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View Full Version : Lasik Surgery As A Model For Health Care Reform


wphelan
Feb 9th 2010, 05:42 PM
http://www.youtube.com/watch?v=3E29LD98ruo&feature=player_embedded

I thought this was an interesting piece by Reason.tv. It looks at Lasik eye surgery and how it could be used as a model for the rest of health care. Lasik eye surgery has been around for about twenty years, and in that time the quality of care has increased while prices have dropped. How is this possible when most health care costs have been drastically rising?

The key is that Lasik is not covered by insurance. It's a cash market. It's subject to real market forces, unlike most of the health care industry. It's never made sense to me that so called 'insurance' pays for most people's routine medical costs. How can one insure against something that is routine? It would be like having car insurance to pay for oil changes. To maintain good health, people get check ups and tests. That's a fact. Shifting costs to a third party drives the prices up because now the patient doesn't care about price. When people don't care about prices, prices are always going to go up. There's something fundamentally wrong with a system where I can walk in to a doctor's office for a routine checkup, tell them I'm paying cash, and they respond by charging me less than they would an insurance company.

But why did the health care industry evolve this way? As it so often does, the US tax code creates perverse incentives that create all kinds of problems. In this case, it's tax-free employer provided health care that has led to ninety percent of all non-elderly people to have their health insurance provided by their job. This makes no sense. What benefit is there to have health insurance coupled to one's employment? It's a boondoggle that forces people to make choices that only exist because of the tax code. Should I keep my office job so my family is covered for health insurance, or should I take the risk and be self-employed in the line of work I've always wanted to pursue? The cost of health insurance wouldn't be a factor in this decision if individuals were able to purchase health insurance on the same playing field as employers. Eliminating the employer-provided tax exemption would go a long way.

Michael
Feb 9th 2010, 07:06 PM
To add to this argument, US has one of the very lowest levels of entrepreneurship in the western world - likely because of employer-provided healthcare insurance. (Btw, France has the highest level of entreprenuership in the western world)

Because of this US workers are more likely to be employed by a massive corporation than a small to medium size company. In the US, small to medium sized companies have a proportionally small (and shrinking) share of the US economy (and the US uses statistical games to hide this fact - by defining small companies as those with 1000+ employees and other such nonsense games).

Outside of the USA, small to medium sized companies are the primary drivers of employment growth in every economy.

Bottom line is that the US tax code massively favors large corporations at the expense of small to medium sized companies. And it is the largest corporations that have the greatest passion for 'cutting' jobs as a way to improve profits. Small companies increase profits by adding jobs. This macro argument offers partial explanation of why the US has such job polarity (lots of really high wage jobs but everyone else works at Walmart or McD's). There is no middle ground there. US healthcare/tax-policy makes it this way.

wphelan
Feb 9th 2010, 08:22 PM
I have no familiarity with the tax codes of other nations. How do they compare to the US? It's hard for me to imagine a more convoluted, market-warping system than the one we have somehow managed to devise.

Americano
Feb 10th 2010, 10:27 AM
I have to comment on Lasik Surgery consumer cost going down in the US. An American can still fly to India, have the procedure completed with German equipment one generation ahead of that used in the US and save money versus having it done in the US.