Health is very different from other services, profit should not be the goal. Business does not attempt to help people, but to maximize profit, which does not necessarily mean increasing availability or lowering prices at all. It might be more profitable to dump the lower income people and jack up the prices on those who can afford it.
Unlike other industries, getting service is often a literal life or death issue, you have to pay or you might die; morally this makes health care very different from other industries.
Profit is the world's way of signaling that you are doing something in an efficient, effective, and long-term sustainable way.
So, given that health care is one of the most fundamental individual needs, profit most definitely should be the goal.
But health care is not the most fundamental need -- that would be food. I find it puzzling that people don't apply the same arguement to this need. Why not say that profit shouldn't be the goal of the food industry? And that supermarkets are immoral for making a profit at the expense of hungry people? Well, because it's clearly nonsense, of course.
But I wonder if it would seem like nonsense if we lived in a world where there was no free market in food supply. We might worry that greedy corporations would only be interested in serving expensive foods to rich people.
You have to be kidding. Regarding food production, go read the Omnivore's Dilemma, go read up on issues with food patents, go read up on the costs of raising meat (which, in effect, only the wealthy can afford to eat). You are in a deep, delusional fantasy if you think the world's food industry is a paragon of efficiency, effectiveness, and long-term sustainability.
Yes, it is, actually. It's amazing that you would cite McDonald's while arguing against a form of government subsidies. Seriously, go read the Omnivore's Dilemma.
The problem with that viewpoint is it assumes people are inherently good; they aren't. When profit is the goal, people suffer. I find the idea that seeking profit automatically creates the best good rather naive and idealistic.
Of course people don't apply the same argument to food, food isn't scarce for most of us and few have problems acquiring it and the ability to produce it can't be easily collected in the hands of a few, anyone can grow their own food.
Anyone cannot operate on themselves and perform some life saving operation, and while those who can certainly deserve to be compensated greatly for that ability they walk a fine moral line knowing their product, or the refusal to provide it, will directly kill people. Doctors are much more like firemen and policeman that businessman. Society has certain expectations of them serving the greater good of the community and helping people when they're in need.
The free market is not the cure for every ill and seeking profit is not, and should not be the goal of every job. Greed is not some inherently good moral trait.
You've got it backwards -- the very reason that food is plentiful is that there is profit to be made in growing and selling it.
Your statement:
"food isn't scarce for most of us and few have problems acquiring it and the ability to produce it can't be easily collected in the hands of a few, anyone can grow their own food"
is directly contradicted by the millions who starved to death when food production was collectivised under various profit-hating communist regimes.
A statement I'm making about us in the present, is not contradicted because at sometime in the past in some other country under totally different conditions it wasn't true.
That may serve as a counter example, but it doesn't contradict what I said. America is not Russia and just because it went down that way for them does not mean that's how it'll play out for us. Knowing some history is one thing, trying to predict the future from it is another.
You seem to be hung up on extremes, that's not the real world. If I say the free market isn't the solution to every problem it doesn't imply I think it's the solution to no problem and suddenly I'm a communist.
I have sympathy for your point of view. But I worry that attempting to remove the profit motive from healthcare could result in potential doctors choosing different professions.
A problem with society having "certain expectations" of doctors - or anyone else - is that extra expectations (above "do a job so that trading with you helps the world") are a disincentive from getting into that profession.
All that said, I suspect that a purely free-market healthcare system would be worse for the very poor than a socialist one like England (unless the culture had a particularly enthusiastic charitable ethic. Maybe that would develop? Does government charity crowd out private charity?).
One possible solution would be to create a free market system, with some government guarantees for those who are unable to pay themselves. That has some problems of its own, but it at least attempts to capture the good bits of a free market system, while not leaving the poor to die in the gutters. Of course, this is more complex than the comment I originally replied to about "just let some entrepreneur take care of it".
In almost all cases profit helps us all. A free exchange benefits all parties. You have something I want, I have something you want.
When this situation gets distorted through monopoly or other forms of regulations it is generally speaking bad for everyone.
Greed is good. My greed is good for you and your greed is good for me. This is the most fundamental philosophy of entrepreneurship albeit said using a word most people through years of indoctrination think is bad.
This is also why I don't like the term social entrepreneurship. Any entrepreneurship that isn't kept a live through some sort of corruption or force is good for society as a whole.
The world isn't that simple and by the way, monopoly is a natural outcome in a free market system exactly because it doesn't always work. It breaks down, that's why we regulate it. The only place the free market actually works is in libertarians imaginations because they think Atlas Shrugged somehow reflects reality.
You do live in a strange world very distant from the one that most of us readers of Hacker News lives in.
Name me one real monopoly that isn't enforced through "social engineering". A free market may have ocasional dominant market leaders like IBM and MS in their time and Google today. None of them are or were monopolies as better technologies and startups will always (lets repeat that word ALWAYS) come around as long as they are allowed.
