TheAgitator.com
Like Loaves and Fishes
Thursday, July 10th, 2008The Left’s approach to health-care cost containment is to give more health coverage to more people with more ailments, all the while making everyone pay less.
And I’m sure it’ll be top-of-the-line care with no wait lists, no rejections for needed procedures, and no health care providers fleeing for freer markets.
Of course the left will celebrate when they ram this though, because though we’ll all then have equally crappy health care, it’s the equal part that’s most important to them.
though we’ll all then have equally crappy health care, it’s the equal part that’s most important to them.
Bingo. Absolute quality matters less than relative quality. This is the same prescription for all areas of cosmic justice.
Being self employed has taught me several lessons.With health insurance I bought a policy that fully covered emergency room services and accidents,and a high,5000.00,fo a non emergency stay.I’ve always paid for drugs from my pocket.
Of course not. But since that’s what we’re currently getting from our corporatist health system, is this really a fair way to compare the two? Neither system has sufficient choices for people due to government regulation.
We already have national health care via the regulatory provision of a market rendered safe for big, bureaucratic businesses. It’s already nationalized, just not in favor of individuals but of big business. All socialized health care does is give us human beings a sort of “bill of rights” in the matter. I have no faith in the government’s ability to provision health care, but I have even less faith in its ability to regulate an oligopoly in anything approaching our interests.
As a longtime libertarian who’s lived in countries with national health care systems, socialized and corporatized health care are not far enough apart in terms of real choice and freedom to tell the difference. So it does no good to draw a distinction where none exists.
But there are useful distinctions to draw; they can be worlds apart in terms of the overall standard of living of the people involved. That was the major point I took away from of Michael Moore’s “Sicko” - of course France’s health care system is more expensive, both in price and in freedom; the question is whether or not it’s worth the price.
We already have socialism in this country; it’s just designed for corporations, not for human beings. Libertarians need to wake up and stop making knee-jerk arguments in these debates, and start offering fresh, anti-establishment, anti-corporate arguments in favor of individual freedom. In other words, we need to give the left a real position instead of constantly deferring to a free market that does not exist and has never existed.
In order to run for political office (or have the name Lou Dobbs) your mind must be completely devoid of any understanding of economics.
Democrats are going to make it work by willing it to happen. It’s their version of a faith based initiative.
I agree with your whole point Jeremy, including this excerpt. Corporatism is Facism though, and is what we’re moving towards. A lot of anti-capitalist rhetoric lately is mistaking this corporatism for capitalism and they think the cure is Socialism.
McCain is a pretty solid Facist in the tradition of the current administration, but for all of Barack’s Socialist promises I think he’ll be a pretty good Facist as well.
Sure. But this is why I see it as unfortunate the Radley just launches on to one side of a debate that is framed from the get-go in false choices that libertarians should reject out of hand. When libertarians defend corporatism instead of attacking corporatism and state socialism on the same grounds, why shouldn’t the Left assume we’re nothing but pot smoking Republicans?
It may not be convenient for those who want to run a D.C. think tank or a hip magazine, but libertarianism is a radical philosophy. When people like Radley present it as status-quo-lite, even as they do good work within that establishment context, they injure the movement we’re trying to build.
I think Jeremy makes a good point. I was thinking about that listening to NPR on the way to work this morning. Free market health care would undoubtedly be better than socialized medicine, but we do not currently have free market health care. We have a partnership between government and the medical industry to extract as much wealth from people as possible by instituting regulations distinctly unfriendly to consumers.
But the answer to that problem is not more government involvement. The answer is to give the existing medical industry a strong healthy dose of the free market. Competition and deregulation would help, but most importantly we need to stop isolating consumers from the cost. You’re never going to control cost as long as consumers are under the illusion that they’re spending someone else’s money.
I don’t know if the current system is socialist, facist, or what, but when I sit writhing in agony for 10 hours at my local hospital, and have to jump through hoops with my primary doctor to get the help I need (and still not get it in the end), that system is broken. Call me whatever names you like, but I’m at least willing to hear what the socialists have to say at this point.
Um, Jeremy, criticizing a socialistic program in a single post does not imply defense of the current corporatist programs as you just asserted.
Jeremy - I agree that most of our health system problems stem from over centralization (and I agree with Krueger that the isolation of consumers from the costs is the major issue)… but what’s your solution? It seems that you’re disagreeing with Radley, so you think that the way to fix a problem caused by nationalization and isolation of costs is more nationalization and more isolation?
I haven’t given it much thought, mostly because I don’t think it’s politically feasible, but the real solution is to move people away from health insurance and make medical care just like any other commodity. If I were king I’d ban health insurance without a really high deductible. Perhaps a gentler way to change things would be to tax the health insurance premiums a corporation makes for its employees.
“If I were king I’d ban health insurance without a really high deductible.”
The biggest part of the problem, though, is not on the consumption side. It is not a problem that people choose to hedge their health care costs.
