Imagine for a minute that everyone had BASIC health insurance. Provided by the government. If they get cancer, it will be paid for. If they sneeze, they will pay out-of-pocket for a doctor. Doctors who are AMAZING will charge... 200 for a visit. Not so amazing ones... 30.

Woah there. If your doctor charges you 150 per visit, you will be sure as hell checking that the doctor is good. While at $30 whatever. If you pay for your drugs, you will be damn sure you need them at $150 a pop. But at $15 a pop, meh better be safe than sorry.

Now an insurance company comes along... Hold up, sure I'll pay for it but how easy is it to make claims? Are they actually paying out or are they just giving you red tape?

It goes on.

Look at the COMPETITION created:

Doctors compete on skill to get not only clients who pay next to nothing per visit but pay hundreds to the doctor, but also on how much they charge.

Treatments compete on effectiveness. Will I pay $10k for a treatment that may be equally as effective as a $1k treatment?

Insurance companies compete on coverage/serving customers. Because anyone can leave and switch, and if they don't they have the safety net. Insurance companies now stop having the per-person monopoly. Very rarely do people have any choice in insurance companies.

Employers have employees who have only the risk of lack of salary when leaving a job. Though that risk is bad, especially when owning a mortgage.

The competition created becomes crazy. Entire monopolistic business models get toppled. And all for a very very small price. The fun part is once the free market kicks in, prices will plumet too. Competition will ensure to that. We just have to make sure competition gets a chance.

Back in 2006 I pulled the latest WHO data and looked at % of medical industry privatized vs overall health of the populace (an function of factors such as infant mortality and lives lost to communicable diseases) in OECD countries.

As best I could tell there was a negative correlation between privatization and quality of care. As I recall the USA was the worst (by far), Australia's hybrid system put them near the middle, and Japan was on top.

Sure the sample data is small and the USA is very very far from a pure market at this point, but it was enough of a wake-up call for me that I stopped blindly believing in economic models.

After all it is only a model, not reality.

Health care may in fact be a 'natural monopoly' such as water or power, or it may be better as a government controlled industry such as education or defence. Only a few radicals think the government should not run or regulate any industry.

Some things to consider:

> Is is better that people always visit the doctor when they have a minor concern? (like 'if they sneeze . . .') because if people are paying out of pocket even at $100 many will not go.

> Many rural areas have only one hospital. Their emergency room is a monopoly. In a perfect market they could charge whatever they wanted and people would still go.

> Can the average person 'make sure a doctor is good?' Do they know how to make such a judgement?

> If doctors needed to compete, would it necessary be a sill-based competition? Is there a correlation between customer satisfaction and early detection for things like annual physicals?

> Do we want to have a society where you level of income determines your quality of care (and probably life expectancy)

I agree that the current US system is close to the worst thing possible, virtually no competition due to insurance being tied to employers, and also virtually no safety net.

I was uninsured for two and a half years. When I went to the hospital and asked how much things cost no one knew. Twice I was misinformed by more than a hundred dollars.

So yeah I think the model you propose may well be better than what we currently have, but I sincerely doubt it is the best possible.

But how would I do that? If I had even a fraction of the skill required to tell a good doctor from a bad doctor, I would be one. Hell, I can't even tell a good car mechanic from a bad one.

Competition is great when you have something approaching a perfect market, but medical care is about as far from that as you can get.

It's not just the health insurance, it's also the college loans (and the prospect of having to pay for your children's college) and the mortgages. People with debt don't make much noise, and while people were likeable and smart, there was an undercurrent of deferring to authority that seemed bizarre.

'Privilege' never used to mean 'wealthy' or 'rich'. It meant "a special advantage, immunity, permission, right, or benefit granted to or enjoyed by an individual, class, or caste."

The word 'freedom' has also been subjected to a subtle change in meaning. The word formerly meant freedom from coercion, from the arbitrary power of other people. People who share your opinion have changed it to mean freedom from necessity, release from the compulsion of the circumstances which inevitably limit the range of choice of all of us.

