Your first sentence is patently false. There are clear economic incentives in preventative care when the patient pays the full cost of care that do not exist in the current health insurance model. Yes, people are reluctant to go to the doctor--and when there is no incentive to do so, that reluctance is not countered and thus predominates in the choices patients make...Some people would make that choice. However, others do not. I know people who go to the doctor at the first sneeze.
You continue to fail to deal with the fact that this is not an ordinary demand issue, as would exist with something intrinsically desirable. Even as a threat it has no certain consequence for a given individual, and given our cultural love affair with risk, the obvious consequence should be apparent even to you.
Actually, perfect knowledge of the costs of care would only be scary in a "sticker shock" manner. Fear is primarily a response to an unknown/unknowable phenomenon. Very little that is well known is much feared.
Exactly, you agree, but then force yourself into the wrong conclusion again because, as before, you ignore the differences in the psychology between car-buying and medical care. Even if you discount the vanity aspect of car-buying, and focus purely on the necessity of it, the consequences of not having a car for a commuter are much more obvious than skipping medical check-ups. I know of no vanity, no social appeal, of having essential medical care, either. So the market is very different for a good chunk of the population.
There is even an occurence of ideology-based refusal of medical care also, often publicized in the media, - clear cases in which a person would live with treatment and quickly die without, so the extent to which people will sometimes go to avoid reasonable care clearly extends beyond financial reason. Obviously, few people are that irrational, but not everyone has to be that extreme to be unconsciously pulled into similar self-deluding rationales and avoidance behaviors. Almost anything can and will be used by some people to avoid care, so the only way to mitigate that is to remove those excuses at the point of decision.
Again, you are presuming incentives do not change. That is an irrational and unsupportable position to take. Incentives most assuredly would change.
Not at all, the whole basis of my commentary is about incentives which will work. I am simply pointing out that the incentives you are citing are not fully functional in the medical market, and therefore potentially detrimental to public health.
Moreover, you naively assume any given medical cost is a simple one-time payment, as for a single procedure, that people can easily shop around. That is only possible in a limited number of situations, and most of the time costs keep accruing unexpectedly as issues, unique to the individual, keep cropping up. There is virtually no way an ordinary person can ever account for every possible future need and then budget for it, other than for the barest of routine services. Even medical professionals themselves can't forsee individual needs sometimes, so how are non-medical consumers going to achieve this?
Those factors do not invalidate my hypothesis. I am not claiming people will be perfect in pursuing preventative care, merely that they will be incented to do so, and that the incentives will have significant impact on their consumption patterns regarding healthcare.
Well that's the whole point, your incentives only affect a portion of the market. Such incentives alone may improve health care compliances for some, but because they don't help the entire market, therefore they are not the best solution for this market.
True enough, but you are talking about a small sliver of overall healthcare cost and consumption. Also, given the problematic nature of serious disease, it is a markedly different economic discussion. Cost of cancer treatment is not what drives the cost of "normal" healthcare through the roof.
You are clearly wrong here, as care of serious chronic disease constitutes the majority of health care spending. It is only a smaller proportion by population, not cost. So your solution would be simply to allow 10+% of the population simply die prematurely, unnecessarily? You have not thought this through in any way that has a basis in humane reason.
Even if hospitals continued emergency treatment regardless of a patient's ability to pay, that still would not cover chronic illness and lead to a much higher mortality rate in the general population. Moreover, how does a person "shop around" when they are having a medical emergency, if they are unconscious no less? It is an absurdity to remotely suggest that.
Prices would fall because the current price models are only sustainable with insurance, and are in fact driven by the insurance distortion. When the economic concern regarding healthcare is a lack of health insurance for some, rather than access to the services themselves, that alone is proof of an irrational pricing mechanism. Prices could not do anything but fall if health insurance were withdrawn from the equation.
Again you falsely assume that installing a rational pricing mechanism will magically induce rational consumption of this particular "product". Also, as pointed out earlier, medicine is not a single product price which a consumer can easily shop around except in limited cases, even if they were perfectly rational. Even professional knowledge doesn't guarantee the ability to fully predict costs for a given individual.
Further, while it is true that healthcare is not a pure commodity, there is competition among physicians just as there is in many service industries--chiefly on the basis of skill/knowledge/competence. Doctor "A" competes with Doctor "B" on the basis of who's "better". A non-distorted market mechanism would leverage even that competition to push prices down overall.
In a functional free market, pricing pressures for such compel both Doctor "A" and Doctor "B" that they are worth the higher fee; their economic incentive is to argue the value of their services and justify whatever fee they seek to assess. The value argument is also part of what would moderate patient behavior and shift the perception of healthcare in a positive direction. People are not troubled by price when they perceive value.
Actually, that is not true. It is illegal in many states for doctors to make claims of better medical treatment. Presumably, the standard of care is just that, and no one therefore can claim to be better without implying another is involved in malpractice. It is a violation of every ethics code I know of.
The only way in which doctors can legitimately compete is in providing a more appealing staff and cosmetically beautiful office, and that obviously has little to do with the quality of medical care. Competition on pricing typically would be on the few common procedures patients understand, a kind of loss leader. It is not a good model to build the best health care on.
It works very well for cosmetic procedures, but then, that kind of medicine is somewhat antagonistic to good health care.
