Topic: Competition in the Emergency Room Marketplace? - page 2. (Read 3449 times)

supporting that is going to be a difficult experiment to conduct

Without the state funding universities and defence and without IP laws there would be no Internet.  You may argue something else would have emerged and people like Jarod Lanier are very clear what the private alternatives would have been.  But the Internet we have today is an outgrowth of the defence infrastructure of NATO and the research budgets that went with it.

If a person pays millions in taxes and requires a treatment that costs £10000, like say a hip replacement, they can get no more value from that tax money than someone who has paid less tax.  The US system charges the rich a lot more for the hip replacement - its important to understand that the rich get nothing for the extra money.  Here is a detailed study: http://www.nytimes.com/2013/08/04/health/for-medical-tourists-simple-math.html  Notice the higher US bills gets nothing extra in terms of medical care.

I never said private enterprise was not right for delivery of medical services.  I said its not right for funding them.  All of Europe has private hospitals and they are superb.  I was born in one and I saw my father pass away in the same one.  However, I don't want to pay some billing company extra money when its cheaper for me to pay via the tax system.  No value is added by adding yet another layer of bureaucrats to do billing.

Ground breaking research is sold to the rich first because they have more money.  But it is often based on pure research funded by governments.  Take away government research and the private system will be deprived of innovations.  The development of nonstick pans from the space program is the classic example.  Here is a small article that says it better than I can: http://www.ft.com/cms/s/0/738da524-08f2-11e3-8b32-00144feabdc0.html?siteedition=uk#axzz2jgA8Dhex

The rest of your points are based on a false split between private and state systems.  There is no such thing as a "free" market - the law of contract, secure property rights, the police and defence systems and ooodles of other state things are essential for a working market.  They cost money so they can't be "free." Private enterprise is the best way of doing a lot of things but it works as part of a framework within a state.  Services like emergency rooms can be delivered privately but the funding has to come from taxpayers.

1.  Your quote "The Internet is a lot more like a bank -its very existence is due to the existence of the state." Is what I was referring to as "believe all that" which to me sounds crazy and possibly to others as well.
2. If a person pays millions in taxes and vat and another pays nothing then that person in a truly free market would get much more value for those payments.  Not sure how that can be disputed.
3. Perhaps that's true but again most groundbreaking tech medical or otherwise is targeted to those that can pay what appears to be crazy prices for it.  The more you remove that incentive the less research gets done to cater to that and the less tech then trickles down more affordably to others.
4. Private enterprise is a great way to deliver services.  Why are medical services an exception?  Is there something extraordinary about setting broken bones?  If you have an issue that drunks at the time of needing those services are poor choosers why reward them for getting drunk?
5. Agreed.
6. I don't see any leverage.  I see private business taking something theoretical and benefiting others through implementation of it.  A million academics can create a million theories but it takes business risking capital to make it work.
7. The Internet exist on a foundation of previous technology.  Whether it was patented or not is irrelevant.  At the core is math created thousands of years ago or did the Greeks need to patent it for Internet to work?
8. I disagree with patents in general but a few years seems reasonable.

In conclusion there is no slippery slope.  There's just a regular slope.  An incentive to get something for nothing can only grow one way.  "Socialist governments traditionally do make a financial mess. They always run out of other people's money."

So many false assumptions.

1. I don't "believe all that".  The fact is that the Internet and the industries surrounding it are outgrowths of state research and have always been subsidised by patents and copyright.  This is not something for debate or to disbelieve - its history.
2. Collectively paying doctors does not reduce the quality of care available to the rich.  Take out the billing systems, the absurd patent rules and the marketing overhead and medicine is a cheaper service.  The rich in the UK live longer than the rich in the US and get the same standard of medical care.  
3.  Much ground breaking research starts off with a government grant.  Successful drug companies are the ones that are able to leverage the pure research budgets of the countries they operate in.  In the US rich people might get treated first but thats simply saying that the drug manufacturers take the big money first.  The actual research is often funded by taxpayers.
4. Private enterprise is a great way to deliver services and its also a great way to deliver billing systems for some services.  Medical treatment for drunk injured people is not a service that private enterprise is best for billing.  Taxation is simpler and cheaper.
5. I mined/generated 2300 Btc in 2011 for about $3 each.  If bitcoin were to be the equivalent of 1 months money printing by the Fed, each Bitcoin would be worth over $40k.  Who would not be interested in that?
6. Bitcoin uses hashes that came out of the academic world and lives on the Internet - its a perfect example of private enterprise leveraging taxpayer research.
7. Example: the Ethernet patent existed before the Internet.  The Internet exists on a foundation of patented technologies.  
8. The US government has a theory that patents filed are an indication of innovation so it allows insane things like software patents.  The patent troll problem relates to this.  In the EU we actually have a sensible patent system that protects inventors for a few years and then forbids the re-patenting of old inventions that has poisoned the US system.

