I think I get what you are asserting now, namely, you are assuming that the excess output entails savings that go strictly to the discounted contractor, rather than being averaged into the product price. Of course, the objection is that in that case, the lower price only exists because of the contract, and therefore there is no clear mandate to average it back into the overall product price. If you didn't make the deal, there would be no savings.
I do not understand why you would deny that the evidence of fitness is, at best, mixed, but it looks like we are not getting anywhere on that. Suffice it to say that there is evidence, whether you consider it conclusive or not, of more efficacious diagnosis and therapies developing over the last 30 years.
In the instance of health insurance, competition mostly occurs at the level of the health plan, rather like other sorts of contracting. When we hire a builder, we use their riveters, there is no competition. Either we are satisfied with their overall organization, or we are not.
I am not sure we can get the best possible care for equivalent prices. I am suggesting that we get better care for the same prices, however, and that even with greater costs, we get so much more that it is still a bigger bang for the buck. This is mainly an impression gleaned from my family's experience in this area, and from some impressive developments in the medical area. |