True monopolies like the telecoms monopolies in many countries are not outcomes of free markets, but rather more or less corrupt deals between governments and a little group of businesses. Most often the monopoly is argued as a way to protect the consumer.
The free market works wonderfully in many different places in the world and in many different aspects of our daily life. Banking, telecoms and health care are not examples of this as they are heavily regulated. Most of us readers of hacker news are doing what we are doing because of the wonders of the free market.
If not we would be marching fists held up high to Washington demanding the creation of the National Department of Internet Services, to give us lifelong employment. Yet we aren't doing that. The free market works great even though our chosen field has been hit by many different bubbles and failures. The market has picked right up with no real government interference (except for financial and gaming fields) and will continue to improve.
Spare me the old marxist marching chants (I should know what they sound like as I used to be one).
No, I live in the real world where unrestrained free trade is bad because people seeking profit are not inherently good when they acquire too much power. See Standard Oil, John D. Rockefeller and some history about why we started trust busting in the first place.
Your view that the free market works wonderfully if left alone is simply naive. The real world is simply more complex than that.
In fact, your belief that there even is such a thing as a free market is naive and ignores the very real fact that corruption is inevitable and businesses seek out regulation to protect themselves from competitors destroying the very free market they so claim to love. Any truly free market is simply a temporary state of existence destined to die as soon as corruption takes hold, which it always does.
You yourself just answered why regulation can't ever work correctly: "The real world is simply more complex than that."
As a programmer you should know that extremely complex systems like the world can not ever be managed by a small group of super clever beings.
This has been the fallacy of each and every of "I'm smart you're not, I'll run things" philosophies originally invented by Plato and perfected by Marx.
The world is a complex system managed by 6 billion autonomous beings. Together these 6 billion autonomous beings for an extremely smart mega intelligence. While you, I and our "leaders" may be smarter than the vast majority of these individuals. Together though is another story.
I agree with your point about corruption as long as we assume the presence of a regulating entity. Corruption is essentially the markets way of calculating a price on overcoming social engineering.
But without regulators in the first place it would not exist and would simply be just other transaction between two or more parties.
I wish I could upvote this comment more than once -- I think it is dead on.
Profit is the creation of value. If there's no profit, then there's no value added.
Profit works great for food, shelter, clothes, heat, and most every basic human need.
I think what really messes up the healthcare market is that the more that technology progresses, the more sophisticated and expensive treatments we discover. The cost and effectiveness of treatments are both soaring, yet people whose means are not rising as fast feel entitled to the best health care no matter what. I think as technology advances, things will only get more distorted until we realize that everyone should only get what they pay for (or what their insurance that is correctly priced by the market will cover and pay for.)
Health is no different than other services in 99.9% of the cases. We should not optimize the entire system for that 0.1% of cases. The market optimizes everything for the better if it is allowed.
For the exceptions, use exception handling also known as charities such as non profit hospitals and health centers who already donate health care to the poor.
The increased efficiency and lower cost of a non regulated approach would benefit all and make it easier and cheaper to provide good care to everyone.
No, it isn't. You're making the huge assumption that both parties are equal in the exchange and one party isn't using force on the other. Again, typical libertarian fantasy assumes everyone is nice, wake up, they aren't.
It doesn't require anything you name here except the absence of force. No libertarian thinks or assumes everyone must be nice and no libertarian thinker has ever predicated his argument on such.
You know, there actually have been some highly intelligent and thoughtful libertarian thinkers, far from whatever fantasy you may have.
You are talking about one of the most highly regulated markets in the US. It's been at least 100 years since the financial markets where free in the US.
You don't think the mortgage market had anything to do with it? As far as I know, the problem is not that CDOs trade at a discount to their underlying value; it's that the underlying value has dropped.
I am pretty sure that was implicit in my comment. I have read the Lewis piece, which is a great way to get an overview from the perspective of the half-dozen folks willing to give Lewis an interview. I'm not saying that this was entirely due to government intervention -- just that the giant tax incentives, aggressive government market manipulation, and $100B+ portfolios long mortgages and short puts created by government agencies.
I agree with you, but it's not that black and white. Insurance companies are usually the ones paying, not the individual. As such, they have a lot of control over the price (especially in the case of medicare). While it might be life or death for the individual, it's not for the insurance company.
Which is a big part of the problem, we've put an entity between doctor and patient who's motive is profit rather than helping the patient. Insurance companies figured out a long time ago that the best way to profit was to deny claims and avoid paying in any way they can.
An entire sub-industry has popped up around coding claims correctly because doctors have figured out what they can and can't get paid for, the effect being the insurance companies now basically dictate treatments rather than the doctor. Frankly it's extremely fucked up and it's caused entirely by companies seeing the most profit.
Unlike other industries, getting service is often a literal life or death issue, you have to pay or you might die; morally this makes health care very different from other industries.