It seems to me that you are trying to say that its a slippery slope from taxpayer funded emergency rooms to North Korean slave camps.  Is that "slippery slope/thin end of wedge" type reasoning the basis of your objection?

I'm not sure this is a law everywhere. There are varying levels of trauma centers, and depending on your trauma/condition/child vs adult/closest ER being overwhelmed/insurance (like Kaiser, which has its own ERs), you may need to skip the closest ER, or even multiple closer ERs, and be taken to one further away with lights and sirens. I often see (and hear on the scanner) paramedic ambulances wayy out of their district (city, or private like AMR, with certain ranges of ambulance numbers for certain service areas).

@Hawker if you believe all that then why not apply the same reasoning to everything in life and just central plan it all.  Why "let" citizens do anything of their own free will.  I'll grant you that as a community simply collectively paying the doctors is certainly doable but that system basically takes more from the more wealthy but gives them less service and somewhere in there people that could've gotten better med care with more money will instead die.  If you are ok with that just to have smaller med problems fixed cheaply so be it.  It sounds pleasant and so what if a few rich people die.  But most ground breaking med tech starts out super expensive for rich people and then trickles down.  The first cell phone was a multi 1000s dollar brick and now I'm typing this on a relatively cheap tiny touchscreen phone.  But you believe government invented that too I guess all is well and the government will keep innovating.  Curious as to what sparks your interest in bitcoin or do you believe government invented that too?  Btw all the things you mention like patents and copyrights and other enforcements are bad not good.  Free market brought you the internet despite all those things not because of them.  What patents existed for Internet before it was invented?  Now there's so much BS patent troll firms it's crazy.  1 click shopping is actually patented.  If you think that's good for innovation and progress we are even further apart then I thought.

All the close emergency care rooms near me (I'm in the US) are of the "Urgent Care" type.  These are not hospitals, the state ambulances don't serve them, and drive on by to the state hospital.  But, a near innocent bystander (or relative or friend) could give me much better health service, and for a lower cost by simply driving my drunken-ankle-broken self to one of these Urgent Care facilities.

The notion that the tax-supported state is NEEDED for healthcare is a weird notion.  It is in no way necessary to put a government authority between myself and my doctor, it is simply more convenient for societies that want to absolve themselves of caring for each other and leave that to the men in white coats (and the armed men in blue coats to collect the fees).
It also serves the state to have the personal information about what healthcare I receive.  Our government has no shortage of curiosity about such personal information despite their apparent inability to keep it private.

Um - we are using the Internet which is partly a state invention.  I am using a PC.  The chip was developed with state grants.  If you are using an Apple, they were developed using state finance for small businesses.  The entire industry runs on kit and software that received huge subsidies in the form of patents and copyright laws.  The whole thing is further underpinned by regulations especially the rules relating to enforcement of contacts.  To describe our ability to communicate for free across the Internet as a "free market" phenomenon is just wrong.  A "free market" is ideal for trading potatoes for pelts in a primitive society.  The Internet is a lot more like a bank - its very existence is due to the existence of the state.

EDIT: the reason that taxation is a good way to fund health care is that the billing systems for health care are a huge cost and its easier to pay doctors salaries and just tell them treat everyone that is sick.  For example, the UK treats foreigners for free despite them never having paid a penny in tax because thats cheaper than making a billing system.

Back on topic: There is no such thing as a market in healthcare when the people who need it are drunk and injured.  Unless you plan to leave them fend for themselves, you require an emergency room paid for from taxation.  

Yes I'm American and yes it is possible that the UK system is better.  If you are in prison and get beaten daily then just being in prison is certainly much better then the 1st option but both are not exactly ideal.  I suspect your definition of local and my definition of local differ.  Not sure why you think that your vat for health food should support someone's diabetes treatments.  I just want to point out that we are having this conversation and exchange of ideas across oceans all made possible by free markets in technology but you fear that same free market can't make healthcare better.

