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Subject:  Re: The real world of health care Date:  12/10/2013  6:11 PM
Author:  1poorguy Number:  1914032 of 2381073

When the bill made the news, it suddenly dropped by half.

It is very difficult (if not impossible) to make medicine a "market" service. Competition doesn't mean much. If I have an emergency (e.g. put a pick through my foot) 1poorlady will be taking me to the local ER (about 2 miles from my house). Does it matter if they charge 2x what others do? No. It's closest, so that's where we go.

And if you die? Doesn't matter, they still charge you. The mechanic doesn't charge you if he can't fix your car. Why do you have to pay if the doctor can't fix your body?

Pile insurance onto this, and things get worse. 1poorlady had a procedure several years ago that involved a night in the hospital (actually, I think two nights). Bill was $37K. I saw it. Then I get my EOB from insurance, and the first thing they did was slash the charge to something like $5K, of which I had to pay my 20%. Without insurance to lop-off that $32K the bill would have been ruinous. But if the hospital could afford to forego that $32K, why did they charge it to begin with? (answer: Because they could...because the market doesn't work here.) And the insurance company has to make a profit, so they're getting their percentage in there (based on actuarial data and rate structures).

The ACA, proposed originally by the conservative Heritage Foundation about 20 years ago, tries to use this feature of insurance to control costs and then creates markets for insurance companies to compete with each other. It at least realizes that competition within the medical industry itself is simply not going to happen. If you are sick or injured you won't be shopping around. It fails, however, because the insurance industry has to pay its people, and has to report profits to shareholders. That friction raises costs significantly. And as long as we rely on for-profit insurance we will never escape that.

It's easy to point at outrageous bills and say the system is broken. But it's really deeper than that. The outrageous bills are just a symptom.

Medicare for all pretty much solves all these problems.
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