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Author Topic: Competition in the Emergency Room Marketplace?  (Read 3214 times)
nimda
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November 02, 2013, 03:17:12 PM
 #1

Ambulances are required by law (and sometimes by sheer "don't let this guy die" practicality) to bring patients to the nearest emergency room. It seems to me that this is a case where there is no chance for competition at all: you don't get to choose your provider, then they bill you whatever they want. Complaints may be me with a snarky "would you rather be dead?" line.

There's a simple legislative solution that helps the customers: legislate caps on costs billed to patients.

Is there a free market solution?

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November 02, 2013, 04:31:30 PM
 #2

A legislative cap will discourage extraordinary measures to save children that are currently standard.

Healthcare = the death business.

The provider incentive is to keep you alive and dieing as long as possible on the highest margin profitable treatment.
The consumer incentive is not to die (which hasn't ever happened).
The secondary incentive is not to be impoverished or uncomfortable.

These incentives will be the same whether it is free market or non-competitive governmental single-payer.

These incentives get a little bit skewed when it is the same entity that pays the survivor benefit (pension/social security) as pays for the healthcare, because there will be an age bias toward killing off those that would collect the benefit and are no longer "contributing".

The question is...
What can Bitcoin do to fix this?  Anything?

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November 04, 2013, 03:38:27 AM
 #3

A legislative cap will discourage extraordinary measures to save children that are currently standard.
It's currently possible to receive treatment in the US at one hospital for $10,000, yet the same exact treatment down the street would cost only $5000 [citation needed]. All the consumer can do is try to have injuries closer to the cheaper one. A well-written law (?) might be able to fix this problem in a way that I can't see market dynamics doing.

Emergency healthcare is a rather unique situation in which there's no room for competition.

Quote
Healthcare = the death business.

The provider incentive is to keep you alive and dieing as long as possible on the highest margin profitable treatment.
The consumer incentive is not to die (which hasn't ever happened).
The secondary incentive is not to be impoverished or uncomfortable.

These incentives will be the same whether it is free market or non-competitive governmental single-payer.
This part makes sense, but I'm not really focusing on tax-funded health care in this topic.

Quote
The question is...
What can Bitcoin do to fix this?  Anything?

Perhaps we shall see.

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November 04, 2013, 04:03:04 AM
 #4

A legislative cap will discourage extraordinary measures to save children that are currently standard.
It's currently possible to receive treatment in the US at one hospital for $10,000, yet the same exact treatment down the street would cost only $5000 [citation needed]. All the consumer can do is try to have injuries closer to the cheaper one. A well-written law (?) might be able to fix this problem in a way that I can't see market dynamics doing.

Emergency healthcare is a rather unique situation in which there's no room for competition.

Quote
Healthcare = the death business.

The provider incentive is to keep you alive and dieing as long as possible on the highest margin profitable treatment.
The consumer incentive is not to die (which hasn't ever happened).
The secondary incentive is not to be impoverished or uncomfortable.

These incentives will be the same whether it is free market or non-competitive governmental single-payer.
This part makes sense, but I'm not really focusing on tax-funded health care in this topic.

Quote
The question is...
What can Bitcoin do to fix this?  Anything?

Perhaps we shall see.
I suspect price is not the only difference between your hypothetical hospitals.

When lawmakers set the price of things, the first thing bought is the lawmakers.

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November 04, 2013, 04:47:06 AM
 #5

Do like Canada, and remove the profit from the hospitals.  It won't matter where you injure yourself.

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November 04, 2013, 07:48:55 PM
 #6

Ambulances are required by law (and sometimes by sheer "don't let this guy die" practicality) to bring patients to the nearest emergency room. It seems to me that this is a case where there is no chance for competition at all: you don't get to choose your provider, then they bill you whatever they want. Complaints may be me with a snarky "would you rather be dead?" line.

There's a simple legislative solution that helps the customers: legislate caps on costs billed to patients.

Is there a free market solution?

Medical care should be free to all at the point of delivery.  Since you are likely to be unconscious, the notion of a "market" price being applied is a joke.


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November 04, 2013, 08:24:40 PM
 #7

The market solution would exist and present itself if it was actually a free market.  Even if you are unconscious medical ID bracelets or other devices could easily identify you to the ambulance.  The main problem here is that in order to accept market based solutions one must accept the reality that rich/wealthy people will get better care because they can afford it and less wealthy and or poor will get lesser care.  That's the definition of market based healthcare.  You get what you are willing to pay for.  Once you are past that hurdle all care will be cheaper for all but it won't be equal care.  Medical care won't necessarily be all insurance.  Different solutions for different preferences can exist.  Certain companies might specialize in ambulatory services on a monthly prepaid basis and then make specific agreements with various hospitals.  You can't predict what a free market will bring because you can't know all the different wants and desires of its participants.
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November 04, 2013, 11:00:06 PM
 #8

Ambulances...
..no chance for competition....
...legislate caps on costs billed...