I suspect you are American and used to a system where patent monopolists rip you off daily.  I'm not sure why you are unable to use emergency room services but then I am not sure why you would want to use them either 

In "proper" systems, all taxpayers have equal access to all medical care and its free at the point of delivery.  A tax on alcohol and on petrol is a perfect way to fund an emergency room.  Here in Europe, we have 20% VAT so the lady paid a lot more than £7 when she bought her high heel shoes.  And all the taxes are local as you only pay for the institutions of your own country.

Local " taxation" is an appropriate way to fund local services but I suspect you mean something else when you say "taxation."  Local taxation by choice is fine as long as I'm free to move however recently (50-100 years) governments started clamping down on that and that's the problem.  There is nothing wrong with a community getting together and jointly building a hospital to serve only those that paid for it.  The problem springs up when you want me to wastefully pay for someone 100s or 1000s miles away that has no incentive to pay for me or I'm unable to use the services I paid for and therefore that hospital has no incentive to provide me or the other person good service since I can't stop paying them if they set my and my neighbors broken ankles badly or overcharge us.

The £7 was tax.  Since you regard taxation as an appropriate way to fund emergency rooms we are in agreement. 

So you are proving my point.  People can and do donate and therefore there is no need to force anyone to pay for anyone else.  It is strange that you feel that 7 pounds is the appropriate price to pay to fix a broken ankle but like I said before market healthcare will not magically make you get countless hours of doctor time for 7 pounds but it is going to be cheaper for all at every spending level high and low.

What you say doesn't add up. Even if the entire government is controlled by an elite group of private interests, you can think of liquor taxes as paying off all the other vested interests who want their workers and family and friends to stay healthy and accident-free. As long the system is stable, everyone is breaking even.

If I was a US-ian, I'd be more worried about how to keep the oversized private health sector from being corrupt evil bastards.

This is how I want my healthcare to be. I will pay my doctor $25 a month (or whatever the cost is) for every month that I am not sick with a terrible disease (colds or small food poisoning don't count). Thus, the entire system is not based on them getting paid for me being sick or dead, but they only get paid if I am healthy and alive.

That would be a great free-market solution that would massively change the incentive structure for healthcare.

I donated about £7 to a hospital earlier today when I bought a nice Gallo wine - the tax is about half the price we pay here in the UK.  If I break my ankle after drinking it, its the best £7 I ever spent.

I can't help but notice you avoid the central question.  I didn't ask if its sad that young women get drunk and break their legs and that we have to provide emergency rooms.  I asked if you have a market based alternative to emergency rooms for those who get drunk and break their legs?

I'm advocating the reality that everything in the end is a market choice.  The market isn't an artificial creation it's simply an ecosphere by which labor gets exchanged for resources and vice versa.  The more you mess with it by creating rules that benefit one group over the other the more distorted and dysfunctional it becomes.  You propose to create rules that benefit the getting drunk without a care in the world group to the detriment of the others a group that doesn't do so by making them pay for it.  The farther along it goes the more people from one group migrate to the other until the paying group no longer has the resources to pay for the non paying group.  That is the current modern healthcare problem.  Instead of possibly saying that as a society we will just treat the very serious life threatening issues we are discussing broken ankles.  Clearly a non life threatening issue which should be delt with in the harshest of terms.  Either pay for med care or here is a stick with some bandages for you to wrap it up and hope for the best.  The group of why should I bother setting aside resources to cover life's emergencies when I can simply have society cover it has gotten so huge precisely because people keep saying oh we need to take care of them.  And the "we" is usually "not me" but lets tax others.  When was the last time YOU donated to a hospital since YOU feel these ankle breakers need help?

As an aside the "you are either free or unfree" argument is a fallacy along the lines of "you are either bald or not bald."

I don't know what you are advocating here.  Some women get drunk.  Some women wear high heels.  Every Saturday night, the 2 groups overlap and there are broken ankles.  

Either you have a concept of a market that works for drunk injured folk or you need a non-market solution.

Why?  And how far do you wish to take it?  If gov has to take care of the sick, drunk, and injured why not outlaw alcohol?  Wait better outlaw walking in tall shoes since you might fall even if you aren't drunk?  Or for that matter why let people walk outside at all.  Stay home so you are 100% safe and a government delivery truck will drop off food for you.  You can't be a little bit pregnant and you can't be a little bit unfree.  It's one thing to say I don't wish to fight this gov bs because it's not worth it and another thing to say oh this stealing and abuse is for my and others benefit.