The worst of all possible health care systems

Employer Provided Health Insurance Delenda Est by Scott Alexander, a psychiatrist who practices on the West Coast, for his blog, Slate Star Codex

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4 Responses to “The worst of all possible health care systems”

  1. Alex Page Says:

    ‘A free market system like our grandparents had would fix them.’ 🙄 I find Scott’s mind fascinating. How can a person look at US healthcare and think, ‘needs freer markets’?

    I suppose he’s imagining a mythical free market which follows the axioms of perfect competition, etc, and can only exist for longer than five minutes in a thought experiment.

    Liked by 1 person

    • philebersole Says:

      Back in the 1940s, when I was a boy, most American families—at least most middle-class families—had a family doctor, who was often a trusted family friend and adviser.

      I once wrote a memoir of one of them on my blog.

      The medical profession, and also the legal profession, were self-governing guilds back then—prompting one of my father’s favorite remarks, which was the most ridiculous thing in the world was a doctor or lawyer saying he was against labor unions.

      The doctor-patient relationship was a free market relationship in the sense that it was a voluntary contract between consenting adults. But it was a personal relationship.

      The doctors in that era were more like doctors in Victorian novels—Anthony Trollope’s Doctor Thorne or Elizabeth Gaskell’s Doctor Gibson (in Wives and Daughters)—than they are like physicians today.

      They made house calls, because nobody went into hospitals except for surgery. Many led hard lives. I knew of some who carried poor patients who couldn’t pay their bills.

      There were “society doctors” and specialists who got rich by serving rich people, but I never encountered such.

      I don’t think it is possible to return to that era nor is it desirable to try, and I have a good (though arm’s length) relationship with my present physician, but I also think there are good things about the past that have been lost.

      Alex, you British compare the past not with the present U.S. employer-provided for-profit insurance system mess, but with your National Health Service, which is an entirely different benchmark.

      Liked by 1 person

      • Alex Page Says:

        Fair enough!

        I still think it’s naive of Scott to consider that a ‘free market system’, with the implication that simply reducing regulations would necessarily make things better.

        (Specific legislation, of course, may be ill-conceived.)

        When a system more free market than pretty much anywhere else works terribly, ‘more free market!’ feels like less a reasoned position than a statement of blind faith.


  2. silverapplequeen Says:

    I know I can identify with most of what’s written here. I moved to the Greater Massachusetts area in 2016 & the only reason I moved back to WNY was because of healthcare. I am on Medicare; here in NY, I have Medicaid as my secondary & there are absolutely no problems, but if there was, I would be able to pick up the phone & contact someone locally in the Buffalo office. In Massachusetts, I had MassHealth as my secondary & it was HELL. There was a small local office but you were not allowed to go there after your initial visit, all communications had to be with the main office in Taunton; no phone number to call at all; you had to communicate by snail mail; you never had any idea if you mail was received whatsoever; in fact, I was continually receiving mail from them saying that I had not submitted paperwork that I had mailed to them several times. Needing healthcare & unable to get it because I didn’t have Masshealth to cover it, I decided to move back to Buffalo, although I absolutely LOVED Lowell, MA & the greater Boston area.

    I would love to move back to MA or maybe some other state but this kind of ineptitude worries me. NY isn’t perfect by a long shot but at least I don’t worry about healthcare.


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