I am convinced that the health care problem in a non-single-payer system (like the U.S.) is mainly a problem on the supply side - there has been an imposition of artificial scarcity because doctors function as a government-supported (heck, government-mandated) cartel. Smash that cartel, allow freedom in the medical services market, and you will have much, much more health care available than before, at better prices.
Tybalt - Good point. Your ideas pass the libertarian litmus tests, too, unlike my authoritarian ban and tax plans.
There’s nothing inherently wrong with health insurance. It simply suffers from the same problem as the medical industry. Too much regulation. If you force them to accept costs, then be prepared for those costs to be passed along. If you force them to cover high risk consumers, then expect those costs to be passed along as well.
And when the government forces insurance companies to cover people who are already sick, it’s not insurance anymore, it’s welfare. Insurance is something healthy people get to cover a potential future problem. It’s not something you sign up for when you suddenly discover you have a problem. Furthermore, ANY free government health care will undermine a commercial insurance system.
Chance,
That’s a valid point and anyone should sympathize, but the problem is that you still have those things happen in countries that practice the kind of health care the socialists are proposing. They just happen more frequently. And when you get to your doctor, he’ll give you a crappier level of care than you’ll get under the current mess of a system.
The problem here is that when the mainstream is discussing healthcare, they’re committing the fallacy of the excluded middle. The only solutions you’re hearing about are those that involve government intervention…it’s just different forms of intervention from either side (even with the “free marketers” in the GOP). Nobody’s seriously discussing actual free market reform. Fact of the matter is, if we were to leave health care in our country exactly the way it is now and make no changes we’d still be in a better situation than we would if we implement the changes that McCain or Obama seem to want…at least by leaving the status quo intact people will start figuring ways around the roadblocks regulation has created.
Tybalt,
I agree with you about the cartel. Reason did a really interesting piece the other day about the ADA keeping competition out of the marketplace by licensing laws, even in areas where ADA dentists weren’t available.
The reason socialist policy even sees the light of day is that schools (I mean all schools everywhere on the planet) actually teach that socialism is a credible economic system. It’s not. And the evidence is irrefutable.
I haven’t heard a single person with the power to actually effect any change (a congressman, senator, or candidate) even comically discuss free market reform. Perhaps Ron Paul has mentioned it, but health care reform wasn’t really a cornerstone of his campaign.
Krueger - And the reason that schools teach socialism as viable is because most school systems are socialistic by nature, yet they actually work fairly well (compared to other socialist programs, at least) and receive the support of most of the populace.
I agree. Except for the part about them working fairly well. But there’s probably really nothing to compare them to. I don’t think any state allows it’s school system to be completely free market because it’s too useful as a tool of the state.
And it wont work worth a damn in terms of holding down expenditures either. I challenge anyone to find a developed country that has a health care system that isn’t heading for “bankruptcy”.
I haven’t heard any plan for universal healthcare that would preclude people from seeking out private alternatives. If government regulation hurt the industry, did the industry rise up as a whole and ask for reform or did they ride the wave of exponential profit?
I hear plenty of people saying give this a try, or this and wait. It will work. How long should people wait to be covered? How much longer should people wait until they are reasonably assured that the insurance they are paying for is actually going to cover a current or future illness?
In the meantime, you are still going to pay for people to get emergency room care. The uninsured may not get the general care that includes preventive medicine, but they are still going to get at least some care through an emergency room.
It seems to me that a big part of the headache for our current system is that it’s so regulated that it’s already semi-socialist. When you decide your current provider stinks, the average person has to wait to the end of the financial year, then fill out about 50 forms and pay the company that stinks in the meantime.
Since your employer is basically picking out your provider (you simply pick the specific plan - small medium or large), the provider’s main job is to keep you just happy enough that you don’t bitch out your employer. Providers are about as insulated from customer feedback in the form of people voting with their feet as they could possibly be. Socialism would be worse, but the current system has half the problems of pure socialism as it is.
” Free market health care would undoubtedly be better than socialized medicine, but we do not currently have free market health care. ”
Can you give me an example of a free market system that works better on average than any of the major socialized systems around the world. Lacking an example your assertion is a fact not in evidence. As health care has gotten more regulated over the decades the average health and life span of americans has dramatically improved in tandem.
Jeremy, Jeremy, Jeremy.
The U.S. has a mixed system. Part private, part public. To say it is “corpratist” like the government isn’t involved suggests a level of ignorance of this topic.
Oh and France’s system is going bankrupt like ours. Not surprising in that it is like ours, mixed. Part private, part public.
I suggest you do more research on the topic.
Radley hasn’t defended corpratism. That is your interpretation of what he has written. Our system is already heavily influenced by the government and neither party is interested in changing that. The idea of going to more market oriented health care market simply is not being offered by either side. The only difference is that the Democrats are far more open about their desire to take control of this segment of the economy than the Republicans.
