Thursday, March 16, 2017

iPhones versus health care

This is Joseph.

There was a recent comment to the Jason Chaffetz's comments that people might allocate resources to health care instead of iPhones.  This is such a huge admission of ignorance as to how expensive the United States health care system is that it is hard to know where to start.

For example, Duncan Black argues that smart phones are actually a pretty major part of basic needs in modern America:
A new phone high end phone costs 500-800 bucks. If I could buy health insurance (Real, not bullshit) for my family for that I'd happily give up my new phone. Of course, the two years ago high end model phone costs $200. The somewhat shittier and not quite latest and greatest can probably be had for 50 bucks. Your older brother can probably give you a handmedown for free. So, phones are not really that expensive (service is in the US because of our shitty noncompetitive market and lax regulation, go to Yurp and pay 20 bucks per month max). Also they're the only way lots of people have regular internet access, so they're pretty much necessary. Smartphones are not luxury items, they're required. 
I like this take because it weaves in a second piece to the puzzle -- monthly service costs are high in the United States.  The more marginally housing somebody is, the less they can afford to have things like land-line telephones (that come with expensive connection charges that presume people are not mobile).  If you needed one item to connect to the outside world, the thing that can act as a phone, gives you a stable phone number, allows you to send texts, and allows you to interface with the internet solves a lot of problems all by itself.  And when you consider used phones then the comparison gets even sillier.

But there is another piece to this puzzle.  Health care costs in the United States are opaque, literally to the point that I couldn't imagine a way to parody them.  Look at this video from Vox (youtube here).  At the end of the process of trying to find out how much it would cost to give birth in a hospital (any hospital), spending hours on the phone trying to get this price quote, the final bill was off by a factor of two.  So you can't realistically price shop in the United States for a foreseeable medical expense (let alone an emergency room visit).

It's not really a case of putting "skin in the game".  People often can only find out prices after the service has been provided -- especially since the system is filled with all sorts of little details that are difficult to estimate ahead of time (how many $50 ibuprofen will you need and is there is a reason you can't bring your own supply?).

There is an important conversation about providing health care in the United States.  But it centers around comparative costs, pricing transparency, the inflexibility of moving with current employer sponsored health care, and how to handle people with economic insufficiency.  It's not an accident that "single payer" style systems are brought up a lot -- they directly attack all of the major problems.  Maybe not the only solution, but trading in smart phones isn't looking like a good deal either.

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