Hacker News Reader

Comment by warcher | Hacker News Reader

It's a fun thought experiment, but we'd never do it.

A free market would look something like this:

1) everybody buys their own insurance in a genuinely free marketplace (this is ENTIRELY not the case now and would probably require significant gov intervention to defeat cartel-seeking behavior from insurance co's. There are good reasons insurance is so highly regulated, only the first of which is that insurance companies are highly incentivized to not pay out since they already have your money, and you can't go elsewhere with your claim.)

2) if you can't pay, you die in the gutter.

View on HN

Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"

> Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"

It wasn't before, so it probably wouldn't serve as one in the future. The issue is that people aren't very good at estimating risk.

I'm young, healthy, and no one in my family has been in a serious car accident/gotten cancer/had a heart attack in the last 15 years. Obviously that happening is a low risk compared to the financial penalty of maintaining insurance today, so why should I worry? Besides, I'm sure I can get some kind of plan from an insurance company if something bad does happen[1]

[1] I'll be sure to look into the feasibility of this statement as soon as I finish all the other important things on my todo list...

Oh yeah, I don't mean it'd work, I think healthcare neatly falls in the category of collective action problems that are poor fits for the capitalistic profit motive. A lot of people would suffer and die unnecessarily. And in a democracy, enough people would be incentivized to vote for exception after exception to destroy any semblance of market competition. Old people are very very good at two things: getting sick and voting. The pathological dysfunction of American healthcare is pretty much inevitable if you try to stuff for-profit healthcare into a democracy.

I'm really not a socialist, I promise. I just don't see how you'd do it any other better, and it's pretty clear to me that the results are definitively in for our free market experiment.

It's funny how we all pretty much agree the govt should be in charge of stuff like roads, schools, military, police, fire dept, courts, quite a long list of stuff, but adding anything to that is marketed as creeping socialism.

In that case, why would the person choose to do skateboarding? Also, does the individual has any family / friend / church support? If you have no family, no friend, not involved in any community, why do you risk yourself for fun? Because "the society" have to pay for your stupidity?

States or the feds could offer re-insurance for your primary insurance provider. That removes the incentive to not pay out, since astronomical risk moves into a larger pool (either the entire state or the entire US).

Point two is already true in developing countries.

"2) if you can't pay, you die in the gutter."

No. It is simply false. Even a 100% free market does not exclude charity.

So, the people too poor to pay but not poor enough for charity die slowly in their hovels?

Somebody pays, or you die in the gutter.

Lotta people talk about charity as a replacement for government services, but folks give around 3% of their income to charity (tax deductible) in the US. That ain't gonna get it done. Not even close.

People would have you believe they would give more if they didn't pay as much in taxes, but there is not one shred of evidence that is the case based on variations in local tax rates. And that's a hell of a gap to bridge based on a such a dubious promise.

Occam's razor, and the available evidence, suggests that people would just pocket the difference and the poor can go to hell. They're happy to argue the point until they're blue in the face, but if the past year has taught us nothing at all, it's that people are more than capable of crafting any number of passionate arguments around their self-interest, truth be damned.

And so we should put government in control of health care. But who runs government? Oh, it's people, who you just argued are all hopelessly greedy and self-centered.

It's not as if we don't have experimental data on both the ability to run a government that is more or less functional with a bunch of self-interested actors in general, or the relative merits of the free market vs socialized healthcare in specific. We ran the numbers. It isn't working. The arguments around doubling down on the free market I find intellectually spurious, and the most convenient explanation from my perspective is the fact that we are thus far wealthy and powerful enough to afford the application of a one-size-fits-all ideology to avoid the emotional strain of admitting we were wrong all these years.

Reply on news.ycombinator.com