You assume that universal coverage would expand demand. This was true when people went from no coverage to Medicaid. For a year and a half . Then their utilization normalized. Your assumption that demand needs to be controlled should be questioned. Most people don’t want to go to the doctor. The medical and pharmaceutical industries work hard to push demand.
If the pharmaceutical and medical industries offered quality appropriate care, demand would be about what it is now. The scarcity of access drives demand for a while. That’s the reason universal coverage makes sense.
I don’t agree. Healthcare has nearly infinite demand. There are two large randomized trials that showed this.
It’s not that people enjoy going to the doctor but they make appointments and no show, or have low value appointments. This happens in medicaid all the time.
I would appreciate any reference to "randomized controlled trials". I suspect you are referring to the natural experiment Oregon did with Medicaid expansion and how they saw a bump in demand for services/ utilization the first year of enrollment. But it flattened off after. So please, enlighten me.
No — his point is simply that when a good is free at the point of service, quantity demanded rises. That’s not controversial; it’s the basic implication of downward‑sloping demand curves. His food analogy illustrates this plainly. In healthcare, third‑party payer systems manage this by rationing through mechanisms other than price. The author’s argument is that the cruder the rationing mechanism, the lower the administrative cost — but also the worse the outcomes. In other words, reducing administrative overhead has real tradeoffs.
Your counterexample doesn’t land because you treat Medicaid’s relatively stable utilization rates as evidence that rationing isn’t necessary. But Medicaid is a heavily rationed system. The question isn’t whether Medicaid recipients would consume more care if it were free and unrationed — of course they would. That’s precisely why Medicaid imposes rationing in the first place.
You assume that universal coverage would expand demand. This was true when people went from no coverage to Medicaid. For a year and a half . Then their utilization normalized. Your assumption that demand needs to be controlled should be questioned. Most people don’t want to go to the doctor. The medical and pharmaceutical industries work hard to push demand.
If the pharmaceutical and medical industries offered quality appropriate care, demand would be about what it is now. The scarcity of access drives demand for a while. That’s the reason universal coverage makes sense.
I don’t agree. Healthcare has nearly infinite demand. There are two large randomized trials that showed this.
It’s not that people enjoy going to the doctor but they make appointments and no show, or have low value appointments. This happens in medicaid all the time.
I would appreciate any reference to "randomized controlled trials". I suspect you are referring to the natural experiment Oregon did with Medicaid expansion and how they saw a bump in demand for services/ utilization the first year of enrollment. But it flattened off after. So please, enlighten me.
In the mean time, there's this:https://pmc.ncbi.nlm.nih.gov/articles/PMC1127687/
No — his point is simply that when a good is free at the point of service, quantity demanded rises. That’s not controversial; it’s the basic implication of downward‑sloping demand curves. His food analogy illustrates this plainly. In healthcare, third‑party payer systems manage this by rationing through mechanisms other than price. The author’s argument is that the cruder the rationing mechanism, the lower the administrative cost — but also the worse the outcomes. In other words, reducing administrative overhead has real tradeoffs.
Your counterexample doesn’t land because you treat Medicaid’s relatively stable utilization rates as evidence that rationing isn’t necessary. But Medicaid is a heavily rationed system. The question isn’t whether Medicaid recipients would consume more care if it were free and unrationed — of course they would. That’s precisely why Medicaid imposes rationing in the first place.
Extremely well put