Is there a free market solution?

Yes.

It's a large meta-entity called "the government". It's run by millions of private interests called 'people' who have a variety of vested interests such as:
-hassle-free care when an unknown, unforeseen, and therefore uninsured-for health disaster strikes,
-minimum inconvenience/contagion when the same happens to others,
-low levels of systemic corruption (or structural violence), which might otherwise be caused by profit motives. For example, market makers tend to restrict the flow of resources (health care in this case) by adding their own fees to each transaction.

Many examples in historical records point to times and places where there was no government, only feudalism or some other inferior ism. Governments naturally evolved to fill the niche.
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November 05, 2013, 04:03:07 AM
 #9

Ambulances are required by law

This is where the free market stops.

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November 05, 2013, 04:11:55 AM
 #10

Ambulances are required by law (and sometimes by sheer "don't let this guy die" practicality) to bring patients to the nearest emergency room. It seems to me that this is a case where there is no chance for competition at all: you don't get to choose your provider, then they bill you whatever they want. Complaints may be me with a snarky "would you rather be dead?" line.

There's a simple legislative solution that helps the customers: legislate caps on costs billed to patients.

Is there a free market solution?



Whether or not someone who is taken in an ambulance will die or not, may be a debatable matter.
The portrayal as though 100% of people given rides in ambulances will die without their care,
cannot be true.
The fact they will not allow people to have free will or choice, once they have apprehended someone,
does seem to be tyranical to me.
As though somehow their own philosophies or doctrines of what is health care, are somehow superior to our own?
But what if, in fact, some or more of their doctrines are not as good?
Then they are just behaving like autobots who are doing what the state told them to do, without regards for whether it is good or evil to the people they do it to.

if they say 'would you rather be dead', well, I see that as some kind of deviant form of extortion almost, hardly becoming of people who are supposedly 'health care' workers.

What if you totally disagree with the health care workers and really do not think they intend to do good for you, but instead have the intention of causing you harms?

The only 'solution' I can think of, is to avoid the state health care system or health care workers; which can be very difficult if catastrophe occurs, or even if a person gets sick.
A person who resists going to them, may get grabbed hold of, by some citizen or citizens, who may think that they are doing good by calling an ambulance, though the person did not want one.

Its an interesting topic.

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November 05, 2013, 05:38:08 AM
 #11

The only 'solution' I can think of, is to avoid the state health care system or health care workers; which can be very difficult if catastrophe occurs, or even if a person gets sick.

What about jesus curing everyone and everything.  Is that not a solution?  You clearly believe in him and you believe he has omniscient powers, so why can't he provide healthcare?  Does he hate paperwork? 

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November 05, 2013, 06:29:43 AM
 #12

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.

Here's some solutions, anyway:

Emergency centers close enough to each other that they must compete; you can then, if requiring further treatment, figure out the hospital of your choosing at your leisure.

Refusal to use any hospital for non-emergencies which does not offer competitive prices for emergencies; this pressures the hospital to offer better prices or sell off to whomever is.

Pre-determined prices paid in advance, mixed in a large pool of other people's advanced payments, to marginalize the cost of varying emergency service costs (i.e. insurance.)

Stop being careless about your health so you won't have to worry about it.

And of course, all of the above.

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November 05, 2013, 07:19:29 AM
 #13

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.
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November 05, 2013, 07:35:43 AM
 #14

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Because it's focused primarily not on the best price, but on the best speed; decisions are measured in how fast your emergency can be turned into a non-emergency, and spares no time for you, or the person who will not be footing your bill but calling for you, to decide the best price for the best value.  The hospital which is closest always takes precedence over the hospital which provides the best service for the best price; it's not a free market problem once an emergency is involved, because you cannot act rationally while on the verge of dying.

Which is why the problem is primarily solved before there is an issue; the free market applies to everything except this one moment, where you and your saviors are paired by non-market values.  If there is a man who will say "No, I'd rather spend another 20 minutes in this ambulance than spend an extra bit of cash at this place", assuming he can still speak and think clearly, I'd like to meet him for I'm positive he's an interesting fellow.

Though I do agree, I am tired of hearing about emergency services justifying taxation and central law.

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November 05, 2013, 08:05:19 AM
 #15

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Because it's focused primarily not on the best price, but on the best speed; decisions are measured in how fast your emergency can be turned into a non-emergency, and spares no time for you, or the person who will not be footing your bill but calling for you, to decide the best price for the best value.  The hospital which is closest always takes precedence over the hospital which provides the best service for the best price; it's not a free market problem once an emergency is involved, because you cannot act rationally while on the verge of dying.

