Topic: Competition in the Emergency Room Marketplace? (Read 3442 times)

Ambulances are required by law Ambulances are required by common sense and the urgency of it being an "emergency"...

If you are an illegal alien, you don't have to pay anything for your emergency room visit.

Thank ObamaCare. The taxpayers pick up the bill for everytttttthhhhing.

We have the what now? Maybe the 248 people that managed to get through the borked web sign-up process might be covered.  Some of them claim to be paying 5x as much, for less.

http://www.abc15.com/dpp/news/region_northeast_valley/fountain_hills/fountain-hills-man-dropped-from-health-insurance-because-of-new-regulations

http://www.businessinsider.com/brutal-obamacare-had-just-248-signups-in-first-days-2013-10

Congress grilled the webmaster-in-chief a couple days ago.  She said she is sorry so its ok now.

http://www.bbc.co.uk/news/world-us-canada-24737591

Yes, it is off topic and I don't want to drag the thread off-topic so I'll be brief.

Do you really think that nobody would have ever asked the question, "hey, do you think we could get these 2 computers to communicate with each other?  Maybe we should try it over a really long distance too."  The concept of no-one trying that seems pretty ridiculous. 

You must realize that government funding comes from money taken from the citizens.  They have no money of their own.  It's just a question of who is more effective at deploying it.
I think you misunderstand.  Yes the person that paid in more can get no more then the same value as his/her treatment but that would have cost them a lot less compared to what they paid in.  So in your example it cost them millions for a hip replacement instead of 10000.  They got a lot less for what they paid.
Yes it's cheaper for you but because the money came from the person in the example above.  They are the ones paying the extra cost.  If there is no value added by another layer of bureaucrats how can there be value added by the 1st layer?  Either government services add value or they destroy it.  If they add value then the more layers the better.  Right?
Are you trying to say that the researchers that work for government now would somehow stop researching if they had to do it in the private sector?  Why?  If they are smart and want to do it they will do it in any setting.  Research is driven by the desire of the human race for advancement or are you saying the government gives them pills that make them smarter or more interested in discovery?
That's true that currently there is no true free market and likely never will be but the laws of contract, secure property rights, the police and defence systems and ooodles of other state things are actually impediments that are starting to badly suffer from the law of diminishing returns.  A service can't be private but funded by taxpayers because it eliminates the most crucial functions of adjusting to customer demands since payments are unrelated to performance.

So if the person is broke what happens?

EDIT: is this a stupid question now you have Obamacare?  I assume that means everyone is covered.

If most of the world still had state-owned and operated telecom, and the US hadn't broken up the monopoly of AT&T, one wonders whether there would have been an internet like we have today...
Why didn't it emerge elsewhere?

The answer is that it did.  France had their own separate internet, Minitel, state sponsored (because France Telecom was still a PTT), which may be why it never made it outside the borders.
By the time France got around to  splitting the PTT, it was 1991 and they were well behind.
I think they finally turned it off a few years ago.  It was pretty good despite its limitations at the time.  IT might have been much more successful internationally, were it not ... national.

And there was the X.25, x.75, and x.400 networks for email, mostly privately supported and paid by business but inter-networked.  It was a very reliable protocol that didn't rely so much on line quality.  Rumor has it you could run it over an unbroken barbed wire fence.

Pay for service, or insurance.  Almost always much much less than the state hospital rates.
We have the religious ones too, they usually cost more, but often still less than the state facility, and fewer and further between.

Interesting - we have that too in the form of religious hospitals with emergency facilities - but how are they paid for?

Imagine that?  We are not yet entirely socialist despite common opinion.
One of the last vestiges of private health care for emergency services remains.
https://www.findurgentcare.com/what-is-urgent-care/
Probably it will get outlawed in the next ObamaCare update since the original was designed to fail so that it could be endlessly expanded.
A quick search shows about 8 of these closer than my closest state funded hospital ER served by ambulances, so cheaper and faster.

Whats an urgent care facility if not an emergency room?  Some kind of American thing I assume?

I did, you ignored it.
I'd drive them to the urgent care facility.  It is closer, and less expensive, and doesn't rely on the taxpayer.
The ambulance drives past a few of them on the way to the closest hospital to my home.

You have not offered one.  If you have an idea how to care for drunk ladies who break their ankles in high heels that is better than a taxpayer funded emergency room, please feel free to offer it.

Still begging the question.  That it is, is not proof that it must be so.

There may be a better way.

No.  The state does pure research and infrastructure very well.  There is no private market for subatomic research like CERN or for carbon studies like the UMIST research that produced graphene.  Private enterprise takes the outcomes and does innovative things with them.  We have no idea what amazing products may come from the CERN work or from graphene. Our modern successful societies are based on a synergy between the two.

Simply because States have taken control of much industrial production, medicine, education, is not proof that it must be so.  It begs the question.

Do you even know what the internet is?   because I can only assume with such a silly statement that you have no idea.

It is a set of communication protocols for computers to be able to communicate with each other.    This can be done over very small distances, one room really.  Then it can build over time.  