Careful there. How is it going to be better for say a family who has a child born with a severe birth defect? It likely wont because such a person will have a pre-existing condition and insurance will simply not be an option. Health care is expensive, and such a family would be clearly made worse off. On the other hand, a yound healthy individual wouldn’t have to subsidize the family with the child above. So you have one group better off, another group worse off. To say a market oriented health care system is “better” is really an empirical question and one that is very, very hard to answer. I think the best one can say is that it is different. At least in terms of care.
The current problem with the way every developed country I know of handles health care is that they have systems that simply are not sustainable. Would a market oriented system be more sustainable? Probably, and in that sense it would be better.
The king is dead…and lets keep it that way.
The above is a horrible idea. High deductible/low premium policies are fantastic…if you are single, young and healthy. If not then they suck. On the other hand if you are married (and have children), are not healthy, or are elderly then having a higher premium but a lower deductible might be a preferable policy. Note that in a market economy those with the high deductible/low premium policies would not subsidize those in the low deductible/high premium segment of the market. A basic result of insurance markets, when competitive, is that sepertation occurs. That is you can’t have an outcome where both types of people are pooled into the same insurance outcome with the healthy subsidizing the unhealthy.
The problem isn’t low deductible/high premium insurance. The problem is more accurately described as problems. As one exmpale, you have the incentive problem with hospitals being required by law to treat people irrespective of ability to pay. As such for a young healthy person with relatively few assets buying health insurance is a suckers game. Further, such people treat the emergency room as their doctor which is far more expensive than going to their regular family doctor.
Then there is the problem with putting more and more health care items into insurance that shouldn’t be insured. A big example is child birth. Child birth isn’t something people like to avoid…at least those who are having kids anyways. They want to have kids, they are trying to get pregnant. Health insurance should be for rare, expensive events. Not expensive events people want to happen. It is like providing car insurance to demolition derby drivers. Same thing with policies that include things like eye-glasses. Glasses are neither expensive nor rare. Similarly for procedures like Lasik. Again, not rare, people are seeking it out and there is a cheaper alternative. All of these stem from the tax preferred status the income people get in terms of health care benefits.
There is no “magic bullet” here. Even fixing the above wont solve the problems. We have a nursing shortage. Why? Because there aren’t enough nursing programs. Why? Good question. The number of doctors is controlled by the AMA. Could something similar be at work with regards to nurses? Yeah, I can imagine rent seeking is a factor. There is no “magic bullet” here. There are just lots and lots of stupid incentive problems that the government has borked up. Yes, often times at the behest of corporations, but also just on their own (Medicare anyone?).
Does Jeremy have a good point? No. Not really. He is woefully ignorant of this issue. This isn’t his fault. Most people are. Me? I’m weird, I actually find this stuff fascinating, but then again I think incentive problems are interesting.
England. You can’t purchase drugs that you need that the National Health system wont provide. If you do, then you are kicked out of the system. Since people in such situations are often quite ill, such an action would be financially ruinous for all but the mega-rich.
Yes, but at the same time all regulated systems are on paths that are not sustainable. Perhaps your observations of better health outcomes and more and more regualtion are coincidence. A case of post hoc ergo propter hoc. You need better reasoning.
There’s a problem. Every job I’ve had requires me to buy low deductible/high premium insurance, even though I’m relatively young. I would have much rather been given that money in salary, but that was never an option.
The free market is not a universal promise of financial wellbeing for everyone. Clearly any system that subsidizes Group A at the expense of Group B (ie: welfare state philosophy) is going to be better for for group A.
The reason is doesn’t work is that everyone wants to be in group A.
Being born with a birth defect is not an automatic entitlement to the income of someone else. Insurance is a voluntary agreement to share risk is not an automatic entitlement.
American health care has dramatically improved in spite of more regulation, not because of it.
Dave,
Exactly. Bobzbob is claiming correlational examples to be causal. Which is ironic since in the same post he blasted all the free marketers for using facts not in evidence
Really, there is an opt-out option at where I work.
I know, but currently such people get treatment and we subsidize it. Changing that will represent a loss for them.
The libertarian argument against socialized medicine really has to be a principle based argument, not a practical outcome based one. The child with the birth defect does not have a right to some of my resources, but I still don’t like to see him just sit there and die. Before committing to one side or the other of this issue, one has to decide whether one cares most about the libertarian principles of private property, or overall good health outcomes for as many people as possible. In the first case it is very easy and obvious to reject socialized medicine. In the second case, however, I don’t think we really know what kind of system is going to produce the best health for the most people with the least wasted resources. As someone else pointed out, we have never seen a functioning free market in modern health care. It may be better in that it will be economically sustainable, but there is no guarantee that it will be better in terms of people actually getting the care they need.
Does opting out increase your paycheck? Does it increase your paycheck by the full amount of your premium cost (minus taxes, of course)?
