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0 pointsspecialist12y ago0 comments

"Look at insane costs of healthcare/education in the US - no doubt caused, in part, by "free money" either through government-assisted programs or employer-sponsored insurance."

Huh?

Even with the modest ACA reforms implemented to date, the growth of healthcare costs has already slowed down. First time since the 90s.

Medicare, which is most akin to single payer in other countries, is the most efficient guarantor (highest medical loss ratio). Long term cost reduction requires extending Medicare to all and embracing the capitation model. Bonus points for resuming prior levels government funded basic R&D.

Tuition costs are rising as subsidies have been removed and student loans have been privatized. The combination created a bubble. Which happens often enough when deregulation and privatization co-occurs, that my hunch is it's casual.

So while universal basic income may prove to lead to inflation, your two examples do not support that argument.

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mattmcknight12y ago

"Even with the modest ACA reforms implemented to date, the growth of healthcare costs has already slowed down."

It's sort of hard to parse what you are saying, but the growth in spending (not costs) went down before the enacting of PPACA. This is likely due to the recession, and something of a counterpoint to those that claim healthcare is subject to inelastic demand.

Having the highest medical loss ratio is not equivalent to being the most efficient, as many services do not warrant claims. Capitation is inferior to market pricing in many ways and not "required" to reduce costs. Another solution is to force providers to charge a single posted price to all consumers, instead of practicing price discrimination. This achieves the purported benefit of single payer, while still allowing for people to choose how much they want to spend on medical services.

Tuition costs rose as subsidies increased. Without subsidies, they couldn't have risen. This created a bubble, which often happens when the government provides price insensitive support to markets.

I am not saying that these are the only answers, but you seem awfully sure of some counterfactuals...

specialistOP12y ago

"Capitation is inferior to market pricing in many ways and not "required" to reduce costs."

Don't confuse markets with incentives.

"Another solution is to force providers to charge a single posted price to all consumers, instead of practicing price discrimination."

Not mutually exclusive.

"This achieves the purported benefit of single payer, while still allowing for people to choose how much they want to spend on medical services."

Until there's price collusion, an oligarchy, natural monopoly. In other words, the exact situation we had with the "free market". (The healthcare exchanges have introduced competition.)

"Tuition costs rose as subsidies increased."

What subsidies? State funding for higher ed has fallen thru the floor. Given the current trend, most public universities will be 100% tuition funded in a few years.

"you seem awfully sure of some counterfactuals"

You mean reality? I worked in healthcare and now higher ed. I'm reasonably sure I know the score.

mattmcknight12y ago

>Don't confuse markets with incentives. I'm not confusing markets with incentives, I am suggesting that markets are the best known means of finding prices. Forcing capitation reduces the creation of new business models. The model already exists (in insurers like Kaiser that provide their own services), and can be chosen by consumers when appropriate.

>Not mutually exclusive. Didn't say they were, but you used the word "require", implying there is only one way.

>Until there's price collusion, an oligarchy, natural >monopoly. In other words, the exact situation we had with > the "free market"." The health care providers of the US do not consist of a monopoly and never have.

>(The healthcare exchanges have introduced competition.) No, they have reduced competition by declaring that you can only offer one of four products to consumers and by regulating the pricing. In many cases, the exchange features only one product.

>"What subsidies?" Loans and grants. State funding for private universities hasn't fallen through the floor, yet their tuition continues to rise.

The common thread is that subsidies on the consumer side (in higher ed, healthcare, and home ownership) increase demand and thus increase prices.

>>you seem awfully sure of some counterfactuals" >You mean reality? I worked in healthcare and now higher ed. >I'm reasonably sure I know the score." No, I mean counterfactuals, where you suppose how the world would be different if some set of things that didn't happen did happen. (e.g., if state subsidies for higher ed hadn't fallen over the past 10 years, private tuition costs wouldn't have risen faster than inflation for the past 30 years)

I didn't mean to make a personal comment there, I just tend to fixate on little things like when the confidence level seems to be overstated. Surely these things are rather complex, or they wouldn't be such difficult problems to solve.

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yummyfajitas12y ago

Medical loss ratio is a stupid metric. A simple way to increase it: reduce fraud protection. For example, suppose you reduce fraud protection by $1, resulting in an increase in undetected fraud by $2.

Medical loss ratio = (med cost + $2) / (admin cost - $1) will go up.

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mattmcknight12y ago

"Even with the modest ACA reforms implemented to date, the growth of healthcare costs has already slowed down."

Tuition costs rose as subsidies increased. Without subsidies, they couldn't have risen. This created a bubble, which often happens when the government provides price insensitive support to markets.

I am not saying that these are the only answers, but you seem awfully sure of some counterfactuals...

specialistOP12y ago

"Capitation is inferior to market pricing in many ways and not "required" to reduce costs."

Don't confuse markets with incentives.

"Another solution is to force providers to charge a single posted price to all consumers, instead of practicing price discrimination."

Not mutually exclusive.

"This achieves the purported benefit of single payer, while still allowing for people to choose how much they want to spend on medical services."

Until there's price collusion, an oligarchy, natural monopoly. In other words, the exact situation we had with the "free market". (The healthcare exchanges have introduced competition.)

"Tuition costs rose as subsidies increased."

What subsidies? State funding for higher ed has fallen thru the floor. Given the current trend, most public universities will be 100% tuition funded in a few years.

"you seem awfully sure of some counterfactuals"

You mean reality? I worked in healthcare and now higher ed. I'm reasonably sure I know the score.

mattmcknight12y ago

>Not mutually exclusive. Didn't say they were, but you used the word "require", implying there is only one way.

>"What subsidies?" Loans and grants. State funding for private universities hasn't fallen through the floor, yet their tuition continues to rise.

The common thread is that subsidies on the consumer side (in higher ed, healthcare, and home ownership) increase demand and thus increase prices.

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yummyfajitas12y ago

Medical loss ratio = (med cost + $2) / (admin cost - $1) will go up.

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