Urgent care
4 - Emergency care

The assertion made by others and yourself is that the vast majority of heath care spending is from category #1.

You can't prove that by only talking about category #4.

What % is semi-elective care?... what % is urgent care?

You haven't even managed to defend your own assertion.

The point I have been trying to drive home by the way Ben is that you don't get to say that if ~2% is emergency that the other 98% is elective.

There are intermediate categories and only the elective portion is elastic.

I have already agreed that things like elective cosmetic surgery can work in a market environment.

The other 3 categories really can't and I selected to focus my examples in the emergency category because they are the most extreme.

Urgent care isn't elastic either... and semi-elective care isn't really so elastic because you are also in a captured market.

Now if your proposal is to have insurance cover all elements of healthcare that are inelastic and then we should have a market for other pieces at least we are then having a real conversation.

However that isn't what you or others have put on the table.

As I said you won't accept you are wrong no matter how obvious it is. So how about you do your own homework Artyboy. You present what those percentages are and just how elastic they are and why. But your claims about all health care being in an ambulance with a heart attack are clearly disproven. As such I am done feeding the troll.

Ben,

I accept reality and facts... I do not just accept baseless assertions.

This is what I said to you:

""The majority of health care spending is not elective in nature either.""

This is where I already acknowledged the fact that the majority of health care costs are not emergency... but I was also pointing out they aren't mostly elective either.

In other words, there are classifications between those two extremes.

You responded as follows:

"Actually, to a significant extent it is."

In other words... you declared that most health care spending is elective. When I asked for proof you showed that emergency care was not the majority.

However that doesn't actually prove that the majority is elective.

It really isn't that hard to understand this Ben.

Imagine we had the following conversation:

You assert that the vast majority of the population of the united states lives in California... I claim that isn't true... so you show that only ~1% live in Connecticut... and then follow up that the other ~99% is why I am wrong.

Don't you see how you would have failed to prove your case???

What happened to the other 48 states in such an analysis?

The reality is that California accounts for 12% of the population and not the vast majority regardless of the population of Connecticut.

Similarly, just looking at emergency health care spending doesn't make your case that the vast majority of spending is elective.

You are guilty of fallacious reasoning here and if you are too blind to see it I cannot help you.

Also... I never said this:

"But your claims about all health care being in an ambulance with a heart attack are clearly disproven."

That is a strawman argument.

I would never state that all health care costs are ambulance bills for heart attack victims.

You have clearly lost your mind or are a liar.

Ben,

I also love this part:

"So how about you do your own homework Artyboy. You present what those percentages are and just how elastic they are and why."

You make and assert evidence free claims... I dispute them... and it is my job to present evidence why you are wrong???

That isn't how the burden of proof works Ben.

The person making the claim needs to support their own contentions.

You and others have claimed that free market economics will work for health care. I raised several objections that you have dismissed without evidence or proper logical rebuttal.

Then when I demand evidence you tell me I need to show evidence that you are wrong.

Please read this so you understand why you are being irrational:

https://yourlogicalfallacyis.com/burden-of-proof