My first job allowed you to opt out of insurance if and only if you had another source (a spouse, basically) of health insurance, which gets it exactly backwards… it should be the unmarried that are allowed to opt out. And even then they only passed a small percentage of their savings on to you.
And I think you will always lose because the demagoguing politician will hold up that family with the unfortunate child, point out that it if we all pitched in it wouldn’t cost all that much, and why he has a plan that will help solve that families problem. Wont we all feel good about how great our nation is because we can help such unfortunates?
Sort of. I don’t have to pay the part I have to pay, but the balance of the premium my employer paid would not be paid to me.
No, that is part of the problem now. That the young and healthy can opt out of paying but still go in and get treatment and no pay the rather large bill.
There are two problems here. One is moral hazzard, that is when you insure people it changes their behavior to being more risky. Then there is the adverse selection that you get people pretending to be one type when they are actually another (high productivity vs. low productivity). I think both are a problem with our current health care problem. Mind you these aren’t the only problems either.
The pure market solution just isn’t on the table anymore folks. You can argue on prinicple all you want, but when you get right down to it, people don’t want the market approach. You are going to have to deal with that reality when approaching health care and how to reform it.
So far one of the better solutions I’ve seen is revoke the tax preferred status of employer paid benefits, and offer a tax credit or even a voucher (possibly tied to income) that allows people to purchase health care. People can still shop around for the best deal for their voucher so it would inject some level of competition into the market and at the same time limit some of the gold plating and people wouldn’t have to fear being at the mercy of the vaguaries of the market place.
Ironically, Bush offered a tax credit plan similar to the one I noted above and the serious policy people on the right and the left liked it for the most part. Of course, by then Bush was so universally disliked that the plan went precisely nowhere.
There are two problems here. One is moral hazzard, that is when you insure people it changes their behavior to being more risky.
Applying this concept to health insurance is frankly delusional. Nobody needs the threat of medical bills to “discourage” them from getting sick. “Hmm, how can I get the maximum value out of my health insurance? I know, I’ll eat this bulging, frothing can of green beans!”
This is the kind of idiocy that results from thinking of people as the abstractions in an economics textbook instead of as, you know, people.
Zeb –
Remember that the libertarian position does not exclude people helping each other. Libertarian policy would not mandate that we all watch people “just sit there and die”. We can work for, donate to, and advocate charities. The difference is not helping versus not helping, but helping voluntarily versus helping at the point of a gun, and going through private organizations rather than state-run organizations.
“American health care has dramatically improved in spite of more regulation, not because of it.”
Do you have any evidence to support that statement? You are right that correlation doesn’t prove causation, however correlation is evidence of causation and if you are going to claim the opposite of the correlation is true then the burden of proof is on you.
“The libertarian argument against socialized medicine really has to be a principle based argument, not a practical outcome based one.”
This appears to be an admission that libertarian solutions to heatlh care lead to less successful outcomes.
bobzbob,
Actually you’re off on that. That should accurately be phrased “correlation may be evidence of causation”. Claiming that correlation is evidence of causation is making the automatic assumption that they’re linked…when in fact the correlation may be completely coincidental and be evidence of nothing at all.
Sorry…for some reason my italic blocks got screwed up. But I think what I was trying to say should still be clear.
Bobzbob,
I think it’s more a factor of Zeb making a really bad argument that most rational libertarians would instantly disagree with.
Personally I advocate free market reforms because I think they’ll lead to more successful and desirable outcomes, not because I’m more interested in looking like the smartest guy in some philosophical bull session who doesn’t care what the end result of my position is.
And that last remark seriously wasn’t meant as a shot at you or Zeb (although I think it kind of came off that way)…just saying that free market advocates are focused on the practical outcomes. Sorry if it sounded like I was trying to insult you…I wasn’t.
Steve,
Yeah, but at least we can say “we told you so”
Actually, I realize that America is headed down the path to more regulation and more socialism. Our current model has all the bad effects of socialism and none of the good effects of competition. Ideally, if we were smart we’d model it more after the Swiss model. Their model retains private choice and competition, and yet does include help regarding affordability for the indigent. It uses the best aspects of socialism as well as the best aspects of capitalism.
They spend less on healthcare than the US (although slightly more than most fully-socialized European countries). The government spends about 25% of every dollar spent on healthcare, while here in the US the government spends about 50% of every dollar spent on healthcare. Unlike socialized European models, they have high consumer satisfaction as well. It’s a far better system than either single-payer or the current American system.
Brad,
Traitor
So there’s basically no economic benefit in opting out… the money you save by opting out of the high premium, low-deductible employer account is probably not enough to buy disaster insurance on your own. So the choices for the young that work in corporate America are either too much insurance or none.
And there’s the rub… like I said earlier, I don’t give this stuff a lot of thought because the real solution (a free market in health care) is not politically feasible.
This is the same idea I had, but trying to convince anyone to raise taxes on health care is a losing battle. The left will beat you up for making health care less universal, the right for raising corporate taxes, and the libertarians for raising taxes, period.
