INTRO --- Priceless: Curing the Healthcare Crisis (Independent Studies in Political Economy) by John C. Goodman

IntroductionRead more at location 167

Note: 1@@@@@@@@@@@@@@@@ eliminare i prezzi ha conseguenze inatese. ROMPERE L OLIGOPOLIO E L ACCORDO STATO ASSICURAZIONI. REINTRODURRE I PREZZI E LA CONCORRENZA. Edit

Other markets in our economy are also examples of complex systems, but healthcare is many times more complex than a normal market. The reason: in addition to garden-variety economic forces, the medical marketplace is institutionalized, bureaucratized, and extensively regulated.Read more at location 173

Note: SANITÀ INCASINATA Edit

Doctors are heavily influenced by medical ethics and traditional ways of doing things. Almost everything they do is affected by third-party payer bureaucraciesRead more at location 175

Note: INCENTIVI DEI DOTTORI Edit

To make matters even more complicated, we have completely suppressed normal market processes in healthcare—in this country and all over the developed world. As a result, in healthcare few people ever see a real price for anything.Read more at location 178

Note: PREZZI? Edit

On the supply side, doctors and hospitals are rarely paid real prices for the services they render. Instead, they are paid on the basis of reimbursement formulas.Read more at location 182

Note: FORMULE E NN PREZZI Edit

An interesting characteristic of complex systems is that when you perturb them (by passing a law, for example), there are always unintended consequences.Read more at location 187

Note: NIENTE PREZZI NIENTE AGGIUSTAMENTI Edit

if patients have no out-of-pocket costs their economic incentive will be to overuse the system,Read more at location 192

Note: INCENTIVO: USA E SPRECA Edit

Also, if patients are not paying money for the services they receive, they're not likely to shop aroundRead more at location 193

Note: INCENTIVO: INDIFFERENZA X IL MIGLIORE Edit

Well-intentioned public policies designed to make healthcare affordable for individuals, therefore, have had the surprising effect of causing healthcare spending to become unaffordable for the nation as a whole.Read more at location 196

Note: SORPRESA: TUTELARE POCHI RENDE TUTTO PIÙ COSTOSO Edit

Another well-intentioned public policy initiative—adopted by some states—is to try to make health insurance affordable for people with pre-existing conditions by requiring insurers to charge the same premium to all buyers, regardless of health status. Yet, this legislation has the unintended consequence of encouraging people to remain uninsured until they get sick.Read more at location 201

Note: STESSO PREMIO X TUTTI: PREMIO MEDIO PIÙ ALTO Edit

Yet MIT professor Amy Finkelstein has discovered that the passage of Medicare had no effect on the health of the elderly—at least as measured by mortality—but the additional spending set off a bout of healthcare inflation for all patients—one that never subsided.Read more at location 210

Note: SPENDERE IL DOPPO X MORIRE PRIMA Edit

In other markets, producers don't compete only on price. They compete on quality as well. In healthcare, however, it appears that when providers don't compete on price, they often don't compete on quality either.Read more at location 222

Note: COMPETIZIONE X LA QUALITÀ Edit

How We Are TrappedRead more at location 230

Note: TITOLO Edit

Perverse incentives are faced by everyone: patients, doctors, nurses, hospital administrators, employees, employers, and so on.Read more at location 232

Note: INCENTIVI PERVERSI Edit

The conventional view is that we have too much freedom, not too little.Read more at location 238

Note: ORTODOSSIA Edit

Getting Out of the Trap: Emerging EntrepreneursRead more at location 250

Note: TITOLO Edit

Where is healthcare's equivalent of a Bill Gates or a Steve Jobs? The answer: There are literally thousands of entrepreneurs in healthcare.Read more at location 256

Note: GLI INNOVATORI Edit

insurance companies, employers, and government. These are the three entities that pay most of the healthcare bills. They are the third-party payers.Read more at location 260

Note: I PAGATORI Edit

With respect to healthcare, they tend to be bureaucratic, wedded to tradition, and resistant to change.Read more at location 261

Note: POTERI FORTI Edit

Getting Out of the Trap: Overcoming Unwise PoliciesRead more at location 302

Note: TITOLO SOLUZIONI Edit

Getting Out of the Trap: Emerging MarketsRead more at location 321

Note: TITOLO SOLUZIONI Edit

PREFA Priceless: Curing the Healthcare Crisis (Independent Studies in Political Economy) by John C. Goodman

Priceless: Curing the Healthcare Crisis (Independent Studies in Political Economy) by John C. Goodman

