Posted on 12/27/2011 5:30:18 PM PST by Libloather
Why health care competition won't work
By Amitai Etzioni, Special to CNN
updated 2:08 PM EST, Tue December 27, 2011
(CNN) -- A proposal by Rep. Paul Ryan and Sen. Ron Wyden to allow those who retire in the future to chose between Medicare and private health care insurance for seniors is the latest addition to the drive to increase competition in health care.
Mitt Romney recently released a health care proposal that would introduce vouchers, which would allow consumers to choose where to take their business, although he did not include Medicare as an option. Newt Gingrich's plan suggests a variety of ways to increase "price competition in the industry."
And President Obama's health care overhaul also includes competition, to take place in new statewide exchanges, in which individuals and businesses will be able to find and compare insurance plans in a centralized marketplace.
But research shows that competition in health care cannot be made to work effectively. As patients, we are just not equipped to absorb and process the information needed to make healthy choices on our own.
(Excerpt) Read more at cnn.com ...
Is that old socialist windbag still alive?
I may or may not be smart enough to make the correct decisions.
However it is my moral right to make MY decisions that affect MY life.
The government provides no added value to health care (it actually reduces its value). It only imposes unneeded cost. Cut out the middleman, and stop government monopolization of healthcare.
...stupid people constitute the grand overwhelming majority of this and all other nations...
However, it's wrongheaded to punish the balance of the population by denying them some autonomy and participation in a market-based health care delivery model. Not a surprise coming from an elitist snob like this ass clown. I say throw him under the Obamascare bus as a kind of consumer guinea pig. He can then write up an outcomes (these sorts loves this methodology so much) oriented review of his experiences...if he survives the experiment.
“so...basically, he’s been hiding from the real world his entire life....”
More like...he’s spent his entire life by trying to validate his idiotic belief system by cramming it down everyone else’s throats around him...
A proposal by Rep. Paul Ryan and Sen. Ron Wyden to allow those who retire in the future to chose between Medicare and private health care insurance for seniors is the latest addition to the drive to increase competition in health care.
choose (health care, abortion services, adoption services, career, investments, education for our children, appropriate foods). Is there anything we can really be trusted to choose under fascist rule?
Actually, they would not need insurance. They have no assets. No lawyer would sue anyone on contingency if there is no hope of getting any money. I am not advocating leaving the health care system to priests, but on this point their vow of poverty would give them an advantage.
Uhhh, choosing insurance plans is not the same as making medical decisions. Never mind. If the author has to be told that he couldn't possibly be capable of understanding it.
Of course he gets it wrong.
The reason health care competition can’t work is that health care (I mean what that English phrase denotes, not health insurance, but actual health care, the provision of curative and palliative treatment for disease and injury) is provided by government created monopolies: licensed physicians in each state function as a guild monopoly (”reasonable and customary” is price-fixing), while all medical advances are for many years sold by commercial monopolies under monopoly grants called “patents”.
The restriction of provision of medical services to licensed physicians is obviously necessary for quality control, just as the restriction of water, electric or natural gas service to one provider is necessary to prevent massive infringement of property rights to create multiple easements. In the latter case, there being no effective market competition, the several states regulate prices. In the former case, physicians are permitted to collude with insurance companies and more-or-less charge whatever the market will bear for services for which demand is quite inelastic. Likewise there is no regulation of prices when the government grants a monopoly in the form of a patent.
I would welcome suggestions for ways to actually produce market competition in health care (the problem is much easier in health insurance, but that won’t fix the cost problem), but I have never heard any convincing ones, and regard the recognition that health care is provided by a guild monopoly and that the most effective drugs and medical devices are sold by monopolies, and thus, if the monopolies cannot be broken, their prices must be regulated, as the only way to fix the problems with both Obamacare and the status quo ante to which repeal of Obamacare would return us.
I agree. However, choice and competition can come into the equation much more fundamentally. People should have a choice as to whether they want to pay up front for the right to have all the latest bells and whistles in their medical care, or to decide that they'd rather have less coverage and more money in hand for their lives ‘at the moment’. The government approach of mandating what health plans should contain is problematic, and pushes some to spend more on their health care than they want to, while pushing others to accept less coverage for cutting edge high-end treatment than they want.