I just hate that the real solution to health care is less insurance, or at least less “free” insurance, and instead we’re moving inexorably in the opposite direction.
UCrawford,
What I was really trying to say is that I don’t know how relatively good or bad the outcomes of free market versus socialized health care would be since we have not tried a free market in health care. The point about libertarianism is that at a certain point, you have to fess up to the fact that no one really knows for sure that a world governed (as little as possible) by libertarian principles will be a better, nicer place for most people. It comes down to a moral position that some entity cannot use force to remove some of my stuff to do what they think is right for others. This has nothing to do with how well it will all work out, even though I and most of the other regular readers here would like to think that more freedom and less coercion will work for the best.
Zeb,
The economists who form the foundation for much of libertarian thought have made pretty convincing cases for why free markets achieve better results (and why socialism doesn’t) and backed it up with plenty of real-world examples to prove their case. That’s what I try to argue from.
As for the moral argument, moral positions that aren’t designed to achieve desirable outcomes aren’t to my mind particularly moral at all. They’re just bull sessions. That’s why it should always be about what results will be achieved first, not a lecture on morality, especially since “morality” is hardly a univerally agreed-upon concept among all people and cultures. Being “moral” should never be the end goal or the point of the debate, it should always be about what could realistically be achieved in real-world outcomes.
It isn’t just about getting sick, it is about risky behavior as well. Such things as say…skiing. A farily risky sport. How about surfing, snowboarding, etc. If you have insurance you might be less inclined to eschew these activities than if you didn’t. Further, there are health care issues such as child birth. Suppose a couple didn’t have it on their health insurance, might that change their behavior? I think suddenly having to face a cost of $5,000 or more to have a kid might change people’s behavior in regards to crapping out kids.
Don’t be an idiot. This isn’t what is causing the problem. It isn’t merely that sometimes people get sick. It is that there are bad incentives that induce people to use more health care than they otherwise would. It doesn’t mean people are getting frivolous triple by-pass surgeries, it means that they are taking advantage of things like insurance covering child birth, Lasik, fertility treatements, and even smaller dollar items, but which are common and in aggregate can be expensive.
I find littel reassurance in that when I read about stories coming from England about mandantory wait times for even painful conditions upto 30 days and beyond.
I’m talking about people who wouldn’t buy insurance to begin with. If you don’t have much in the way of assets, and are reasonably healthy, then yes there is a benefit.
Depends on things like public goods, positive and negative externalities, and informational asymmetries. All of these things are usually seen as diminishing the welfare enhancing aspects of a market economy.
Libertarianism is, by definition, a set of principles applicable to almost all aspects of governance. Just because you’ve managed to identify a case where someone fares worse under a libertarian solution than they might under some other plan doesn’t make it an inferior alternative. There is no such thing as a perfect plan where everyone walks away perfectly satisfied.
As long as the only acceptable answer to the health care issue must promise unlimited health care on demand to everyone who wants it, all solutions are doomed to failure. In other words, the first step in solving this problem is admitting that someone is going to have to put some restrictions on demand. Libertarians believe that the free market is fairest way to conserve any limited resource.
Universal health care is not a human right anymore than a forty-hour work week or a new car. I would much rather Congress concentrate on securing the rights defined by the Constitution than making up new ones.
UC,
Which would suggest that you’re a utilitarian who believes that liberty tends to maximize utility. Libertarianism, on the other hand is fundamentally a moral system.
Both types of arguments hold sway, for various reasons. One could argue that enslaving 1% of the population would maximize the utility of the world (in fact, Democrats make that argument all the time, by choosing the top 1%). That wouldn’t make it *morally right*, from a libertarian POV. One could also make the argument that liberty maximizes utility, which is what you’re doing (and which is often very persuasive).
#47 UCrawford:
It’s a mistake to think that you can somehow divorce results-based thinking (”desirable outcomes”) from the realm of moral judgment. People generally determine what outcomes are desirable through some appeal to moral reasoning, whether they are aware of it are not. Most of the people who advocate for universal health care and compulsory health insurance are preoccupied with a belief in the virtue of some form of distributive justice. To suggest that an “economic” measure of “better results” (say: greater efficiency in the sense of matching medical services to those who are willing and able to pay the most for them) is better than a distributive justice measure of “better results” (say: all people with equivalent medical needs having those needs satisfied to roughly equal level given the scarcity of resources available to all) is itself a moral judgment. The desirability of outcomes is simply not value-neutral.
Steve,
Entirely true. I used to ride a motorcycle, and would do track days, where you take the bike to a racetrack and get the opportunity to ride it at its limits.
I had employer-sponsored health insurance, so I didn’t get injury coverage on the motorcycle policy. And if had no employer coverage, I wouldn’t have ridden on the track at all (because my insurance wouldn’t have been valid there). If I had no employer plan, very little money and thus couldn’t afford injury insurance on the motorcycle plan, I probably wouldn’t have ridden a motorcycle at all.