You have 122 highlighted passages

You have 114 notes

Last annotated on June 20, 2016

ContentsRead more at location 23

Note: Ricetta: far pagare il consumatore. 1) formazione di conti risparmio sanitario e franchigie elevate 2) il paziente: 1. paga attingendo all' conto 2. esaurito il conto tira fuori il contante e 3. superate le franchigie (alte) interviene l' assicurazione. Goodman non tiene conto di 1. Arrow, asimmetria informativa (+ protezione x il consumatore) 2. Stiglitz, selezione avversa (obbligo assicurativo) 3. Hanson, remore psicologiche (vogliamo che siano altri a pagare x illuderci della benevolenza dei dottori) Risposte possibili: 1: esiste un market failure + consistente che bilancia l' asimmetria: il visto/non vist (la competizione dà benefici diffusi mentre l' errore medico è concentrato 2: le evidenze smentiscono: i + sani sono i + inclini ad assicurarsi (causa carattere scrupoloso) 3: lotta al signalling Edit

Preface     An Intellectual OdysseyRead more at location 48

Note: PRE@@@@@@@@@@@§§§ SENZA PREZZI SI FA PICA STRADA Edit

Note: Necessità che il paziente spenda i suoi soldi (risparmiati forzatamente in un fondo). Anche l' offerta si liberera Costi d' agenzia: 3 pay non funziona I disaccordi non riguardano i fatti ma le opinioni: c' è gente che nn tollera che la salute abbia un prezzo Edit

managed careRead more at location 51

Add a note

Hillary Clinton's healthcare reform plan went down to inglorious defeat. What they probably will neglect to say is that a very similar proposal had the support of most Senate Republicans at the time.Read more at location 55

Note: FALLIMENTO CLINTON Edit

The Clinton health reform failed because of White House ineptitude and grass roots resistance.Read more at location 57

Add a note

Patient Power was on freeing the patient. A good part of the book was devoted to the idea that when people are spending their own money they behave very differently than when they are spending other people's money.Read more at location 68

Note: PATIENT POWER Edit

What I didn't anticipate was that the changes on the supply side of the market would be far more profoundRead more at location 70

Note: IL LATO DELL OFFERTA Edit

When patients aren't spending their own money, there is no way doctors can compete for their patronage based on price. When they don't compete on price, they don't compete on quality either. The services they offer will be only those services the third parties pay for and only in settings and ways the third parties have blessed.Read more at location 74

Note: THIRD PARTY Edit

Who do you think is going to be more creative about meeting unmet needs? Executives at a handful of insurance companies? Or 800,000 doctors dealing with real patients day in and day out?Read more at location 77

Note: E LA CREATIVITÁ? Edit

The orthodox view is that doctors are the problem. They have too much freedom, we are told. They need to be constrained and told what to do.Read more at location 80

Note: ORTODOSSIA: IL PROBLEMA SONO I DOTTORI Edit

What we need is a system in which the provider side of the market competes to provide value because it is in their self-interest to attract patients in that way. We will never solve America's healthcare crisis from the buyer side of the market. It can only be solved from the provider side.Read more at location 84

Note: LA PROPOSTA Edit

The second thing I missed the last time around was the importance of prices. The single worst public policy decision in all of heath care was the decision to eliminate money prices from the market for medical care. Have you ever wondered why the panhandler on the street corner has a cell phone, but no access to primary care? It's because he can buy a cell phone in a real marketplace, but he can't buy healthcare that way.Read more at location 87

Note: IMPORTANZA DEL PREZZO E DELLE FRANCHIGIE INDIVIDUALI Edit

enrolling children in the Children's Health Insurance Program (CHIP: essentially, Medicaid for children) does not result in their receiving more medical care.Read more at location 91

Note: ISCRITTI O NJ ISCRITTI LE CURE SONO LE STESSE Edit

The third thing I failed to fully appreciate in the earlier book is the second biggest mistake in all of health policy: making it illegal for insurers to charge premiums that reflect real risks.Read more at location 101

Note: RISCHI REALI E INDAGINE Edit

This means that insurers have an economic self-interest in avoiding people with health problems and in failing to encourage them to seek optimal treatment once they do enroll.Read more at location 104

Note: INEVITABILI ESCLUSIONI MA MAGGIORE CHIAREZZA Edit

In a normal market, prices convey information. A high price tells innovators and entrepreneurs the market places a high value on getting a problem solved. It communicates that the reward for finding a solution could be high as well. When the price system is artificially suppressed, that information does not get communicated. Almost all of our problems in health policy stem from this central fact.Read more at location 122

Note: PREZZI E INNOVAZIONE Edit

Yet through the years I have discovered that the most important differences people have over health policy have little to do with facts, reasoning or logical argument. The most important differences stem from differences in fundamental world views. There are a very large number of people in this field who find the price system distasteful—at least for medical care.Read more at location 126

Note: IDEOLOGIA ANTI PREZZO Edit

For well intentioned reasons perhaps, they are emotionally predisposed to favor the suppression of normal market processes.Read more at location 133

Note: BUONE INTENZIONI Edit