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Comment by kansface | Hacker News Reader

> The free market does not work in all situations.

Sure, but you did not enumerate a single free market. I'd wager the US healthcare industry is far and away the most regulated market in the entire world. We know that regulation protects the big players at the expense of their would be competition and drives up profits. Colleges are hardly any better, and ISPs are nearly all monopolies granted by municipalities in exchange for kick backs of various sorts. The government has interfered with every industry in this list via direct/indirect regulation, grants, guaranteed loans, or tax incentives. Lets go ahead and throw in housing in our list, too.

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From a European point of view I have a hard time understanding your opinion.

In other countries, regulated/public healthcare works better and is more efficient than your system, it's hard to deny it... I don't see how doubling down on cutting regulations would solve anything.

In a way it reminds me of the gun control issue: the idea that deregulating gun ownership and carrying will make everybody safer seems so absurd from abroad... I guess it's cultural.

Regulating a service and providing it at public expense are completely separate concepts.

Europeans do not have cheap healthcare as a result of price controls on private medical practices (regulation), but as a result of redistribution and subsidy (spending).

At least in France, it's both. The cost for the patient is usually low thanks to the health insurance, but also because of price control. A GP visit is 25 euros by law, covered from 70 to 100% depending on your insurance. Doctors can choose to charge more but then patients need better private insurances to be reimbursed.

You can find the price lists here:

* https://www.ameli.fr/paris/medecin/exercice-liberal/facturat... * https://www.ameli.fr/paris/medecin/exercice-liberal/facturat...

How many visits does it take to get a simple prescription?

We have something similar, I've been appointed consultations only to be asked how I felt.

You can get a simple prescription at the first consultation. For what I remember 10yrs ago, to see a specialist, you need to go to you general practitioner first. Then he will decide if you need a referral.

Edit: you can go directly to a specialist or not follow the « health path », you will just get less reimbursed. Some specialist can be seen without referral (gyn, psy...)

If doctors can choose to charge more to willing patients, that doesn't seem to actually be a price control. Perhaps 25 euros is the amount that the insurance system will reimburse?

The French system is fairly complex, it's not single payer. To sum up, for "everyday" health issues the public health insurance reimburses 70%. For grave long-term illnesses, you're covered 100%.

You're supposed to have a private health insurance (it's now mandatory for all employees) that reimburses the remaining 30% and all extra costs. That includes some dental and optical work, but also stuff like single-bed rooms in the hospital. Your additional private insurance also covers doctors charging more than the "official" price.

No, the per capita cost of healthcare in the US is astronomically greater than Western European countries, including both private and public spend. In the UK the NHS is a socialised service that is free at the point of use. If that's not 'regulation' then I don't know what is.

It's not a regulation of a private industry. It's a law on the people to pay for public health. If we still want to call it a regulation then it's a regulation on individuals instead of the health business.

To regulate an industry is to make rules about how its participants may behave. This worlds away from government participating in the industry directly.

Public housing is a public service; rent control is regulation.

Public transit is a public service; fuel efficiency standards are regulation.

Medicare is a public service; the medical licensing regime is regulation.

Europeans have cheap healthcare because most of the R&D is subsidized by the US paying list prices.

Europeans can spend such a huge amount (16% of govt budget vs 10% in the US) partially because the US is subsidizing their defense.

The US will eventually go to socialized medicine and then you will see the pace of medical advancement slow. Unfortunately it will be impossible to see because it is unknowable what would have been invented with a capitalist system.

The argument is that although the U.S healthcare system - based off of some metric - underperforms compared to a system which makes no claim of being based on a free market, the U.S. healthcare is also not a free market by any means. Lightly regulated it is not.

Also, you combine "works better" and efficiency: This is slightly unheplful, as although (let's say) the NHS is very cost efficient is - however - not anywhere near as impressive when it comes to patient outcomes. I am not well-versed in the topic to provide a well thought out counterexample however I believe that the Swiss system would be a suitable example?

Comparing the deregulation of businesses with guns is fallacious if not ridiculous: However, being British etc, I do share your fears as to healthcare deregulation.

An unregulated healthcare market, complete with all the benefits of the free market, was the rule in the US until the Pure Good and Drug Act of 1906. It's history is... entertaining.

An act which incidentally is credited as the most beneficial piece of US legislation to date in terms of addiction reduction and prevention.

Can you prove that the US healthcare industry is more regulated than countries like say, Germany or Canada? Because it would be incredibly hard to believe that somehow America is more regulated than countries that have more direct control over their healthcare.

I think that's exactly the point: direct control and heavy regulation are two different things.

This in-between fairyland with artificial barriers to entry on the frontend but no control on the back end is what's creating these captive markets where old companies to do almost anything because new companies can't join the market.

To add to that point, because the government guarantees things that it has no control over, it means the businesses in these industries have the best risk/reward ratio possible: no risk for unlimited upside, because the risk is taken care of by taxpayers.

I still think the way to go is to have a price index where if procedure X is available in (list of countries with good healthcare system) for $Y, then it should be illegal to charge more than $Y in the U.S. Have a central authority that manages the price index and the list of countries that we survey prices from. Then doctors and hospitals and pharmaceuticals couldn't all take advantage of the system by charging $500 for a fucking IV drip.

I believe Australia uses something similar, at least that's what I noticed while living & working there. Ex: https://www.health.nsw.gov.au/Hospitals/Going_To_hospital/co...

In the US there is the Surgery Center of Oklahoma which does something similar; I believe there are doctors in Oregon who do the same as well.

https://surgerycenterok.com/pricing/

> We know that regulation protects the big players at the expense of their would be competition and drives up profits.

You're describing poorly thought out or outright captured regulation.

Regulation is not defacto bad. There are plenty of regulations from the last 100 years all over the world that are demonstrably positive.

Three honest questions:

1. Is there a place that is deregulated enough that it can be used as an example?

2. If so, does that place significantly outperform all others?

3. If so, what holds back the people in more regulated areas from adopting that type of system?

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