Those communication protocols would have been developed regardless.   The slow development of the internet before it was commercialised and took off is another example of how inefficient the state is.
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That's impossible to prove as its based on an alternative history in which the real Internet created by state funded bodies doesn't exist.  Its also off topic - the question is whether there is a place for competition and market forces in emergency rooms.  My view is that there isn't - people who are ill/injured and drunk/incapacitated are not in a position to make rational choices about what emergency room to go to.

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Do you even know what the internet is?   because I can only assume with such a silly statement that you have no idea.

It is a set of communication protocols for computers to be able to communicate with each other.    This can be done over very small distances, one room really.  Then it can build over time.  

Those communication protocols would have been developed regardless.   The slow development of the internet before it was commercialised and took off is another example of how inefficient the state is.

Where is this private market of which you speak?  Alternate history?
If you are talking about the concurrent marketplace, you might as well flip this silly assertion on its head and assert that there would be no internet without the private market and open source free software unprotected by IP.
And there were alternative information networks.... Orange Book anyone?

Not really.  The private market existed while the Internet was being created by state backed bodies.  The absence of an alternative information network is empirical evidence that without the state funding of universities and defence there would be no Internet.  

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.

Women have always gotten drunk and have been suffering broken ankles since high heels were invented.  You have conceded that there is no way a market can be run for drunk injured people.  Our cities are full of such people every Saturday night.  So we provide emergency rooms.  If you want to advocate that we leave them to their fate, feel free to do so.

By the way, I'm not picking on women here - drunk guys who beaten up are in the same position.

Sure it does, the market is operation through the government which reaps huge taxes through the liqueur tax.  They have a strong interest in encouraging people to become drunk, that they get hurt is just a fringe benefit for them as it validates the nanny state.
Government is a market participant, it is just that one participant that has the right to kill you and take all you have if you happen to be in a geography it controls, but in order to maintain folks in that geography it only harvests those it can most easily get away with, such as this foolish woman who didn't bother to remove her Louboutins after getting drunk.

Correct.  The market has its uses.  The care for the sick, drunk and injured is not one of them.

So in your example this woman made no prior emergency plans whatsoever via insurance and to top it off got drunk and the rest of society now should be forced to take care of her.  We'll in that case why bother with any market solutions at all if people don't need to plan for their own lives.  Talk about perverse incentives.

"Bad" emergency hospitals would eventually be blacklisted by medical insurances. Your ambulance would probably work to/with your medical insurance, and would not take you to the blacklisted hospitals. Or at least avoid it if possible. That would of course create a strong incentive for hospitals not to be blacklisted, since being blacklisted by most insurances could drive them to bankruptcy. And that would ensure "bad hospitals" to be rare and of quick living.

By the way, the assumption that you always have to go to the nearest hospital is exaggerated.


He, it's funny how fast people conclude what they want to conclude. It took me only a couple minutes to come up with the answer above. And I'm just one random guy. How dare you say millions of people working freely wouldn't be able to come up with a much better solution that we cannot even imagine today?
It really looks like what people against slavery abolition in the 19th century would say: "But who would do the hard work? Agriculture would collapse! We would all starve! Do you want to live in a society where people starve to death?"

Lets take a typical Saturday night admission to an emergency room.  Girl gets hammered and falls on her high heels and breaks her ankle.

Can a drunk person be expected to make rational plans?  No.

Do we want to live in a society where a drunk woman with a broken ankle is supposed to look after her own care?  No.

Under these circumstances, there can't be a market solution.

That's what it is focused on now precisely because it isn't a free market.  If it was then companies providing those emergency services to you would care about doing a good job just like any other servics or they go out of business losing their invested capital.  Unless it's total charity all decisions are still paired by market forces.  The problem is with the current system a lot of those forces are illogical and invisible to the consumers of those services and therefore are devoid of any feedback regarding their success or failure at solving the problems.  Hospital selection isn't dictated by the consumer but by "laws" so no adjustments can be made and everything costs more as a result.

Because it's focused primarily not on the best price, but on the best speed; decisions are measured in how fast your emergency can be turned into a non-emergency, and spares no time for you, or the person who will not be footing your bill but calling for you, to decide the best price for the best value.  The hospital which is closest always takes precedence over the hospital which provides the best service for the best price; it's not a free market problem once an emergency is involved, because you cannot act rationally while on the verge of dying.

Which is why the problem is primarily solved before there is an issue; the free market applies to everything except this one moment, where you and your saviors are paired by non-market values.  If there is a man who will say "No, I'd rather spend another 20 minutes in this ambulance than spend an extra bit of cash at this place", assuming he can still speak and think clearly, I'd like to meet him for I'm positive he's an interesting fellow.

Though I do agree, I am tired of hearing about emergency services justifying taxation and central law.

Why would the free market not apply?  What can be more rational then planning properly for emergencies that involve you living or dying?  If anything it's irrational to hope that some government run "free" emergency care will help you out.

