Comment by ddingus | Hacker News Reader

Comment by ddingus | Hacker News Reader

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>All I'm pointing out to you is that the "profit motive" has nothing to do with that

You have not met that burden. Not even close.

The best case is a mixed environment, with a for profit portion that can address clear for profit cases well.

And those exist!

But, doing that sans a robust system that actually just delivers health care to sick people is crazy bad policy.

There is another argument in your favor out there, and that is consistent, transparent pricing. Or "Equal Pricing"

In Singapore, there are no real surprises and people have options that don't cause them to trade, homes for example, to get sick people they care about healthy again.

Here? Nothing but surprises!

And frankly, that being the case actually does support the difficult argument:

If making money is the priority, then making sick people healthy isn't.

On the other hand, if making sick people healthy is the top priority, and then we talk about money?

Very different scenarios.

The US is firmly entrenched in the former. Examples of the latter exist in the world and perform well.

The profit motive matters. How it's framed, what priority it has, and more all do contribute to the overall effectiveness and again that cost and risk exposure.

> You have not met that burden. Not even close.

What? I absolutely have. I’m not sure what you’re on about. Switzerland is as close as it gets to a profit-driven purely private healthcare system. Indeed, the US was modeled off of it. The only difference between the two is that the former is based on a robust individual market while the latter is driven by group benefits.

> But doing that sans a robust system that actually just delivers health care to sick people is just bad policy

I don’t think anybody is suggesting not delivering health care to sick people. The question is whether the private sector can provide an actuarial product.

> In Singapore, there are no real surprises

Agree, Singapore’s healthcare system is excellent, and price transparency is very important. The reason the US system is devoid of price transparency is because the majority of Americans simply don’t care about prices, since they have little skin in the game. This is true for old people on Original Medicare, poor people on Medicaid, as well as employed people on generous group plans. If none of those describe you, then you’re unfortunately SOL. THAT’S the problem. Not the profit motive.

> If making money is the priority, then making sick people healthy isn’t

Again, it’s a cute pithy quote, but that’s not how the real world works. If making money is a priority, then feeding hungry people isn’t. If making money is a priority, then providing cheap clothing and shelter isn’t. It’s impossible to understand how the world works through such a simplistic lens.

As I showed you above, the Medicare A/B test is illuminating. Medicare Advantage payers are primarily in the business of making money, and yet their members are on average healthier, have higher quality plans, and at lower cost.

Feeding people isn't a priority!

World hunger anyone! It's a real thing.

We have it because making money is a higher priority than feeding people is.

Cheers, I have other things to do, and did enjoy this discussion!

> Feeding people isn’t a priority!

Feeding people is 100% the priority, which is why the vast majority of people in the first world have access to food primarily produced by a predominately private food industry.

The US is in the top 5 in the world for food security: https://www.worldatlas.com/articles/the-world-s-best-countri...

To the extent that there exists poor people unable to afford food, that’s a problem solved by welfare and subsidies, not by nationalizing food supply chains.

Apply that to healthcare.

"Unable to afford food" = making money is a higher priority.

Unable to afford the doctor = making money is a higher priority.

Many food banks will give people who want food, food. Few questions, sometimes no questions asked.

It is rare to have similar access to health care.

Where did I mention nationalize?

I did not do that, and meant to not do that.

> Many food banks will give people who want food, food. Few questions, sometimes no questions asked.

> It is rare to have similar access to health care.

No it’s not, you just described Medicaid. The Venn diagram of people that rely on food banks for food and people on Medicaid is basically a circle.

Also, it’s debatable if food banks are a superior way of getting food to poor people, vs expanding food stamps and/or a UBI which can then be used at grocery stores.

> Where did I mention nationalize?

You seem to be attacking the profit motive as a mechanism by which to provision goods and services for which there is highly inelastic demand. My point is that if you think that the way we provision food is workable, then the concept of private healthcare with subsidies (basically the Swiss model and MAdv) should be as well. In both of those models, profit and “making money” is still key.

Medicaid asks a LOT of questions, the food bank does not.

You are saying a for profit system can work. You are about pricing in that scenario too. Fair enough. Given your perspective, your position on this is understandable. It is not agreeable, in my view.

Our way of provisioning food could be improved significantly. Food differs from health care significantly. Secondky, that we have food banks at all is deplorable and embarrassing.

That is all I care to entertain on that largely useless comparison.

I am attacking the profit motive in health care specifically because it carries an inherent conflict of interest and is poorly aligned with markets.

In any case, I am going to stop here for real, and just make it clear I do oppose health care as a market and do so because people do not have control over their need to participate and we all know what happens in a must buy, cannot walk away from the deal scenario: lowest value for the most possible dollars.

That comes up ALL the time and is why most of the world has removed that conflict of interest from the task of fixing sick or hurt people.

> Medicaid asks a LOT of questions, the food bank does not.

Not sure what you're talking about. Medicaid is extraordinarily generous. The only questions that are asked are in determining whether one qualifies to enroll in Medicaid, but once you're in, you pay almost nothing. Even prescription drugs are capped at $75, no matter how rare or fancy.

> Food differs from health care significantly

I disagree. Both are examples of critical goods/services without which humans die. They both factor into long-term health and quality of life.

> Secondky, that we have food banks at all is deplorable and embarrassing.

I completely agree. While I've been extolling the virtues of pricing systems to provision goods and services, I've also made it clear that welfare is extremely important. The US currently extends welfare to low income people, through SNAP/EBT food stamps, Section 8 Housing vouchers, and EITC. In my opinion, there's still room to further expand the generosity of these systems, and even consolidate them into a basic income.

It's worth disentangling welfare from public vs private, because it's easy to conflate the two. It's entirely possible to rely on private markets to bring down prices and increase availability, while using publicly funded welfare to enable access for those less fortunate.

> Feeding people is 100% the priority, which is why the vast majority of people in the first world have access to food primarily produced by a predominately private food industry.

This isn't true when feeding people is the _100% priority_, like in a big crisis, as a major war. The market flies out of the window and doesn't return before after the war is over since it just can't reliably produce goods in way that is appropriate for a crisis.

When the crisis is over however, the game of profit based production is restarted again.

No disagreements re: crisis / war. That's typically when states of emergency are conventionally recommended.

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