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Kistaro Windrider, Reptillian Situation Assessor

Unfortunately, I Really Am That Nerdy

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An opinion
airbrushed, thoughtful
Let’s say you start a business. In this business, you provide a service to people.

Let’s say there are only two to four providers of this service in any given area. Now people who need this service can’t reject it. If they reject it, they will probably die. They can’t choose which provider they go to most of the time, because someone else takes them there and decides which one to go to. Often, they won’t let you say no to the service.

Now let’s say, in return for this service, you charge them all of their money.

Why wouldn’t you? The law says you can charge what you want to provide a service, and the free market says that if you charge too much, they would go somewhere else or simply forgo the service. But they keep coming to you, so obviously your prices are usual, conventional, and reasonable.

This is the fundamental problem with health care in America.

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hmm, I should post this in my own journal

I don't know if you have *the* fundamental problem, but it is *a* fundamental problem. If health care it to be a fully free market, then the right for a provider or consumer to decline the transaction would exist. Except for emergency/unstable situations, this remains the largely the case. However, the EMTALA law in 1986 made it impossible for emergency rooms to turn away people who showed up. Over the years, costs have been jacked up largely by advances in techology. Such fancy devices and techniques have been in high demand with the national mentality of wanting everything done now. I happen to work for an academic referral where we do a fair share of extra tests because the patients have been through the basic workups by now. Also, for the record, I'm salaried so I get nothing extra for doing so; I have no performance bonus type evaluations or anything like that. Along with the extra fees incurred, there is the wonderful force of the insurance companies. It's an interesting free market where the buyer gets to set the price after the deal is done. It kind of reminds me of bargaining in third world countries, except it is more civilized there.

Health care could continue to function with a business model, which is more how non-academic practices work. There the extra tests and procedures go toward income. There's a sad pressure to push for these additional evaluations to frankly keep the office afloat. Reimbursement versus expenses have devolved to the point where primary care doctors have to churn through patients in 5-10 minutes to make ends meet. This is sorely insufficient for good patient care.

So, let's suppose we not treat health care as a private good in a free market. Instead it becomes a public good (like trains, highways, or parks... not the best comparisons) under a national health care system. Some downsides are longer waiting times since health care providers aren't pushing patients down the assembly line and can spend some time with them. Less extraneous tests are offered, and I suspect there would be a process (maybe quick, maybe slow) to advocate for a patient that we think really needs another procedure. Under such a market, obviously prices would be set the government, which frankly already has a significant hand in doing so via Medicare. I'd become a government employee and take a pay cut but probably get additional benefits.

America isn't moving anywhere close to that. I'm not sure the President or Congress really know what they're doing at all. Last I checked, there's still a public insurance option floating around the table, and rumblings of mandatory insurance like in Massachusetts have been mentioned. The mandatory insurance may force a cut of 15-20% in premiums, which is frankly still not afforadable for the families it's supposed to help. In fact it seems more like a boon to the insurance industry than anything else. Worry not, those who can't do it could just pay the government a fine instead. Look, it's obvious taxes are going to have to increase (or government has to become more efficient haha) to expand health care in any significant fashion, but there's something shady about this proposal. I'm not sure it even addresses the rising costs. Does anyone else feel like America is half-assing health care reform right now?

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