Here's a place where the free market doesn't apply for the free market requires rational actors; there's nothing rational about getting hurt, passing out, and waking up in a hospital with a bill.

Here's some solutions, anyway:

Emergency centers close enough to each other that they must compete; you can then, if requiring further treatment, figure out the hospital of your choosing at your leisure.

Refusal to use any hospital for non-emergencies which does not offer competitive prices for emergencies; this pressures the hospital to offer better prices or sell off to whomever is.

Pre-determined prices paid in advance, mixed in a large pool of other people's advanced payments, to marginalize the cost of varying emergency service costs (i.e. insurance.)

Stop being careless about your health so you won't have to worry about it.

And of course, all of the above.

What about jesus curing everyone and everything.  Is that not a solution?  You clearly believe in him and you believe he has omniscient powers, so why can't he provide healthcare?  Does he hate paperwork? 

Whether or not someone who is taken in an ambulance will die or not, may be a debatable matter.
The portrayal as though 100% of people given rides in ambulances will die without their care,
cannot be true.
The fact they will not allow people to have free will or choice, once they have apprehended someone,
does seem to be tyranical to me.
As though somehow their own philosophies or doctrines of what is health care, are somehow superior to our own?
But what if, in fact, some or more of their doctrines are not as good?
Then they are just behaving like autobots who are doing what the state told them to do, without regards for whether it is good or evil to the people they do it to.

if they say 'would you rather be dead', well, I see that as some kind of deviant form of extortion almost, hardly becoming of people who are supposedly 'health care' workers.

What if you totally disagree with the health care workers and really do not think they intend to do good for you, but instead have the intention of causing you harms?

The only 'solution' I can think of, is to avoid the state health care system or health care workers; which can be very difficult if catastrophe occurs, or even if a person gets sick.
A person who resists going to them, may get grabbed hold of, by some citizen or citizens, who may think that they are doing good by calling an ambulance, though the person did not want one.

Its an interesting topic.

This is where the free market stops.

Yes.

It's a large meta-entity called "the government". It's run by millions of private interests called 'people' who have a variety of vested interests such as:
-hassle-free care when an unknown, unforeseen, and therefore uninsured-for health disaster strikes,
-minimum inconvenience/contagion when the same happens to others,
-low levels of systemic corruption (or structural violence), which might otherwise be caused by profit motives. For example, market makers tend to restrict the flow of resources (health care in this case) by adding their own fees to each transaction.

Many examples in historical records point to times and places where there was no government, only feudalism or some other inferior ism. Governments naturally evolved to fill the niche.

The market solution would exist and present itself if it was actually a free market.  Even if you are unconscious medical ID bracelets or other devices could easily identify you to the ambulance.  The main problem here is that in order to accept market based solutions one must accept the reality that rich/wealthy people will get better care because they can afford it and less wealthy and or poor will get lesser care.  That's the definition of market based healthcare.  You get what you are willing to pay for.  Once you are past that hurdle all care will be cheaper for all but it won't be equal care.  Medical care won't necessarily be all insurance.  Different solutions for different preferences can exist.  Certain companies might specialize in ambulatory services on a monthly prepaid basis and then make specific agreements with various hospitals.  You can't predict what a free market will bring because you can't know all the different wants and desires of its participants.

Medical care should be free to all at the point of delivery.  Since you are likely to be unconscious, the notion of a "market" price being applied is a joke.

Do like Canada, and remove the profit from the hospitals.  It won't matter where you injure yourself.

I suspect price is not the only difference between your hypothetical hospitals.

When lawmakers set the price of things, the first thing bought is the lawmakers.

It's currently possible to receive treatment in the US at one hospital for $10,000, yet the same exact treatment down the street would cost only $5000 [citation needed]. All the consumer can do is try to have injuries closer to the cheaper one. A well-written law (?) might be able to fix this problem in a way that I can't see market dynamics doing.

Emergency healthcare is a rather unique situation in which there's no room for competition.

This part makes sense, but I'm not really focusing on tax-funded health care in this topic.


Perhaps we shall see.

A legislative cap will discourage extraordinary measures to save children that are currently standard.

Healthcare = the death business.

The provider incentive is to keep you alive and dieing as long as possible on the highest margin profitable treatment.
The consumer incentive is not to die (which hasn't ever happened).
The secondary incentive is not to be impoverished or uncomfortable.

These incentives will be the same whether it is free market or non-competitive governmental single-payer.

These incentives get a little bit skewed when it is the same entity that pays the survivor benefit (pension/social security) as pays for the healthcare, because there will be an age bias toward killing off those that would collect the benefit and are no longer "contributing".

The question is...
What can Bitcoin do to fix this?  Anything?

Ambulances are required by law (and sometimes by sheer "don't let this guy die" practicality) to bring patients to the nearest emergency room. It seems to me that this is a case where there is no chance for competition at all: you don't get to choose your provider, then they bill you whatever they want. Complaints may be me with a snarky "would you rather be dead?" line.

There's a simple legislative solution that helps the customers: legislate caps on costs billed to patients.

Is there a free market solution?