I am a hispanic male working as a computer programmer, and maybe because of that it's easier to see the privilege my occupation affords me as my grandmother lives in a country where the median income after tax is 500 american.. Where every so often the police, and army decide to shoot it out in the streets.. Where 51% of the population is beneath the poverty line..

Maybe it's easier for me to see privilege as I went to a highschool that was a minority majority school in the poor part of town. Where some kids weren't worried about there health care from the flu, but there health care from a flying bullets within there apartment complex. Where the kids in the cafeteria line that had white slips are getting there only meal of the day because it's paid for by the government.

Not only do I think it's important to understand we are privileged; I believe it is also our responsibility to act on that privilege to make sure all are granted the same basics our life affords as engineers (job security, food, health care, personal security[violence], time off to vote, etc). Only when the general public is granted those basics will I even partially not think of my self as not privileged.

But all the same, I'd prefer to say that they are "less under-pivileged" in an environment where they can be fired for what they do on Reddit in their spare time, leaving them unable to provide for a wife with medical issues.

In the case I am thinking of, many people said that the privileged person in question shouldn't have been doing unpopular things if he had a wife to support. Which really underscores my point.

On a global scale, anyone who is reasonably assured that local militia won't come in and rape their wives in front of them before executing their entire family is pretty privileged. Or anyone who has no fear of starving to death etc etc.

I thought it was a good piece, but then I am English and really rather like the safety nets that let me change career without fear. The ones that meant my motorbike accident cost me a year of my life - but didn't make me bankrupt. I cannot imagine living without them. That for damn sure makes me privileged. Even if half my wages do vanish into the taxman's coffers.

I am actually very much for safety nets, but I don't see why companies should have a special obligation to pay up. If society wants safety nets, society should pay (and companies would pay their share via the taxes they pay, too).

Probably cures for cancer. The thing is, Pinterest for X is a quicker path to money than becoming a biomedical engineer and making Yet Another Incremental Contribution Towards Treating and Curing Cancer. So a culture that focuses more on acquiring money over other values will have more crappy start-ups and less scientific advancement. A culture that diverts some effort away from financial gain towards humane safety nets or research is going to see more research and more risk-taking.

Without the fear of failure, whats to stop one from making improperly weighed decisions?

Why do you think you know the proper weights for decisions a priori? Ha, and I bet you're American, too. Founded on opportunity and experimentation, now one of the countries where everything has to follow a Grand Plan for Success.

Real life is an experiment-in-progress, not a Grand Plan. Attempting to instill fear in the populace so as to encourage Grand Planning doesn't actually help anything.

It's not dramatic, it's just that normal for Israelis is far more open and assertive than for Americans. Partially a cultural difference, but largely an effect of not actually being screwed for life by one bad decision.

The author dismiss everyone who disagrees with him as "privileged" and wanting to "benefit from your fear". This is ridiculous and insulting. There are countless people who advocate the free market, not to entrench their position, but rather to give them a fighting chance against the existing economic hegemony in the first place. The "truly privileged" often don't want a free market, because the truly privileged are benefiting from the inherent inequality in a restricted market. This is obviously not true for everyone - but look at our recent bailouts of banks and car manufacturers. Do you think they would rather have a free market that would force them to sink or swim based on their own efficiency? Hell no! They would be out of business by now, if it weren't for the government using the power to kill peculiar to the government to coerce citizens into giving their money to mismanaged banks and manufacturers, so they could reap the wealth that comes with taking risk and offload all that risk onto everyone. (This, of course, ignores the fact that much of the mismanagement, particularly of the banks, was forced upon them by government regulation in the first place. For more information, I recommend Thomas Sowell's The Housing Boom and Bust. http://www.amazon.com/Housing-Boom-Bust-Revised/dp/B004I1JQ9... - not an affiliate link.)

I understand that he probably doesn't intend to defend the bailouts (though I consider them, or something like them, inevitable in a restricted market). But what he advocates is the same kind of thing - forcing people to pay for other people's risk (I understand that it's a very different scenario, because this risk is unavoidable, but in this limited aspect it's quite similar). His arguments make sense on the surface, and, indeed, perhaps universal health care does work better in a model that is already fundamentally broken (I seriously doubt this, but it's an argument for another time. But dismissing a free market argument without considering how a free market might actually work, assuming that it would operate without changing the rules that the current healthcare system works under, is setting up a straw man and triumphantly knocking him down.

