4.2.19

INSUFFICIENT MARKET TESTS.

John "Grumpy Economist" Cochrane spells it out.
People really do not need health insurance for regular small expenses, as they do not need car insurance to "pay for" oil changes. And any insurance system relies on an underlying cash market to find what the right prices are. Collision insurance works reasonably well because there is a supply and demand market for auto repair in which people pay their own money and there are competitive suppliers and free entry, offering services along a wide quality-price spectrum.

The underlying cash market has disappeared in health care. If you try to just pay for service, you face the ridiculous sticker prices. Everyone needs to go through some sort of middleman. We have, collectively, fallen for the fallacy that "negotiation" can lower everyone's price, rather than (try to) lower my price by raising yours. It is widely recognized that catastrophic insurance plus health savings plans are a much better structure than current pay for everything structures. But you can't do that if people showing up on their own to buy things are faced with fictitious "list prices."
Indeed so. I had some dental work done over the summer, and after the insurer got done dickering with the clinic, it transpired that I had paid more than what the insurer viewed as my proper co-pay to be, and a check materialized in my mailbox.

It's worth reading his post in full.  There's too much confusion for anyone to be able to calculate what the opportunity cost of insulin, or any other useful drug, is.  And somehow, the miracle of universal Medicare will make all those difficulties go away.

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