This One Goes to Eleven (Robert Wright & Mickey Kaus)

[DWAnderson]

Originally Posted by stephanie

it's only by people not having coverage that you can have any affect on the cost curve through the market. If people don't have coverage, they have to decide if that MRI or ultrasound or day in the hospital or cancer surgery, as referenced above, or tests for various possible illnesses are worth the out-of-pocket costs to them. So let's all be upfront about this.

It is correct that by devolving to consumers the decision to buy or not buy a good, or to buy an alternative is how markets work. Nothing particularly sinister in that, especially when the result is superior goods at superior prices.

Originally Posted by stephanie

On the other hand, the government can push the cost curve through negotiating rates and the like, and can also introduce market forces by limiting what Medicare will cover in a way that ensures that what we as a society think needs to be covered still will be.

Negotiated rates are essentially price controls, with all of the attendant problems, like superior providers leaving the market, fraud and the like. Those are a an inherent bug of a top down system not a feature.