This scenario exists only in progressive and HNers heads. Companies make money and Capitalism works by offering more services not fewer. Are there companies that does short-term thinking? Yes. But overall, our standard of living and quality of services has always improved
> relies on a true free market, which healthcare definitely isn't.
I think this is the part that people miss the most. When a purchasing decision is made based on something like "who has the best quality shoes in price range X", competition can occur.
When the buying decision is "will I live or die", there's not really any choice made there. Couple that with the complete lack of transparency for how much a give procedure will cost, and you've strayed so far away from a free market that it's not even recognizable.
I mean, even the hospital can't even remotely accurately tell you how much something will cost before you actually get a bill...
>Any better than 'good enough' isn't rational and the people running that company should be fired.
This is kind of the reason the Japanese economy is stagnant and continues to fail in winning global marketshare. Businesses that are too good will fail or at least not compete with businesses that settle for being good enough.
> If a company has an opportunity to make money, they will. Any better than 'good enough' isn't rational and the people running that company should be fired.
...where "good enough" is relative to a particular level of quality and price point, of course. Otherwise there wouldn't be different markets for rich and poor people. And this mechanic helps avoid a "collapse into mediocrity" that you'd otherwise get if all goods and services were offered at a single price point.
The real problem is what you identified at the end, that healthcare isn't anything like a free market. There's no buyer mobility, no transparency as to the level of the service you're getting - heck, you don't even know how much you're going to pay in advance, unlike almost every other industry.
IME anything that looks vaguely like a cost center often has something vaguely resembling an acceptable service/quality level and people typically aim to achieve that with the lowest cost. It’s not at all uncommon to cut budgets/headcount when that goal is exceeded noticeably.
That was a rational capitalist argument. If a company has an opportunity to make money, they will. Any better than 'good enough' isn't rational and the people running that company should be fired. In the long term the entire industry will slowly adopt this and the standard of care may rise slightly as these gains are used for competitive advantage instead of pure profit but that will take a while at best and relies on a true free market, which healthcare definitely isn't.