"So manifests the quintessential American pragmatic hypocrisy: all tout the wealth-building virtues of creative destruction until the torch of change is under you. Then, change is “unethical.” Only law is more artificially sustained by its own ethical sophistry and willfully abstruse erudition as is the gross establishment of American health." - Paul Buchheit

More right winged nonsense about how the market will save us. Here's my rebuttal: http://piaw.blogspot.com/2008... - Piaw Na

The problem with trying to change things cleanly in health care is that you're literally dealing with whether or not some people live or die. It is the veritable third rail. Because of this, the field is notoriously ultraconservative. "New-fangled" in medicine generally means within the past 10 years or so. That's how long it takes before learning institutions feel comfortable with novel initiatives. For people in the tech industry, this pace is glacial and possibly incomprehensible. - Victor Ganata

And mind you, this is in the era of the Internet, of patient autonomy, of evidence-based medicine. Things used to be *worse* - Victor Ganata

Markets don't care if people live or die. Keep that in mind when you encounter massive amounts of resistance from everyone who has a vested interest in keeping things broken but working. Physicians are just a tiny demographic of this colossal field known as health care. You'll probably need to deal with legislators, malpractice lawyers, the Joint Commission, insurance companies, pharmaceutical companies, and various allied health fields as well, just to mention the ones off the top of my head. Good luck. - Victor Ganata

I agree with you, Piaw. Take away the incentive for profit, and things run much smoother, when it comes to actual delivery of patient care. Ask anyone who has had to deal with an insurance company denying a claim, from either the patient or provider end of things. At the VA or at County, you don't deal with this bullshit (there are other headaches to deal with.) As a physician or allied health care worker, you get to do the job you were trained for and actually get to take care of people. - Victor Ganata

Yeah. I think the proper response to people seeking to add more "free market" forces to healthcare should be: "Haven't you guys already done enough damage?" - Piaw Na

Our current system is not "free market" in any meaningful sense. That said, I can't think of any non-subsidized system that would work for the simple reason that many people have very expensive conditions and would not be able to afford treatment otherwise. - Paul Buchheit

The only way you could practice free market medicine is to be willing to let people die, even if you could save them fairly easily and/or cheaply. This is how things tend to operate in developing nations. No money = you don't get to live. Personally, I'm pretty sure it violates the Hippocratic Oath, but what do I know. - Victor Ganata

Paul, read my blog article. It explains how free market failure leads to the inability to deliver healthcare affordably. Most other developed nations (and even some developing nations) run things differently. And letting people die because they can't afford health insurance due to the afore-mentioned market failures is immoral. We created a civilization so that it wouldn't be the strong taking what they want --- to replace it with one where only the rich get to live seems to be not much of an improvement. - Piaw Na

Piaw, I've read your comments previously. I'm not defending our current system or proposing some kind of libertarian system, only stating that our current system can not accurately be termed "free market". And like I said, we can't expect everyone to pay for their own healthcare for the simple reason that it can be impossibly expensive for some people, and so, as you say, they would die. - Paul Buchheit

By the way, your view of this issue seems a bit black and white to me. I didn't get the impression that the author of this blog post was advocating whatever it is you are arguing against. Sometimes, the right solution is not the one that was obvious to anyone. - Paul Buchheit

The right solution is obvious to anyone except to those who live in the US. Every other industrialized nation pays less for more coverage of their citizens. That much is obvious, so I get very suspicious when someone starts a post by talking about how the US cannot afford universal coverage. We can, we just haven't had the political will to do so. Perhaps this recession will go deep enough that we will finally develop the political will to do so. - Piaw Na

I think part of the cost problem is that a lot of Americans have this deranged idea that more expensive medical care is better medical care. They want their health care like they want their fast food: now, and the way they want it. This results in unnecessary expensive "preventative" procedures that don't really prevent anything except maybe lawsuits. But the rational practice of medicine is not a consumer-provider relationship. Just because you want an MRI today does not mean you need it today, or ever. - Victor Ganata