As it was, I rode the bike, on the racetrack, slightly exceeded its limits, and crashed it. And when I needed to get my knee tested for ligament damage (only a sprain, thank god!) I got to go to a nice sports medicine doctor for a tiny $10 co-pay.
Incentives matter!
If the cost of breast implants were covered by government, not only would a lot more women have them, but they would be outrageously expensive.
Instead, they are being given as high school graduation gifts by average people. That’s the power of the free market.
Brad,
There’s probably some truth in that, since I’m a minarchist and do believe that limited government is necessary (thereby supporting a little bit of slavery). In fact, if you dig down I suppose that all minarchists are utilitarians to some degree. If I were operating from a purely libertarian perspective, I’d probably be an anarcho-capitalist. But there really haven’t been too many arguments I’ve made where I thought anti-liberty actions would achieve more desirable results than pro-liberty ones so I’m only slightly immoral
Also, whenever I’ve seen somebody claim that an anti-liberty position increases utility for everyone, it’s only because that person’s done such a poor job of looking at the long-term implications of what they’re proposing and it’s usually pretty easy to figure out where they’re wrong. Short-term solutions that screw us down the road don’t count as desirable results for me.
But I do hold to the perspective that any solutions I propose should be applied to all and not specific collective groups (like the Dems do with the “rich”).
jjhays,
You’re right, and I don’t think I explained myself very well. Obviously, I believe in some version of morality to guide my decisions. My main point is that if you’re looking to sell your position to someone who doesn’t yet believe in your morality, then it’s a better idea to focus your sales pitch around what the results of what you’re proposing will yield rather than beating him over the head with a “But it’s what’s moral!!!” lecture. Persuasion over preaching I guess is what I’m saying.
But I see what you’re saying about not being able to divorce the two and you’re right.
Steve,
Unless you’ve got a heart condition. Then the wait to see a cardiologist in the NHS for your initial consult is around 6 months. After which they might start treating you.
And to the REPUBLIC, for which it stands, one nation under God (added by Congress in the 1950s I think), indivisible (just ask Lincoln with his Constitution suspension, mass murder of states wanting to seceed), with LIBERTY and JUSTICE for all.
Essentially the Pledge of Allegiance (obedience to the state and country) is meaningless rhetoric. When did we truly have a republic? How often is liberty and justice applied fairly and consistently?
I like mexico’s system. Almost all drugs are available over the counter. This doesn’t included narcotics (but it should). Most of the time you don’t really need a doctor, you need a drug. This way you only go to a doctor if you don’t know what is wrong with you or need surgery or scans. How many times have you have to go to the doctor just to get antibiotics etc.?
It isn’t just about getting sick, it is about risky behavior as well. Such things as say…skiing. A farily risky sport. How about surfing, snowboarding, etc. If you have insurance you might be less inclined to eschew these activities than if you didn’t.
I’m going to let my man John Holbo answer this:
Further, there are health care issues such as child birth. Suppose a couple didn’t have it on their health insurance, might that change their behavior?
Given the number of children around the world who are born into absolute poverty, I think the answer is “no, not at all”. It’s human nature to have children in defiance of economics.
I think suddenly having to face a cost of $5,000 or more to have a kid might change people’s behavior in regards to crapping out kids.
That’s nice, Steve. I suggest you call your mother and thank her for crapping you out.
Have you considered that your hatred for everyone who’s not you might bias your reasoning?
The British model is the worst example possible. It is the very definition of socialist service; slow, cloistered, ineffective and expensive. But there are socialized systems that work better, like those in France or Germany, so it would probably be better to look at the successes rather than the failures if this is what we’re gonna get. Those countries emphasize prevention and diet, which seems to be a good cheap way to raise the general health level of the population.
By the way, +1 on the Swiss system, but it would require something akin to an armed incursion to convince big pharma and big insurance to become not-for-profit, which is a big lynch pin of that system.
What makes you think that these things are commonly covered?
I worled for a major health insurer for 20 years, up until 2002. Fertility treatments weren’t covered unless mandated by state law (& that’s a whole ‘nother can of worms). The increasing popularity of LASIK procedures made it a sudden huge money-loser & coverage was accordingly dropped. There were always stringent limitations on how much they’d pay for childbirth expenses.
As far as our current system is market-based, insurers are not going to give money away.
You guys have entirely blown off responding for my request for evidence that a free market system would be better. Instead you quibble about causation vs. correlation. Please provide evidence of a free market system that is more effective than the best socialized systems.
BTW, we HAVE tried a free market system in this country, however we moved away from it quite dramatically- because it didn’t seem to be working.
WTFAYTA?
I’m not suggesting we make anyone behave in any particular way. What I’m saying is that incentives goddamned matter. You and this idiot Holbo can ignore this if you want, but…well its just stupid. Seriously, did you really read my comments as saying that I’m opposed to a market based solution?
