Tyler Cowen had a short and provocative blog the other day on the third party payer problem and whether it does or does not lead to increased costs. Using the price history of treatments for autistic children, which are usually NOT covered by insurance, Tyler suggested that the 3rd party payer phenomenon may not be the cause of runaway inflation for healthcare. I understand the theory, but tend to agree with Tyler. I think it has more to do with asymmetric information and bargaining power. For treatment in a hospital I know the uninsured pay MORE, frequently a lot more. Not sure about outpatient as I have very little personal and no professional experience with those treatments and payments.

As to shopping around for a heart surgeon, that doesn’t work so well when you suddenly have a heart attack. It also doesn’t work when the surgeon knows a lot more than you do about both your condition and the availability and urgency of various options. Asymmetric information can and does lead to market failure (doesn’t mean the government can do it better, just that an unregulated market doesn’t maximize consumer welfare) and this will always be a problem in markets for healthcare. If Doc says you need procedure X, and it costs Y, who are you to argue with him…. especially if you are losing blood while you “think” it over (if you are conscious).

The problems are clear, the solutions, not so much.

I understand your point, but my comment was directed at Coyote’s final paragraph.

Texas is atypical in requiring strict physician oversight of PAs and NPs. I suspect that will change soon, as the general public’s demands for more care overcome the entrenched interests of some of the physicians. What’s weird is that most family practice and internal medicine physicians I know would gladly let PAs and NPs handle the simple stuff so they can focus on the more challenging cases. With Texas having so few physicians, they must continually be swamped. Maybe Texas doctors like 80-100 hour work weeks.

There the politics, regulation and bureaucracy is just as bad as the gov’t, but w/ even less oversight.

Case in point: Home Owner’s Associations. Some how various libertarians point to these as much better institutions to enforce local aesthetics statues.
WTF? Maybe if you could opt-out at some point. But how are mandatory HOA fees any different than local or municiple taxes? (Answer: you can’t even deduct them from your Federal taxes!)
And when my politically far-left HOA in Reston, VA didn’t get the turnout on a referendum it was pushing, and paying for w/ members’ dues(ironically alienating the old-guard SDS members who founded it) they simply EXTENDED the ELECTION!

At the very least if a village or town tried this, they’d be restricted by state and federal election statutes.

So why would anyone trust the AMA, who has a vested conflict of interest, to provide a broader license structure to create benficial choice for the customer?

One sore point that I have been on the warpath about is aortic aneurysms. In the US, more people die of these than die of AIDS (15,000-20,000 a year). The disease is silent until the aneurysm ruptures, then you are dead. The test is a simple under $100 ultrasound and the condition can be surgically fixed. Yet, I have received hundreds of warnings about AIDS and none about aortic aneurysms.

There are all kinds of situations where doctors seem to just spout the party line without really thinking. Why do we vaccinate all newborns for Hepatitis B but only vaccinate adults of they are at risk of coming in contact with contaminated bodily fluids? My kid’s doctor had no idea. Its what we do…