You said that medical prices can not be pushed down because they are essential, thus don't respond to free-market pressures. That is my understanding of what you said.

That's simply not what I said. I said that the primary reason for the difference in pricing between "essential" and "non-essential" medical goods is the shape of the demand curve at and around the equilibrium quantity. I'm not sure how many different ways I can exlain it to help you understand, especially given the fact that I've said explicitly that both of them respond to market forces perfectly well. Continue with your lecture if you will, but it's pretty clear now that I'm not the one who is missing something.

The interesting question in economics is never, "Does X market respond to market forces?" because every market responds to market forces. The interesting question is, "What does the market look like and why is the outcome what it is?"

I'm really trying to tease out what's in your head here and if you have some sort of underlying point you're trying to make. I made a very narrow point about something way up the thread, and you turned it into a meandering half-assed Socratic lesson trying to teach me something I assumed we both understood perfectly well. I'm now apparently being taken to task for not mentioning price transparency when we just spent the past several posts going round and round on how supply affects price.

The problem with these discussions is that the person with the really shallow understanding thinks he's maneuvering the conversation somewhere clever and the person who actually knows what he's talking about assumed that the clever "end" they were driving at was just one of the axioms at starting point of the discussion that everybody sort of leaves unsaid. It's like trying to sit still and nod politely while somebody ploddingly explains to you the joke you just told.

I'm surprised you haven't read any of that, since you seem to have a degree in economics.

Look, price transparency is good. Markets are good. I understand that supply curves slope up and demand curves slope down. Now that we have that out of the way, do you have something substantive to contribute, or am I wasting keystrokes and inviting more of this facetious self-congratulatory horseshit?

Well, I have a degree in economics, so it's probably not that I'm missing the basics of supply and demand and need to be led there one sentence at a time. It's more likely just that I'm not claiming that increasing the supply of medical care won't reduce the price.

The post I originally responded to noted that non-essential care has dropped in price as if that's evidence that Evil Socialism is driving up the price of essential care. But it's not as though non-essential care is an unfettered free market and critical care is heavily regulated. They're both highly regulated markets with limited supply of specialized caregivers. The key difference is that non-essential care is (surprise!) non-essential, so the shape of the demand curves in the critical regions differ and the equilibrium prices at easily-reached supply levels differ.

If you want to talk specifically about how to increase the supply of critical medical care, that's an interesting topic. There are a whole lot of reasons why it's not the simplest thing in the world to do, but it's definitely interesting.

You're clearly trying to lead me to something really clever, but I'm just not getting there. This is all pretty basic economics, so what am I missing? Is there a way you could say it without the use of question marks?

No, it's reasonable to assume that the demand curve is more or less smooth and continuous. "Essential" goods act just like any other normal goods once you're out to a certain quantity. But below that, the demand curve shoots off into the stratosphere. That happens for water or food. It happens for critical medical care. It doesn't happen for Troll dolls or DVDs.

I have no idea how you could have gotten that from reading my post and the link I provided. Supply and demand work perfectly well in healthcare. But for lifesaving health care, the demand curve is basically vertical where supply and demand meet in the real world. The demand curve for essential goods approaches infinity as quantity approaches zero and drops off rapidly after your essential needs are met. That means that you're almost completely insensitive to price until the supply increases beyond that point.

If we ever get to the point where there are a bunch of heart surgeons milling around for every one person who needs heart surgery, we'll be way down at the same point on the demand curve as we are for rice and fresh water. But that's not where we are.

We consume food at a much lower marginal utility. We've progressed far enough in our provision of food and water that we produce enough that we now consume them way down on the marginal utility curve. If we were starving hunter gatherers, we'd gladly trade our last beads and monkey skulls for a little bit of food for the same reason. For a variety of reasons, we haven't yet progressed to the point where medical care is provided that far out on the curve (although some of it is--lifesaving antibiotics that would have been worth kingdoms can now be bought like Skittles). Once machines that automatically perform heart surgery are available right next to the vending machines that clog our arteries, we'll wonder why we ever had this conversation.

It looks like at least 27 states are going forward with it in 2014 with a number of states sill debating.

"Having problems?" "Going to prison?" Are we still talking about Medicaid?

So you're going to do the super smart thing and not have any health insurance at all, right? That'll show 'em.

That seems like a really bad decision, no? And whether your state participated has nothing to do with whether HHS counts Medicaid as "private" enrollment. Which it doesn't.

If there was a way to guarantee that you'd pay cash up front for all of your medical care or go off and die without bothering the rest of us, I'd be all for allowing adults to opt out of having health insurance. But there isn't. If you go to an emergency room and don't pay, the rest of us get stuck with the bill. If you get major surgery done and declare bankruptcy, the rest of us end up eating it. Somehow, we have to deal with those people. Right now, we deal with them by letting it slide and making responsible people cough up the difference.

I had a fun exchange with one of our VPs as I was going over the terms of our exit agreement and what it meant for me to protect company IP. His summary was, "You can't use anything you did or learned here in another job," which is pretty weird phrasing.

Me: But the reason you want me is that I'm an expert in industry X. I've worked here for 10 years, so most of my most current expertise comes from working at this company.
Him: Nothing you learned here.
Me: I'm not talking about taking algorithms and inventions from here and giving them to competitors. I'm saying that "nothing you learned here" is broad phrasing that doesn't really describe what you want.
Him: If you learned it here, it's company IP and you can't use it at a competitor. All of the experience.
Me: So when you hire somebody for your team, you put out a req that says, "5 years experience in industry X." I've seen those.
Him: Right.
Me: So were you doing that to steal IP from other companies?
Him: No.
Me: So if I promise you that I'll only bring to other companies the things that you are taking from other companies in those job postings, we're cool?
Him: [long pause] Yes, that's OK.

Fortunately, I ended up moving to a totally unrelated field, but damn that's a creepy thing to have hanging over your head. "We can't describe what you're not allowed to do, but we'll sue the fuck out of you if you do it."

But what's the actual out of pocket maximum, reasonably speaking? It should be listed on your plan. I mean, being out several thousand dollars is bad, but if we're talking about a catastrophic injury that could potentially cost tens or hundreds of thousands of dollars, it's a pretty good outcome--one that shouldn't financially cripple anybody as long as they eventually get a job again. We'd all love to have zero-deductible free insurance, but it's just not mathematically possible.

The fact that you have to stick with your own insurance rather than dropping onto Medicaid is a function of your state's Medicaid rules. Being unemployed, you may well have qualified for Medicaid in a different state. If your state rejected the Medicaid expansion and that cost you the opportunity to get subsidized care, it would be good to have a chat with your state representatives, because they're sticking it to you intentionally in order to make the ACA look like it's not working.

Should I suffer a debilitating injury now, I will have to choose between lifelong financial destitution or being crippled.

Are you saying that after your $5K deductible is covered, you won't get any coverage from your private in surance? Or that $5K is permanent financial destitution? How does this scenario really play out?

So you aren't eligible for Medicaid? I did you check? The Medicaid rules vary by state, but the Feds did expand Medicaid coverage as part of the ACA. But you may live in a state that rejected the expansion in order to make the ACA more painful for people like you, so YMMV.

Not if you have an expensive preexisting condition.