Yeah, which is precisely why as incomes rise, the ability to save (i.e. transfer consumption across time) increases, and so forth child births drop…like a rock. There is a reason why in developed nations you see birth rates by natives (i.e. people who have lived their whole lives there) at below replacement levels. Why women have children later in life or even not at all. Nope no economics here. Here is an idea…in poor countries it is because of poverty that the people there have more children, not less.
Nope child bearing isn’t a rational decision at all, why it is just an instinctual drive that forces humans to rut like wild animals and crap out kids. We have zero self-control in this area.
I only hate stupidity and the denial of reality.
So why are you asking us to give you an answer you already know?
Further, I doubt your assertion that we moved away from a private system to a more socialized system simply because it wasn’t working. I’m thinking Bravo Sierra on that one. For example, the reason health care is provided by employers and recieves a tax preferred status wasn’t because the private market for health care wasn’t working, but that firms during WWII wanted to offer incentives to prospective new employees and with the government mandated wage controls they couldn’t do it the obvious way via pay, so they lobbied for the health care benefit exemption.
Kind of shoots that corpratist rhetoric right in the foot too. After all, corporations are now reeling under rising health care costs and looking desperately for ways to get out from under them.
The data in this Cato report indicates that there were some impressive gains in health care results early on in the century and that they have actually flattened out in the last half of the century. Now, I’m not saying the flattening out is due to socialized medicine, could be simply the case of picking the “low hanging fruit”. But this idea that things weren’t working strikes me as inaccurate.
Oh, and they aren’t working too swell right now either. You look at places like France, England, the U.S. and Canada and you see the same thing to varying degrees: health care systems that are financially unsustainable.
Sigh… you’re not reading my posts at all. I’ve had several jobs where I health insurance is almost free and canceling it does not increase my paycheck. Therefore there would be no economic benefit to rejecting the insurance program. I think many young people who work in middle class careers at large corporations are stuck in the same situation… they’re basically forced to buy insurance they don’t need.
If the company would give me that money in salary I probably would have carried only high deductible/low premium insurance throughout my twenties. But that wasn’t an option.
I’m not sure how much more clear I can be here.
The move away from free market medicine had nothing to do with our health care system not working. During WWII the government subjected corporations to a wage freeze, right when we had a labor shortage because the most desirable workers were drafted into the military. So companies, in an attempt to attract workers without raising salaries, started to offer benefits like medical and dental insurance. Before that most people paid out of pocket for medical care.
No one is answering your question about how a modern free market health care system would look because we just don’t know. It’s never been tried, so quit acting all superior because we’re “dodging” your question.
Li saith: By the way, +1 on the Swiss system, but it would require something akin to an armed incursion to convince big pharma and big insurance to become not-for-profit, which is a big lynch pin of that system.
Out of curiousity, how much original pharmaceutical research is coming out of Switzerland?
It shouldn’t be forgotten that in the late 19th and early 20th centuries, many working class people received cheap access to medical services through “Lodge Practice Contracts” offered by their Fraternal organizations. The medical profession worked itself into a tizzy over the cheap rates that the Fraternal organizations were negotiating for their members, and thanks to the Government’s grant of licensing power to State medical Associations, doctors who serviced Lodge Practice Contracts were often stripped of their licenses to practice. As the medical profession became cartelized under the AMA, the licensing procedures for Doctors became more time consuming and prohibitively expensive, screwing the poor on the supply side once again.
http://libertariannation.org/a/f12l3.html
There are surprisingly few comments about charity here. Back in the days before poverty became a growth industry, the poor were largely helped by charitable organizations, churches, and families.
Health insurance is heavily regulated, right down to the premiums that insurers can charge, & since most regulation is at the state level, every insurer has to file 52 massive sets of paperwork every year.
You also have 52 separate sets of mandated benefits - e.g., insurers have to cover 100% of charges for treatment of phenylketonuria in Minnesota.
The result is a massive bureaucracy within the health insurance industry that exists solely to interact with state governments & the obvious multiplication of effort that goes with that.
A national health insurance program would at least offer some economies of scale. In any event, we don’t have anything approaching a true free-market industry today.
As much as is comning out of the U.S. Have you heard of Roche or Novartis?
For more details, click here.
Yes, our non-free-market health care system is failing, so let’s make it even less free!
“No one is answering your question about how a modern free market health care system would look because we just don’t know. ”
Thank you for the honest admission. That it would be better was made as a positive assertion above.
Moving to employer provided healthcare is not the same thing as moving to a regulated system. The employers at the time were just buying the insurance on the free market. So I don’t think your statement is germaine.
I would like to know why you think virtually all industrialized nations moved from free market to regulated/socialized system in the last century or so.
And don’t make a positive statement if the real answer is “don’t know” - or I do get complain.
“There are surprisingly few comments about charity here. Back in the days before poverty became a growth industry, the poor were largely helped by charitable organizations, churches, and families.”
