Imagine if the U.S. government gave out free smartphones to some segment of the population. Over the years, they’d get used to replacing their phones for the smallest reason — a scratch, a tiny crack, dropped it a little hard — because it costs them nothing. Some might even start swapping phones every month or every week.
“Ah,” someone says, “but the government negotiates huge discounts with the phone makers since it buys in bulk!” I think this misses the forest for the trees when it comes to cost control.
We don’t have to imagine how Medicare works because it exists, so I don’t see the use of such analogies.
I suspect that it’s mainly doctors who need to be more responsive to cost incentives as they’re often the ones recommending unnecessary tests or treatments.
My analogy is not with socialized healthcare but with the medicare scheme. Socialized healthcare works in lots of other countries due to a combination of rationing and (in the case of drug prices) prioritizing accessibility over R&D.
> I suspect that it’s mainly doctors who need to be more responsive to cost incentives as they’re often the ones recommending unnecessary tests or treatments.
Doctors would recommend fewer tests if their patients were more price sensitive, I think. I'm not sure a more direct route to making doctors price sensitive when they are on the provider-side, why would they want you to utilize less? There probably also needs to be malpractice/tort reform in the US.
I edited my post to say Medicare shortly after your reply (sorry). But if there’s evidence that Medicare is especially profligate with unnecessary tests and treatments then you should give that evidence, rather than arguing by strained analogies.
I think that analogies are helpful for elucidating the point but in terms of concrete evidence, there are two gold standard studies that really reveal this issue. These studies are very hard to come by because it is typically difficult (for good reason) politically to experiment with people's healthcare, but we are lucky to have two: the RAND healthcare study and the Oregon medicaid lottery.
My understanding of both of those studies is that (particularly for pre-registered analyses), we saw that adding some sort of cost-sharing substantially reduced utilization of healthcare services (~30%) without any impact on health indicators even multiple decades down the line, with the possible exception of mental health indicators. Nowadays people try to p-hack their way out of these conclusions, but it is pretty strong high-N experimental evidence.
>Imagine if the U.S. government gave out free smartphones to some segment of the population.
Obama phones were literally a thing and
>Over the years, they’d get used to replacing their phones for the smallest reason — a scratch, a tiny crack, dropped it a little hard — because it costs them nothing.
Did not happen because this is absurd and not how any entitlement program anywhere has ever worked, and more importantly, in healthcare you WANT THIS TO HAPPEN
It's cheaper for someone to go see their doctor when they "think I might have something wrong" then once they actually know something is wrong, and so substantially cheaper that even US insurance companies try to entice it by making yearly physicals free or other preventative care, but it doesn't work as well for the US because even with insurance incentivizing it, you still end up with all the billing BS that can leave you harmed by going to the doctor
> I think this misses the forest for the trees when it comes to cost control.
Sorry, the actual empirical evidence is that the government setting prices has done better all over the world than whatever the US does. This magic belief that allowing the government to control access magically produces bad systems is just wrong. Government is capable when you vote for people who want to make good government
“Ah,” someone says, “but the government negotiates huge discounts with the phone makers since it buys in bulk!” I think this misses the forest for the trees when it comes to cost control.