This mostly avoids the conflation of health care with health insurance which seems to baffle most politicians. Health insurance companies don't even run health insurance much less health care. The plan sponsors-employers or CMS for most Americans-run the system with a mix of incompetence and malice. All those provider networks need to be brought down by plan sponsors. The exception is private equity which should just be outlawed. Health is not the only industry they are looting.
Private equity* is one of the species of hollow wooden horses that would not survive even a cursory mouth inspection were it not that legality colors laws to paint who is inlaw & who is outlaw.
“Natural law” —real horses— concepts are subverted at every turn.
“The more I think about it, ol’ Billy was right, lets kill all the lawyers, kill ‘em tonight.”
But whether lawyers are conceived of as the rubber upon the road (hard & put up wet), or the axles, driveshafts, transmissions, or even engines of all this “creative” destruction, dreams of avarice, of power, backed up with fat rolls of bribe & wanna be fat rolls of bribe-takers from “the top” to the bottom are the demand that creates all the supply.
It could have been others, but it always was going to be somebody. Turned out to be Rockefeller's & Carnegies gangs who Flexner’d their bribe rolls.
Markets? Make bribery —both sides— a capital offense.
Customers, in charge of choosing (& having unfettered access to choice-points info).
Not patients, apportioned to planks by the pirates described above.
None of this prescription has ever been, or will ever be.
Simple, but people are simpler still, so impossible.
inequitable(adj.)
"unfair, unjust," 1660s, from in- (1) "not, opposite of" + equitable, which is ultimately from Latin aequus "even, just, equal." Related: Inequitably. The same formation in English has also meant "impassable on horses, unfit for riding over" (1620s), from Latin inequabilis, from equus "a horse" (see equine).
Much of what ails the US is monopolies / oligopolies - healthcare might just be the biggest. Richard Werner has shown through analysis of banks that the path forward is smaller institutions and competition. Sadly the smaller companies don't pay the same level of bribes (campaign donations).
40% of people get health care via various government programs, and prices are set by how much health care groups can bribe, I mean lobby, our elected representatives.
Your lesser consolidation model still doesn't solve the customer problem, when the customer is typically sick, needs an intervention, and possesses far less knowledge than the providers do. As the saying goes, would you pick a brain surgeon solely on the basis of having the lowest price?
Could we expand the model of health care from for profit to non profit? That is the Kaiser Permanente model, begun in World War 2 to take care of shipyard workers in California. It has grown enormously, and is far from perfect, but it gets a lot of things right.
Doctors go to school for 10 years before starting work & making enough to pay down the ensuing debt. I had thought this was a driver for the insufficient supply that hampers competition. Some argue this is not true & some that it’s very true:
I've always thought one month of pure free market health care would be a valuable lesson.
Premise 1: No barriers to entry or exit. Anyone can be a doctor, nurse, or an EMT! Got me my overnight side hustle!
Premise 2: The market sets prices. What is your price for not dying? Having a heart attack? Sign over your 401K and I'll shock your heart. Kid dying? I'll take your house. Thanks. Need that cancer drug? Fork over all your money.
Thank you for this excellent post! Yes, unfortunately, "choice" in healthcare almost always means uncertainty and loss - guess which health plan will cover all your drugs and services this year, guess which doctor your insurer will be happiest with, guess which hospital will charge you the least for this or that test or procedure. Transparency would actually mean fewer choices - in a good way - when an appendectomy costs the exact same no matter where you go, healthcare is no longer a roll of the dice, and the rhetoric of choice can no longer disguise these crazy disparities in price, service, etc. Thank you again!
This mostly avoids the conflation of health care with health insurance which seems to baffle most politicians. Health insurance companies don't even run health insurance much less health care. The plan sponsors-employers or CMS for most Americans-run the system with a mix of incompetence and malice. All those provider networks need to be brought down by plan sponsors. The exception is private equity which should just be outlawed. Health is not the only industry they are looting.
Yes.
Private equity* is one of the species of hollow wooden horses that would not survive even a cursory mouth inspection were it not that legality colors laws to paint who is inlaw & who is outlaw.
“Natural law” —real horses— concepts are subverted at every turn.
“The more I think about it, ol’ Billy was right, lets kill all the lawyers, kill ‘em tonight.”
But whether lawyers are conceived of as the rubber upon the road (hard & put up wet), or the axles, driveshafts, transmissions, or even engines of all this “creative” destruction, dreams of avarice, of power, backed up with fat rolls of bribe & wanna be fat rolls of bribe-takers from “the top” to the bottom are the demand that creates all the supply.
It could have been others, but it always was going to be somebody. Turned out to be Rockefeller's & Carnegies gangs who Flexner’d their bribe rolls.
Markets? Make bribery —both sides— a capital offense.
Customers, in charge of choosing (& having unfettered access to choice-points info).
Not patients, apportioned to planks by the pirates described above.
None of this prescription has ever been, or will ever be.
Simple, but people are simpler still, so impossible.
inequitable(adj.)
"unfair, unjust," 1660s, from in- (1) "not, opposite of" + equitable, which is ultimately from Latin aequus "even, just, equal." Related: Inequitably. The same formation in English has also meant "impassable on horses, unfit for riding over" (1620s), from Latin inequabilis, from equus "a horse" (see equine).
Much of what ails the US is monopolies / oligopolies - healthcare might just be the biggest. Richard Werner has shown through analysis of banks that the path forward is smaller institutions and competition. Sadly the smaller companies don't pay the same level of bribes (campaign donations).
40% of people get health care via various government programs, and prices are set by how much health care groups can bribe, I mean lobby, our elected representatives.
I have no idea how to cure what ails us.
Well written piece
Your lesser consolidation model still doesn't solve the customer problem, when the customer is typically sick, needs an intervention, and possesses far less knowledge than the providers do. As the saying goes, would you pick a brain surgeon solely on the basis of having the lowest price?
Could we expand the model of health care from for profit to non profit? That is the Kaiser Permanente model, begun in World War 2 to take care of shipyard workers in California. It has grown enormously, and is far from perfect, but it gets a lot of things right.
Doctors go to school for 10 years before starting work & making enough to pay down the ensuing debt. I had thought this was a driver for the insufficient supply that hampers competition. Some argue this is not true & some that it’s very true:
https://paragoninstitute.org/paragon-pic/physician-np-and-pa-growth-has-significantly-outpaced-population-growth/
https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act
Why not make medical school free? ( with the caveat that medical schools increase their enrollment)
I've always thought one month of pure free market health care would be a valuable lesson.
Premise 1: No barriers to entry or exit. Anyone can be a doctor, nurse, or an EMT! Got me my overnight side hustle!
Premise 2: The market sets prices. What is your price for not dying? Having a heart attack? Sign over your 401K and I'll shock your heart. Kid dying? I'll take your house. Thanks. Need that cancer drug? Fork over all your money.
Thank you for this excellent post! Yes, unfortunately, "choice" in healthcare almost always means uncertainty and loss - guess which health plan will cover all your drugs and services this year, guess which doctor your insurer will be happiest with, guess which hospital will charge you the least for this or that test or procedure. Transparency would actually mean fewer choices - in a good way - when an appendectomy costs the exact same no matter where you go, healthcare is no longer a roll of the dice, and the rhetoric of choice can no longer disguise these crazy disparities in price, service, etc. Thank you again!
On the dialysis debacle, Tom Mueller's _How to Make a Killing_ is excellent - check it out!