I basically treat NP/PAs and doctors as a pulse with a DEA license attached. Once you realize you basically need to figure it out for yourself, for much of anything but surgery and meds, you'll realize you are better off with them vs having police put you in a tiny cage for ordering drugs without a prescription (in my state I can self order imagery and labs, so don't need docs for that). I consider their opinion totally disposable but they offer some stuff the government will imprison me for if I don't get the magic signature for.

Just treat them as totally incompetent and nudge them where they need to go. No need to assume or rely on competence that may not exist.

A minute of research has led me to conclude the discussed limit which comes from the 1997 Balanced Budget Act[1] was, like most of these sorts of efforts, passed by a Republican controlled Congress with weak opposition from Democrats. Republicans in the House voted 219 for and 7 against with Democrats 51 for and 154 against[2]. There was even less resistance in the Senate with 52 Republicans for with 3 against and 21 Democrats for and 24 against[3]. OP's "suspicion" was not "unfounded" and there was in fact "one party... driving this policy more than the other." If your complaint is simply that OP speculated on this without evidence, you're just as guilty of flagging their comment based on your own speculation without any evidence.

[1] - https://www.cms.gov/priorities/innovation/files/migrated-med...

[2] - https://clerk.house.gov/Votes/1997241

[3] - https://www.govtrack.us/congress/votes/105-1997/s130

I’ll take it. I’ll take the flag. My comment was cynical and unfounded in the kind of discourse that we should see on HN. I will not edit it either. For posterity, I was thinking of the recent cutbacks to prevent “waste, fraud and abuse”, which, coming from a senator, should have been grounded in an even higher standard, rather than walking away from requests for clarification.

There are a lot of hospitals where there is an endless supply people showing up to the ER with non-emergent stuff because it is the only place required to take them, and their number is only limited by wait time due to triage; they'll just leave if it takes too long as their life isn't threatened and they have something else to do.

You could hire a whole army of doctors and they'd still be there, word gets around. If the doctors are cheap enough to cover whatever you can get from debt collection agencies to sell off the debt they'll never pay, then you could hire a lot.

Most markets fail here. I can't even make good decisions about which electronics or appliances to buy, which restaurants to visit, which mechanic to use, and it's not for lack of research or unwillingness to pay. Advertising allows brands to build undeserved market reputation, and brands regularly sabotage their own legitimately established brand reputation for financialization.

For the overwhelming majority of things people to go to the hospital for, where you go doesn't really matter, because the treatment and diagnosis is extremely routine. This includes very serious things like cancer. My mother, through a variety of fortuitous events, was able to have her breast cancer treated at one of the top ranked cancer specializing hospitals in the US. She had acquaintances that had theirs treated at the local university/training hospital. They ended up receiving literally the exact same treatments.

Same for my own stuff. The first time one of my children got sick it was terrifying, so I naturally took him to the most premium pediatric healthcare institution. And what did they do? Basic tests to rule out anything particularly nasty, and fever management. The exact same thing the cheapest hospital does, except I got the privilege of paying 10x more for it and feeling like a complete sucker. From that point on - 'oh he's sick? shall we go to the university hospital, or the religious nonprofit?'

That's a cart-before-the-horse analysis.

Labelling markets "rational" is pure rhetoric. There's nothing even remotely rational about a market system, because the moral basis of calling markets "rational" is... greed.

Just greed. Nothing else.

All of the failed outcomes, deaths, pollution, lost opportunities, distortions of democracy, and other damages are a direct consequence of this moral system which claims that greed is rational - when in fact unfettered greed is clearly and objectively sociopathic, with predictable sociopathic outcomes.

Huh, I really like this approach. My economics knowledge isn't great, but I do know that healthcare is quite inelastic because people are willing to pay high prices to be healthy. A mixed model would siphon off the most desperate to a good option, and inject local competition.

I advocated against universal healthcare for a long time, since I was worried that it would cause stagnation in health innovation, but now I see a need for universal healthcare for the 80-90% most common procedures (and leave private clinics to innovate). The only downside I can think of is less dependence on insurance, which has the potential to drive up premiums. But, if that means taking care of the poor for the most common ailments, then it's a worthwhile tradeoff.

What I mean is that the dynamics of healthcare are not conducive for a competitive market.

Compare grocery shopping:

You have frequent/repeated interactions; if you always get ripped of by one shop, you can go to another. Before you go grocery shopping, you will have a decent mental model for: prices levels at each shop, quality of produce and accessibility/distance. You also have the full choice in where to go, basically every time.

Hospital interactions (especially ER) is the polar opposite:

You will have few interactions with it over your lifetime (hopefully), costs are basically impossible to know beforehand (and difficult to compare, too), quality of treatment is extremely difficult to judge as patient (because every case is somewhat unique, and outcomes can easily come down to luck/individual doctor). Especially in the ER case, you often don't even have a real choice of hospital and even in cases where you could (and had all the info) there might be throughput limitations on "desirable" hospitals that prevent you from switching (=> having to wait for 5 months).

Another factor I think is that hospitals gain less from being "good": As a "good" grocer, you get to steal market share from your competition at low cost and risk to yourself; for the hospital, scaling up is more difficult and risky, thus "good" competitors are also less threatening comparatively (thus less of a motivation to improve things).

> I could tell you some stories about folks who wound up worse off because the care was still rationed, just by the state instead of an insurance company.

I wish this would stop being used like it's a credible argument. The truth is that we can find these cases in any healthcare system. The only valid evidence when weighing system versus system is aggregate numbers.

For the record: With "classical free market selfregulation" I mean something that is quite far from any civilized system. Standards of care, education of caregivers and even pricing levels to some degree are all regulated in your example (which I think is a good idea).

I would literally expect overpriced snake-oil from actual free market healthcare, and there is significant empirical evidence that this would happen from my point of view.

When the government accepts AMA lobbying and sets a regulatory cap on the number of new residencies, it is regulating, and is fully culpable for doing so. Your logic basically defines the government away, treating it instead as the product of the influences acting on it.