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Comment by namdnay | Hacker News Reader

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namdnay

> The problem is that governments don't work that way

Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap

> What does a Congressman get

Nothing, they don't negotiate

> What about the government bureaucrat

A performance bonus, a raise, a promotion? Just like any other organisation?

> What you need is for people to be able to choose based on published price information

OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?

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> What you need is for people to be able to choose based on published price information

What they're saying is that a large amount of healthcare spending is driven by patients and providers, but paid for by insurance companies. Neither patients nor doctors have an immediate, short-term incentive to make sure they utilize insurance company resources judiciously. On the contrary, the both have an incentive to consume as many insurance company resources as possible (the patient wants to make sure they get every possible treatment, even if that means consuming 10x resources to prevent a 1/10th as likely outcome, and the provider wants to bill as much as possible to increase revenue).

I can tell you, as somebody whose family has catastrophic coverage only, that we think long and hard before we blow $200 so that a doctor can tell us to take some ibuprofen and drink plenty of fluids. And we also ask lots of questions about how much various recommended treatments will cost vs. what they will do for us.

> Well, they can... Just look at France. Amazing healthcare, a lot of it private, relatively cheap

In a place with a different political system, population, demographics, culture, economy, etc... and France has a price transparency law.

> Nothing, they don't negotiate

They pass laws dictating how others can negotiate (or not).

> A performance bonus, a raise, a promotion? Just like any other organisation?

But not like any other organization, because if you gave a government employee a million dollar bonus for doing their job there would be a riot. Meanwhile they can get million dollar private sector employment for not doing their job.

> OK, go and buy a pound of ground meat. Or an LCD screen. Are you seriously telling me you can get a better deal than McDonalds or Apple?

I'm telling you I can get a better deal than the Department of Defense.

Doesn’t the French government have some leverage via pharmaceutical intellectual property rights? I’m no expert, but I don’t think it’s as simple as “everyone should just buy in bulk like we do.”

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