Cobb

You got that right.

The keystone of equitable capitalism is an efficient market. An efficient market is one in which the cost, as well as the worth, of every commodity is known to all parties.

And I'd argue that the Web is the best tool ever invented to broadcast this information. It's not perfect yet, and won't ever be perfect in my lifetime, but it's already helped me to jump on certain symptoms and disregard others.

The truly intelligent person is the one who can separate the wheat from the chaff. Not everyone is able to do this, and we hear every day about people suckered in by another scheme.

There's no law against idiocy.

Yet.

I only took one economics course in university (and it was an eco-for-dummies course for non-specialists, at that). Only thing I learned out of that is that the Third World will need a God-himself miracle to close the gap (or even to maintain it), and that y'all'll be after our Canadian water soon enough. So, basically, i'm totally ill-equipped to answer this question. Mebbe we can coax someone from Drezner's or somewhere to tackle this.

But in the meantime, could you tease your question out a bit further? I'm not clear on why you feel Libertarianism hinders access to health care (that is what you're on about here, right??).

Myself, I've only recently put on a pair of minarchist shoes, which at first seemed a good fit, but now seem a bit cramped. Still, methinks it a great starting point when trying to draw up an ideal political-economic system. My question is how do we get there from here and what are acceptable "losses" (if any)?

FWIW, I'm going to venture a guess and say that hardcore Libertarians might say fixing a broken leg, like any other product or service, is worth whatever someone's willing to pay for it. In their worldview, the market would be open to anyone who wants to invest in the hospitalization bidniz. As long as information on prices is freely available, the most efficient market will emerge for any region. Each service provider's catalog of services and corresponding prices will levelset itself according to whatever cutomer profile/niche they're after. In theory.

That's exactly the problem. Prices are not freely available and insurance companies, attorneys and health care providers are collaborating in a deadly triangle to keep prices from being freely available. So each has invented an encrypted terminology which obfuscates what's really going on.

I don't think Libertarians hinder access to healthcare. I don't think Libertarians do anything. Here's some good work for them to do which is to politically agitate for an efficient healthcare market. They have no vested interests which makes them ideal.

This is the great opportunity of the decade.

Here's something you may not have considered:

If you belong to a company-sponsored health plan, after you visit a doctor and pay your co-pay, the insurance company will send you an "explanation of benefits" statement. It usually shows that they paid your doctor a negotiated discount -- sometimes as high as 40% or 50%.

Okay you economists out there, what's the effect of this?

Your doctor gets most of his revenue from third party payers. So let's say you want to buy her/his services out of your own pocket, cash on the barrelhead. You pay nearly double what your insurance company does.

This kind of discounting happens not only at the health care professional level, but at the institutions. Your local Blue Cross doesn't ever pay a hospital its billable charges. They negotiate a HUGE discount and write them one check a year.

Does this not seem like an anti-competitive practice to block all but the rich from paying for their own health care? Seems like it to me. The health insurance oligopolies' most feared competition comes not against each other, but against the out-of-pocket consumer. Cut out the walk-in customer, and for the big boys it's all gravy, baby.

This customary practice has the effect of grossly overstating the actual cost of health care in the United States. It is also obscenely unfair to the self-employed and small business people.

The simple solution (i.e. the one that will never happen) is a "most favored payer" law. Doctors or hospitals can charge only what they offer the most favored payer for any given service. If your obstetrician office visit garners $76.00 from Aetna or Oxford or Blue Cross, s/he would have to offer that rate to anybody walking through the front door with cash.

The effect of this would be:

Small insurers would be able to compete for health insurance business on a level playing field.

People could actually save money in anticipation for routine health care, and insure only for major medical. Because people would be spending their own money rather than an insurers, they would be more judicious in spending, in turn driving down the cost of this care.

But this will never happen. Oh well.

Scott,

This sounds like the good fight. All we've got to do is keep naming it and getting influential people to say the right things out loud. As a small businessman, it means a hell of a lot to me, and it is obscenely unfair.

The question is how do I pay the people who are going in the right direction?

I know for sure that health care in the US is overpriced, and I think the way states are challenging the FDA to get perscription drugs from Canada is paving the way towards us seeing the kind of market reform that's needed. As I mentioned before, being in IT I know a lot of Indians who find it cheaper to go India for dental work. Globalization of health provision may be the only way.

In the meantime, anything that can be done to demonstrate how cheaply good health care can come is all to the good. Maybe the aging baby boom can help.

I can't find the site that listed cash doctors nationally but its happening.

http://www.pbs.org/healthweek/featurep3_413.htm

"Inside, though, you won't find room rates behind the counter, but prices for blood draws, IVS and bandages. It's a parts-and-labor list for a different kind of medical practice.

LISA GRIGG, MD, SIMPLY MEDICINE: "I don't take any insurance, not even Medicaid, and I charge you $2.00 a minute."

Doctors launch cash-only practices

http://www.msnbc.msn.com/id/5014568/

http://www.calladoctor.net/cash-only-doctors-COD.htm

And don't forget we got Archer HSA (health savings accouts) in the medicare precription payoff for old people.

It will save american medicine.

I can't find the site that listed cash doctors nationally but its happening.

http://www.pbs.org/healthweek/featurep3_413.htm

"Inside, though, you won't find room rates behind the counter, but prices for blood draws, IVS and bandages. It's a parts-and-labor list for a different kind of medical practice.

LISA GRIGG, MD, SIMPLY MEDICINE: "I don't take any insurance, not even Medicaid, and I charge you $2.00 a minute."

Doctors launch cash-only practices

http://www.msnbc.msn.com/id/5014568/

http://www.calladoctor.net/cash-only-doctors-COD.htm

And don't forget we got Archer HSA (health savings accouts) in the medicare precription payoff for old people.

It will save american medicine.

As a libertarian, I say this is all well and good, in that information increases market efficiency.

But in principle, we should all be free to negotiate our own contracts, with no restrictions save the protection of innocent third parties.
Otherwise, it's just another form of Hillarycare.

True_Liberal:

Free markets are only free if the players aren't coerced by unnatural forces that warp the market.

Discounting in health care insurance markets is oligopolistic (whew!). A "most favored payer" law would protect health care providers from being coerced into shutting out cash consumers of health care services.

I think only the most dogmatic of libertarians would say that the markets are just fine the way they are.

Scott, your idea is price controls and price controls never works.

You can go to a doctor now, explain that you are going to pay cash, and then negotiate the prices.

(To quote WEW): "DarkStar, go to the head of the class!"

I think we might be confusing prices and costs. A company's costs may not be open for all to pour over, but who cares? A company's calculations re costs and what not can be black boxed. All I care about is the output. Is the price something I can afford?

It's a game. Companies offer a price low enough to tempt us to pay, and we offer to pay enuff to make it worthwhile for them to offer (the product or service).

As long as the prices are known (e.g. i know I can get a better deal if i drive half-way cross the county), the most efficient, most sustainable market will eventually emerge.

Pricing is one of the most important things a co. can expend grey matter on. Too high a price, your competitor eats your lunch. Too low, and you don't make costs. Either way you fail.

What is more difficult for the client/customer is ascertaining VALUE. Can this oncologist give me better quality of life for a longer time than the guy down the street?

Tough choices, and the more information, the better.

I have my own barometer of the economy. Of necessity, I eat at a few fast-food joints. For some time, the staff were reasonably competent, well-mannered, and communicated well.

No more. The competent ones have "moved on" (heh...) to better-paying jobs, and their slots are being filled with incompetents.

Such is life in a growing economy.