Given how hamstrung regulators are these days thanks to a pro-corporate Congress, it doesn't say much other than that the government we've elected has chosen not to control costs.
Many people have strong support for a single payer system. Seeing this simple failure illustrates a risk in moving that direction. Who do you trust to do a better job keeping costs in control? The greed (or fiduciary duty) of an insurance company or the governance of bureaucrats?
I trust the market more because the government has proved to be far more corruptible. There should be a government option for sure, but regulations should focus more on making the healthcare market healthy.
* Open straightforward pricing
* Removal of trademark protections for named drugs
"I trust the market more because the government has proved to be far more corruptible."
Proved? Has the U.S. government actually been proven to be more corruptible than private industry?
I realize you might have been using a bit of overly-strong language, and not actually meant that in a literal way.
Still, frankly speaking, I trust the government a heck of a lot more than private businesses like Comcast or the health insurers.
Your statement, all the same, leaves me wondering if somehow I've missed out on some news stories or something, that shows how the government is corrupt while BCBS or UnitedHealth act with integrity.
There's no way to say "proved" about anything but mathematics that meets with it's usage in that context. It's not overly strong language, just used in a different context therefore with different meaning.
I trust an insurance company and healthcare provider because they are adversaries. Insurance vs insurance, insurance vs provider, provider vs provider. They're being driven with competition and ultimately greed. If one of them does a bad job, another that's doing better will replace it. They're all playing with their own money.
A government bureaucrat tough doesn't really have any skin in the game. They might be driven by good natured ideals, but I think that's far too vulnerable to compromise. From politicians being bought by lobbyists to a revolving door between industry and bureaucracies personal greed leads only to healthcare providers and government colluding for their own individual benefits to the detriment of the citizen who has no option but to pay taxes and get the services of the single healthcare system.
In theory a benevolent dictator is the ideal form of government, but in reality the people with power just aren't angels. You can use competition and greed for the greater good if you do it properly, you just have to recognize what you're doing and how to manipulate human behavior for the best outcome.
So, to clarify, when you say it's proven that government is more corruptible than business, you don't mean it's proven.
Look, knock government all you want, but unambiguous and strongly-phrased claims like that need something better than "this is so because I trust that this is so". Otherwise, we're just in truthiness territory.
"A government bureaucrat tough doesn't really have any skin in the game."
Neither does a contract specialist in an insurance company, of course. Both are just showing up for a job. Only one of them has a specific profit motive in mind, though. And it seems to be the exclusive domain of private industry to reward middle managers for short-term results, no matter what long-term problems those short-term gains create for the organization.
Man, the more we go over this, the more I trust the government to manage something as life-altering as health care. They're responsive to all citizens, we get to conduct regular changes of power, there's no profit motive, and we've got a wonderful model in a ton of other countries for how well it could work.
"In theory a benevolent dictator is the ideal form of government ..."
Whoa! What?? Where on earth did you get that? For someone who likes markets as much as you seem to, I'm really surprised you wouldn't endorse something that reflected, you know, the will of the people.
>I trust an insurance company and healthcare provider because they are adversaries. Insurance vs insurance, insurance vs provider, provider vs provider. They're being driven with competition and ultimately greed. If one of them does a bad job, another that's doing better will replace it. They're all playing with their own money.
I mean, alternatively, doesn't the ultimate utilization of what the market can bear mean "no aggression pacts" between companies? As far as I've observed change in local options and markets in recent years hasnt been from innovation or disruptive new comers in many healthcare fields but instead buyouts and mergers consolidating the power until you're left with giants that just sort of leave one another alone. This doesn't breed competition, it breeds complacaency and a market with extremely few choices.
I don't know the answer but this idea that corporations will fight for our dollar doesn't sit well with me, as the current state of healthcare options shows this to not be the case. The barrier of entry just on cost (equip, doctors, medicine) excluding regulatory issues is prohibitive, and doubly so for insurers. Disruptive forces that would provoke competition or a change in pricing just seems too difficult to get off the ground.
There are plenty of markets where competition drives the margins to near zero. I'm not saying medicine can or should be one of them, but something along that trend is wholly possible.
The government _does_ have a role in this. They need to be there to foster the healthy competition environment with appropriate legislation and regulation. Part of that healthy regulation is punishing highly illegal "no aggression pacts" and enforcing antitrust laws to prevent mergers that would suck out the competition.