People should have many options regarding just how much the want to spend to ensure access to what they consider right for them. If they'd rather have a new car than to ensure that they're covered to see any specialist they want, anywhere they want, then they should have the right to choose a cheaper plan. If someone thinks spending their money on a Rolls Royce medical plan is more important than upgrading their kitchen, or going on an expensive vacation, then they should have ample opportunity to do so.
These types of choices are made all the time, in different contexts. People decide to buy the cheaper tires, even though the braking distance with these might be a little longer. They decide to buy $10,000 of life insurance, not $1,000,000, because they just want enough to be buried. People buy computers and TVs and decide whether or not they want to pay extra for extended warranty coverage. The list goes on and on.
One does not have to be a scientist or a physician to understand the implications of spending money on high-end coverage, or basic coverage that excludes some things.
“and regard the recognition that health care is provided by a guild monopoly and that the most effective drugs and medical devices are sold by monopolies, and thus, if the monopolies cannot be broken, their prices must be regulated,”
Some of what you say makes sense, but I disagree on several points. First, insurance companies are more likely to be at war with physicians than to collude with them. More often than not it is the physician fighting the insurance company to ensure a particular patient gets what they need. There are most certainly unethical physicians who stretch the concept of medical ‘need’ in order to make more money, but this is by far the vast minority of physicians.
You are correct that patents on medications and devices give certain companies short-term monopolies, but that is the price that society pays for having people out there who make the efforts and take the risks for the development of new medical treatments (and who pay for the insurance that protects them from massive lawsuits if the treatment or device has unintended results). The prices on these things inevitably come down over time, not unlike new computer technology.
Physicians do not represent a guild monopoly. First of all, price collusion in medicine is illegal and highly monitored. Second, physicians compete with one another, and it is thus unlikely that even if it were legal they would agree to fixed prices. Just as important a consideration is that physician fees are not what drives the high costs of high technology medicine. Look at medicare reimbursement for physicians, and for the physician fee component of expensive procedures. The physician reimbursement represents a relatively small proportion of the whole. If physicians worked for free, and everything else stayed the same, medical costs would not go down substantially, and would soon rise again. Think about how many people are involved in a medical ICU stay, and the cost of the equipment involved (e.g. ventilators, advanced monitoring equipment, MRI or CT scanners, etc. etc.).
The way competition can work is if physicians and hospitals are allowed and encouraged to compete with each other to provide those services for less. As a person with advanced education, training, and experience, you can find innovative ways to cut costs without cutting quality. As a politician with little expertise in anything other than being a good bs’er, it's unlikely you would be able to come up with legitimate operative solutions.
>Medicine is not like buying gasoline.
Actually, yes it is. People certainly try to rationalize why it is not, but assume you’re in the middle of the desert, and that gasoline is the only way back to civilization, then that gasoline becomes pretty crucial as well now doesn’t it?
Food is pretty crucial. We have plenty of people supplying it, so it doesn’t much seem so hard to get. Assume it was actually scarce. In the face of starvation, medical care becomes comparatively trivial. During a famine getting food shipped out becomes more important than shipping medicine.
How about clean water? We figured that out a long time ago, and thus it is also trivial. Lack clean water though and you get cholera outbreaks, and mass death.
Then someone mentioned how choosing a surgeon was a real difficult choice, and not one to be taken lightly. True enough.
Choosing a brake mechanic is kind of important as well. Somehow I can manage to rely on the market and the courts to make that work.
Surgeons have tricky, high consequence jobs. However there is no magical thing from a command economy which changes that fact. Bureaucrats don’t have to have access to better information than the average consumer. Knowing government employees, they likely won’t care if they do have it. Their life isn’t on the line. The patient’s is. Who do you think cares more? It’s pretty closely related to who spends their money more carefully, someone spending their own money or someone spending other’s money?
People for some reason attach special importance to medicine as if it is the only field in the world which can have life or death consequences. Let’s be honest, it’s not. It’s one of many. However it is one which is constantly rationalized into being handed unto centralized control.
Here’s a really easy example. Which is more dangerous a surgeon who screws up or an airline pilot who screws up? The former kills one person when it happens. The latter can kill hundreds of people. Oddly enough nobody is screaming for nationalized air transport (yes I know air transport isn’t a necessity, but I’m looking at consequences here).
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