And what about people who haven't had a compelling reason to maintain a running comparative opinion of their local ERs, simply because they don't have a chronic condition that keeps sending them back to ERs?
OP's point is valid: it's reasonable to expect someone to look up information before deciding on, say, where to eat that evening. It's farcical to expect someone experiencing acute angina or stroke symptoms to inform themselves about their free-market healthcare options by looking up online reviews or whatever for local ERs.
My experience is people know the “good hospitals” and “bad hospitals”, much like they know “good schools” and “bad schools” or even the “good DMVs” and “bad DMVs”.
The problem is most people have no choice.
For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.
What matters is the institution. And they absolutely do have reputations.
For example, Kaiser Permenante has a reputation so foul it’s known nationwide, despite only operating a few states.
Also, I’ve never had any difficulty getting an ambulance to take me to the ER of my choice (that is, my insurers choice), and I’ve done this many, many times.
Honestly, I appreciate reading about your experiences, and bottom line, I'm happy that you're able to access medical care.
Your experience hints at some of the flaws in US healthcare:
For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.
Right, and if the ER doctor you happen to draw is out of network for you, RIP your savings and/or credit score. Isn't this a decently common problem, where even an "in-network" institution employs practitioners who are "out of network" for you, so you thought you were covered by your insurance company's rules, only to be surprised days after treatment?
EDIT: this "out-of-network provider at an in-network institution" problem was so common and frustrating that Congress has had to ban the practice, as linked in the article: https://archive.is/50VQv
take me to the ER of my choice (that is, my insurers choice)
Leaving the choice of ER to one's insurer doesn't sound like my idea of "free market" healthcare. What if they choose your area's "bad" ER? I suppose you can indirectly pre-choose your ER by choosing an insurer which covers the ER of your choice -- that is, unless you get insurance through your employer, in which case I guess you'd have to purchase private coverage for your ER of choice.
Different institutions have different reputations in single-payer publicly funded health systems too, so I'm not so sure if that's the crux of the matter. What upsets me is that those people who are in the most desperate need of healthcare are almost by definition in the worst possible position to make an informed choice. Picture an unconscious victim of an accident, violence, stroke, heart attack, etc. Oh, and it seems generally impossible for even an awake and alert person to "shop around" by comparing price quotes for the healthcare they need, preventing competitive choice.
Then there's the issue that ERs must stabilize and treat anyone who enters, regardless of ability to pay. Someone has to cover the cost of this.
What kind of "market" keeps prices secret from incapacitated consumers? I think MereInterest summed it up perfectly: The nature of medical emergencies prevents actual markets.
And it doesn’t require a free market to refrain from using “bad places.” I avoid the “bad DMV” like the plague - and that’s a branch of the state government.
Regarding free market health care. It can be done - a good example is Canada.
In Canada, health care is free to patients. The state pays doctors directly. The prices are set by the state, so doctors compete on quality/patient preference.
In America, almost all hospitals are nominally nonprofit (religious, university, etc). In Canada they are often for-profit (there are quite a few public ones too.)
Patients can see whoever they want. Good hospitals get patients, bad ones don’t.
Good hospitals make profits, while bad ones don’t.
That seems like a good system to me.
My Canadian relatives love it. The comparison I made is really just me paraphrasing them.
Comments
And what about people who haven't had a compelling reason to maintain a running comparative opinion of their local ERs, simply because they don't have a chronic condition that keeps sending them back to ERs?
OP's point is valid: it's reasonable to expect someone to look up information before deciding on, say, where to eat that evening. It's farcical to expect someone experiencing acute angina or stroke symptoms to inform themselves about their free-market healthcare options by looking up online reviews or whatever for local ERs.
My experience is people know the “good hospitals” and “bad hospitals”, much like they know “good schools” and “bad schools” or even the “good DMVs” and “bad DMVs”.
The problem is most people have no choice.
For ER care individual doctor ratings are unimportant, because you have no idea who the doctor will be.
What matters is the institution. And they absolutely do have reputations.
For example, Kaiser Permenante has a reputation so foul it’s known nationwide, despite only operating a few states.
Also, I’ve never had any difficulty getting an ambulance to take me to the ER of my choice (that is, my insurers choice), and I’ve done this many, many times.
Honestly, I appreciate reading about your experiences, and bottom line, I'm happy that you're able to access medical care.
Your experience hints at some of the flaws in US healthcare:
Right, and if the ER doctor you happen to draw is out of network for you, RIP your savings and/or credit score. Isn't this a decently common problem, where even an "in-network" institution employs practitioners who are "out of network" for you, so you thought you were covered by your insurance company's rules, only to be surprised days after treatment?
EDIT: this "out-of-network provider at an in-network institution" problem was so common and frustrating that Congress has had to ban the practice, as linked in the article: https://archive.is/50VQv
Leaving the choice of ER to one's insurer doesn't sound like my idea of "free market" healthcare. What if they choose your area's "bad" ER? I suppose you can indirectly pre-choose your ER by choosing an insurer which covers the ER of your choice -- that is, unless you get insurance through your employer, in which case I guess you'd have to purchase private coverage for your ER of choice.
Different institutions have different reputations in single-payer publicly funded health systems too, so I'm not so sure if that's the crux of the matter. What upsets me is that those people who are in the most desperate need of healthcare are almost by definition in the worst possible position to make an informed choice. Picture an unconscious victim of an accident, violence, stroke, heart attack, etc. Oh, and it seems generally impossible for even an awake and alert person to "shop around" by comparing price quotes for the healthcare they need, preventing competitive choice.
Then there's the issue that ERs must stabilize and treat anyone who enters, regardless of ability to pay. Someone has to cover the cost of this.
What kind of "market" keeps prices secret from incapacitated consumers? I think MereInterest summed it up perfectly: The nature of medical emergencies prevents actual markets.
The current health care system sucks.
And it doesn’t require a free market to refrain from using “bad places.” I avoid the “bad DMV” like the plague - and that’s a branch of the state government.
Regarding free market health care. It can be done - a good example is Canada.
In Canada, health care is free to patients. The state pays doctors directly. The prices are set by the state, so doctors compete on quality/patient preference.
In America, almost all hospitals are nominally nonprofit (religious, university, etc). In Canada they are often for-profit (there are quite a few public ones too.)
Patients can see whoever they want. Good hospitals get patients, bad ones don’t.
Good hospitals make profits, while bad ones don’t.
That seems like a good system to me.
My Canadian relatives love it. The comparison I made is really just me paraphrasing them.