You have to look deeper than just private healthcare insurance. When I argue for free markets, I don't just argue for free market insurance. Why is healthcare so expensive? Particularly when hospitals are usually built and funded by the government anyway? Why do we need health insurance to avoid going bankrupt?

A firm that began offering the same healthcare at lower prices would be overflowing with customers (the current hospitals, which have exorbitant prices, already are). So why doesn't anybody do that? First, because of the litigatory nightmare that is the modern healthcare system that, because of an absurdly low standard for malpractice suits (which are fine in principle, I admit) require doctors and hospitals to pay enormous amounts in malpractice insurance. Second, the restrictive and state-controlled medical licensing scheme, which drives the price of medical education through the roof. Third, the tremendous amount of regulation surrounding healthcare itself.

You may become indignant at this point, saying that total deregulation of the healthcare market is nonsense and poppycock, and that, while deregulation may drive many prices down so low as to be generally affordable without health insurance, there will still be some situations that would still be expensive enough to ruin most people. First, private licensing would still be available. The boards and organizations that already exist to license healthcare would still exist, they just wouldn't be controlled by the government, so you could work outside of them, allowing for more affordable healthcare in less restrictive licensing schemes. Clear malpractice and fraud would still be crimes, of course. To address the second objection, private insurance would still be available for those disastrous times, but it would be far cheaper because the frequency of bank-busting medical treatment would be vastly lowered. It would be affordable to pay for your own health insurance, rather than using an employer's, making it easier to start your own business. And that business would be started in an environment free of government-mandated monopolies (by far and away the most common form - look at the problems with Uber and Lyft), inconsistent and restrictive licensing schemes, and other harmful and difficult-to-avoid forms of regulation.

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My point in this long comment isn't really to convince anyone of my economic opinions. My point is simply that hand-waving my arguments away without considering their actual implications and what I actually advocate is not an argument at all. I'd love to engage in debate, but this is impossible if he's unwilling to listen to my arguments.

I have a lot of problems with what you wrote, but will just focus on one thing. You base your argument at least partially on the idea that hospitals overflowing 'with customers' is a desirable thing. First, hospitals are already overflowing with patients. Demand is not an issue.

Secondly, hospitals and other health care providers are in a different market - the better the service, the less their customers need them. If they are motivated by maximizing profit - they have two ways of doing it: keeping you sick, or getting more sick people. Neither of those strategies are good things.

You might argue that this isn't necessary, because there is always a supply of sick people. I would refer you to my first point - demand isn't the issue, and the point of the different healthcare providers are explicitly to reduce demand.

Demand is always an issue - in this case, high demand and a tightly limited supply have resulted in astronomical pricing. We can't really affect demand, other than to cure various diseases, but we can easily affect supply by easing the intense regulation and government-mandated licensing monopoly.

I also never said that hospitals ought to be for-profit (though I wouldn't suggest outlawing for-profit hospitals, either). There are many advantages to a non-profit approach, and non-profits do not have to have the government's support to exist. I am only arguing that the government should get out of the issue, except when it comes to judicial matters of crime or civil suits. An organization can have a motivation other than profit - many do. Many organizations (the Red Cross, for instance) would be more than happy if they were unneeded and obsolete. I realize there are certainly some corrupt people who would try to use their position for unjust personal gain, but this is always the case, and would become harder to do than under the current model, not easier.

(As a very firm Christian, I tend towards the idea that the best model for hospitals is to be managed by the church (e.g., the numerous and beneficial Catholic hospitals around the country), which would be in line with what I previously said about non-profits, though I realize I am probably nearly alone in that opinion on this forum. I don't believe that secular hospitals should be outlawed and all hospitals should be required to be church hospitals, merely that church hospitals are the best model.)

Regardless, my point wasn't really to argue the free market position in this case. My comment was more to point out that the OP doesn't actually engage with the arguments he claims to refute, as he doesn't look at what a free-market advocate would actually say.

Just because raganwald writes it doesn't mean it belongs here.