Small states. And there _are_ problems with them, painting them all as perfect doesn't help anyone.
Not to mention that the US pays for much of the defense costs for NATO (on purpose with good reason) which further distorts what one country could actually afford and why you couldn't just force a different model on the US and expect success.
There have been many efforts to build state single-payer systems and they've all failed. Vermont got closest but couldn't find the money.
It's a big shift to the economy. Taking what's now a benefit for a huge chunk of workers and turning it into a tax of both businesses and individuals. It's not an easy thing to do, you have to adjust people's compensations to make up for it and lots of people will be unhappy with the change.
Not to mention incompetence and understaffing. One guy retires and now another is responsible for overseeing spending in two areas. And at least sometimes the bureaucrats aren't aware of the relevant laws.
When I was 24 I got in a skiing accident. I broke my femur into 4 pieces.
Ski patrol took me down the hill. They threw me in an ambulance. They gave me some pain drugs which blurred my memory. The ambulance took me to the nearest hospital. When I arrived there, they gave me several options to remedy my shattered leg. I chose one - the next day I could not remember the other options nor why I chose the option I did.
So I'm just curious. Where in that equation would open straightforward pricing have helped? Would I have refused an ambulance ride? Would I have done the research to call my own? Would I have requested to be taken to another hospital - the next closest one, by my guess, being an hour away? Should I call ahead and make sure their prices are reasonable?
I don't understand how the free market can work with medical care. People oftentimes are not in a position to make decisions based upon price. The free market answer to "not dying" is "I'll pay everything I have".
People sometimes aren't able to making decisions, but dire emergencies don't make up all of hospital care.
Even then, a counter anecdote, I live in a city with maybe 4 hospitals within minutes at any given time and another dozen within a half hour or so. In the most dire situations I would have a choice and with anything less than critical I have a wide variety of options to choose from. If I need medications there are dozens of pharmacies to choose from.
Yeah if you break your leg in the back woods, you're not going to have a choice for the initial care. But you will have a choice for any follow-up care. Also other people who aren't you using that same hospital will have choices between it and it's further away competition.
You're right the "I'm dying and far away from urban areas" is a pretty location-based captive market, but it's far from the whole market.
When I was a young teenager I broke my arm at a school event and ended up sitting in a hospital bed for hours waiting for them to find my parents to give consent for treatment. Even most broken bones have some pretty wide time periods to find and travel to the best hospital option. (Just not a broken femur, that shit is serious)
The US is the only first world country that has these problems. You don't need to come up with a fancy solution, just copy what another country does. It's not like it can get worse.
The US isn't the same as the rest of the first world (outmoded as that term is).
A disproportional amount of research and medical industry happens in the US. In a way, many of the developed nations' medical systems are made possible by the American medical economy. We end up paying for more of the development and exporting our technology for as much as we can get. The cost structure wouldn't be the same worldwide if America switched.
We have 50 states. Each one of them is capable of setting up a single payer healthcare system on it's own, yet none of them have. Not for lack of trying, but none have been successful. I don't think we should even have the national conversation at all until at least one state finds success implementing it themselves.
There are a large number of medical companies outside of the US as well. Additionally governments encourage research in general through patents and subsidies and provide direct funding. Not to mention that a lot of research happens at universities. Additionally many of these companies are located outside of the US.
Ignoring all of that just from a purely financial perspective, the amount of money spent on health care simply can't be explained through research, both in quantity and when it comes to the reality of what people actually pay for which treatments.
Medical research doesn't explain why people think twice about calling an ambulance or go as far as taking a taxi or driving themselves or a loved one to a hospital in an emergency. If you do that in Germany, you'll get a lecture and will be considered an idiot who has unnecessarily endangered themselves.
So the answer is "American consumers are suckers who are paying for the rest of the world, and there's nothing we can do about it"?
How about US prescription drug marketing costs (something that's illegal in most other countries)? Drug marketing costs are similar or higher than R&D costs in many cases - why does drug marketing even exist?
Drug marketing isn't illegal in most other countries, just marketing to consumers. You're free to market to physicians pretty much everywhere which is where the real money is spent anyways.
In Germany marketing to physicians is legal but doctors are effectively forced by insurance agencies to prescribe whatever drug is the cheapest equivalent unless there is a medical reason not to.
So even though there is marketing going on the actual effect is rather minimal.