Which is why the problem is primarily solved before there is an issue; the free market applies to everything except this one moment, where you and your saviors are paired by non-market values.  If there is a man who will say "No, I'd rather spend another 20 minutes in this ambulance than spend an extra bit of cash at this place", assuming he can still speak and think clearly, I'd like to meet him for I'm positive he's an interesting fellow.

Though I do agree, I am tired of hearing about emergency services justifying taxation and central law.
That's what it is focused on now precisely because it isn't a free market.  If it was then companies providing those emergency services to you would care about doing a good job just like any other servics or they go out of business losing their invested capital.  Unless it's total charity all decisions are still paired by market forces.  The problem is with the current system a lot of those forces are illogical and invisible to the consumers of those services and therefore are devoid of any feedback regarding their success or failure at solving the problems.  Hospital selection isn't dictated by the consumer but by "laws" so no adjustments can be made and everything costs more as a result.
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November 05, 2013, 11:32:45 AM
 #16

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Lets take a typical Saturday night admission to an emergency room.  Girl gets hammered and falls on her high heels and breaks her ankle.

Can a drunk person be expected to make rational plans?  No.

Do we want to live in a society where a drunk woman with a broken ankle is supposed to look after her own care?  No.

Under these circumstances, there can't be a market solution.



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November 05, 2013, 03:44:40 PM
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"Bad" emergency hospitals would eventually be blacklisted by medical insurances. Your ambulance would probably work to/with your medical insurance, and would not take you to the blacklisted hospitals. Or at least avoid it if possible. That would of course create a strong incentive for hospitals not to be blacklisted, since being blacklisted by most insurances could drive them to bankruptcy. And that would ensure "bad hospitals" to be rare and of quick living.

By the way, the assumption that you always have to go to the nearest hospital is exaggerated.

Under these circumstances, there can't be a market solution.

He, it's funny how fast people conclude what they want to conclude. It took me only a couple minutes to come up with the answer above. And I'm just one random guy. How dare you say millions of people working freely wouldn't be able to come up with a much better solution that we cannot even imagine today?
It really looks like what people against slavery abolition in the 19th century would say: "But who would do the hard work? Agriculture would collapse! We would all starve! Do you want to live in a society where people starve to death?"

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November 05, 2013, 04:17:59 PM
 #18

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Lets take a typical Saturday night admission to an emergency room.  Girl gets hammered and falls on her high heels and breaks her ankle.

Can a drunk person be expected to make rational plans?  No.

Do we want to live in a society where a drunk woman with a broken ankle is supposed to look after her own care?  No.

Under these circumstances, there can't be a market solution.


So in your example this woman made no prior emergency plans whatsoever via insurance and to top it off got drunk and the rest of society now should be forced to take care of her.  We'll in that case why bother with any market solutions at all if people don't need to plan for their own lives.  Talk about perverse incentives.
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November 05, 2013, 05:42:45 PM
 #19

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Lets take a typical Saturday night admission to an emergency room.  Girl gets hammered and falls on her high heels and breaks her ankle.

Can a drunk person be expected to make rational plans?  No.

Do we want to live in a society where a drunk woman with a broken ankle is supposed to look after her own care?  No.

Under these circumstances, there can't be a market solution.


So in your example this woman made no prior emergency plans whatsoever via insurance and to top it off got drunk and the rest of society now should be forced to take care of her.  We'll in that case why bother with any market solutions at all if people don't need to plan for their own lives.  Talk about perverse incentives.

Correct.  The market has its uses.  The care for the sick, drunk and injured is not one of them.


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November 05, 2013, 05:57:59 PM
 #20

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.
 
...
Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Lets take a typical Saturday night admission to an emergency room.  Girl gets hammered and falls on her high heels and breaks her ankle.

Can a drunk person be expected to make rational plans?  No.

Do we want to live in a society where a drunk woman with a broken ankle is supposed to look after her own care?  No.

Under these circumstances, there can't be a market solution.


So in your example this woman made no prior emergency plans whatsoever via insurance and to top it off got drunk and the rest of society now should be forced to take care of her.  We'll in that case why bother with any market solutions at all if people don't need to plan for their own lives.  Talk about perverse incentives.

Correct.  The market has its uses.  The care for the sick, drunk and injured is not one of them.

Sure it does, the market is operation through the government which reaps huge taxes through the liqueur tax.  They have a strong interest in encouraging people to become drunk, that they get hurt is just a fringe benefit for them as it validates the nanny state.
Government is a market participant, it is just that one participant that has the right to kill you and take all you have if you happen to be in a geography it controls, but in order to maintain folks in that geography it only harvests those it can most easily get away with, such as this foolish woman who didn't bother to remove her Louboutins after getting drunk.

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