The point isn't to have no rules... It's to ensure the ability to compete... right now certain protectionist rules only serve to help incumbents, and are only aided by lobbying efforts.
To countermand that, what is needed are policies to ensure competition. Compulsory patent licensing for starters, and a dual-source requirement for prescription medications paid for by the state would be another.
What we have had, and continue to have is not a free market, and it doesn't serve you to have it continue as such.
It's true that insurance companies have been fairly effective at keeping their costs down - mostly by finding clever (and often dubious) justifications for refusing to pay for treatments. This is of little consolation to the customers who've found that they can't get life-saving medical treatment due to insurance company shenanigans.
When was the last time a regulator (or government agency) admitted to failing because of incompetence, stupidity, or bad luck? It seems they are eternally underfunded and understaffed, and never make mistakes. I consider myself and my associates to be quite diligent and intelligent, yet every one of us is sometimes at fault when we fail.
The NTSB/FAA does a _great_ job of regulating. Aircraft have the beneficial property of being immune to bullshit. Mistakes, incompetence, and corruption lead very directly to planes falling out of the sky which is a very public and costly failure.
They're great because they have to be _and_ being great leads to success. You can, with solid engineering, completely understand and prevent failing. There aren't any act-of-God accidents. How and when aircraft fail is designed from the start; when they do fail there is always a cause and it's always fixable.
You can read plenty of NTSB reports about accidents (and they take mistakes which don't actually result in harm very seriously too) and they really do point out incompetence and stupidity. The most important part is that it isn't about blame or prosecution, it's about finding, fixing, and preventing problems. Revenge against people who screw up intentionally or not isn't helpful, making it impossible to screw up is.
All of the airplanes that crash were approved for production by the FAA. I am not sure how you would measure the failure rate of the NTSB, other than by looking at the number of repeated failures, which is tough, as many incidents are one-offs, or can be categorized as distinct without being substantially different.
In any case, one could regard the FAA's primary failure being that the airliner market is a duopoly. The FAA and its counterparts have helped make it so expensive to develop and approve new aircraft that only two companies can do it, and even they only design one new airplane every ten-twenty years. Bombardier, which is a large and established aircraft manufacturer could afford to develop an airliner, but not to get it approved; this results in slow progress, high prices, and little competition.
It would be interesting, if impossible to know how safe aircraft would be if Boeing and Airbus were granted an unregulated monopoly. I would guess their aircraft would be very safe and expensive (as they currently are), just like 'Ma Bell's service was in the days of its monopoly.
Every mistake, every crash is a failure and there are remarkably few of them. Mistakes happen and the mistake is always in not predicting the failure correctly.
And there's quite a bit of competition; Boeing and Airbus are integrators, they don't build all of the parts and there are plenty of parties competing for the various parts. Likewise they both make the largest aircraft exclusively, but as you get smaller you add more and more alternatives to the mix.
You're also wrong about no new models. They release updates and changes all the time. Completely new planforms just aren't needed. The basic design is fundamentally unchanged and doesn't need to be changed. There's just nowhere to go. Only small iterations of improvement.
There are plenty of opportunities for new models; Boeing wanted to make 3 new aircraft, and had to settle for 1 new and 2 upgrades. The 737 has been flying for almost 50 years, and Boeing still can't give it long enough landing gear to properly accommodate properly-sized turbofans because of the regulatory burdens. Bombardier thought there was an opportunity for a new single-aisle airliner, but hasn't been able to come up with the money to get a certificate.
The fact that there are no new aircraft manufacturers coming on-line only proves that the regulators have created a duopoly.
Looking around on the internet it sounds like the cost of the aircraft accounts for about 10% of the cost of a ticket. Frankly, airplanes sound downright cheap compared to the cost of staffing and fuel. Doesn't seem like the right place to start looking for cost-cutting measures.
If you want to understand how important new aircraft are, you need to take more factors into account, such as turn times, average numbers of transfers, etc. into account. The airlines have been moving away from the hub-and-spoke model, towards point-to-point for quite some time; aircraft CPM plays a significant part in this shift (as well as in slowing it down).
The larger Embraer E-Jet series (E170/175/190/195) jets do somewhat compete with the Boeing 737 & Airbus A320 for the regional market. The E195 is smaller, and significantly cheaper than the 737. The E-Jet has a respectable safety record, and few major accidents.
The DC-10 is notable for having several major crashes due to design flaws, which significantly reduced sales of that aircraft.