Yes, and they also the poor largely died from illness at much higher rates than wealthier people.
Moving to employer provided insurance under government fiat with a tax break is a step towards a regulated system.
Several reasons. Health care is one of those things (like education) that everyone thinks should be free and equally provided. Doctors require years of schooling, and a simple mistake on their part can end someone’s life, so it’s easy to justify government regulation/control of their jobs. Ditto for drug regulation. Finally, most of the countries with fully nationalized health care don’t do much (compared to the US) drug and medical research so it doesn’t cause as much harm to remove the profit from medicine.
It would be a disaster to further regulate or nationalize the American health care system.
“Finally, most of the countries with fully nationalized health care don’t do much (compared to the US) drug and medical research so it doesn’t cause as much harm to remove the profit from medicine.”
Except that private companies only contribute about 29% of total research funding, and the vast majority of that is for final stage clinical trial work. Virtually all the basic work is publicly funded. So the “profit from medicine” is a small factor in medical research.
“It would be a disaster to further regulate or nationalize the American health care system.”
Do you have any evidence to support that statement?
The government fucks up everything it touches. As “evidence to support that statement” I offer everything the government has ever touched.
By the way, if anyone wonders how the government will finance universal health care, the answer is simple. They will do it the same way they’ve financed all of their welfare state nightmares. They’ll just charge it to the account of future generations. You want evidence? Just have a gander at the current public debt. At the moment it’s $9,493,175,590,922.86
I’d be glad to discuss government solutions with anyone who writes a check that takes that to zero.
If it is almost free, then you are paying something. Now maybe in your specific case there was little gain, but where I work a young, reasonably healthy employee, would see some extra money in his/her paycheck every two weeks. You can’t make policy recommendations because Matt Moore sees little impact to just Matt Moore.
You are perfectly clear, what you are failing to realize is that some might decide to carry no insurance at all and keep the money they’d otherwise spend through their company provided health care plan.
Regarding a “free” market for health care:
The market was also less free with the advent of the AMA and its attempts to restrict entry into the market. This raises prices and its impact on quality is dubious at best. Further, various laws and rules prevent people from going to health care providers other than doctors. That is suppose there is a person who can’t afford to go to the doctor, but could afford to see a nurse if the problem isn’t that severe. This option is precluded and instead they are forced to go to the emergency room when the condition gets really bad. That is the most expensive option there is.
I agree that a free market is not going to result in money growing from trees, everyone becoming beautiful, and cats and dogs living together. However, there is a problem with the sustainability of health care schemes that rely too much on the public sector.
Gammon’s Law. In government regulated institutions the as inputs increase output decreases.
Linky
No, I do realize that. I just don’t have a problem with it.
If my employer is willing to buy me 600 dollars of insurance a month, and they only charge me 40, I’d be a fool to turn that down. I tend to think people, even young people, are not fools.
I agree totally with all your AMA talk, btw. Interesting info, too… are there any decent books on the history of managed health care?
Li,
The Swiss system isn’t not-for-profit. The “base” insurance, mandated for all, is not-for-profit, and the supplemental insurance is for-profit.
More here:
“How does it work? The Swiss example shows that universal coverage is possible, even in a highly capitalist nation with powerful insurance and pharmaceutical industries. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. They can make money on supplemental insurance, however. As in Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government.
What are the concerns? The Swiss system is the second most expensive in the world — but it’s still far cheaper than U.S. health care. Drug prices are still slightly higher than in other European nations, and even then the discounts may be subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. In general, the Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.”
Is it ideal? No (in my humble opinion, a free market is ideal).
But it’s a damned sight better than single-payer, and most of the system allows for profit. Again, it’s a mix of socialized and free market aspects to medicine, that seek to limit the socialized portions as much as possible (while still offering universal coverage).
Free-market economics. Without a market there is no way to assign the correct value to a good, so we end up paying too much or too little for everything and supply never equals demand.
There’s a joke about what would have happened if Communism had succeeded in taking over the world. All the countries in the world are now socialist, with the exception of Japan, which still has completely free markets. Why’d leave one country alone? Because otherwise they wouldn’t no what things should cost.
[...] appeal on social issues, is its apparent fuck-you approach to issues of poverty. Here’s Radley Balko on heath care: Of course the left will celebrate when they ram this though, because though we’ll all then have [...]
Steve Verndon, you’ve probably moved on, which means I get the last word! Yay!
Anyway, corporatist in this day and age usually means rule by corporations in collusion with government. Part private, part public. That’s *precisely* what I meant by corporatism. France may indeed have a corporatist system, but it leans more in the direction of public control via the state rather than of private control via the state.
In fact, there IS no such thing as a corporation without government; they are legal fictions chartered by state fiat. To see corporations as mechanisms of the “free market” is a bit of a contradiction on its face. But, I don’t want to blow the Catoids minds all in one fell swoop.
I may be ignorant of the nuanced particulars of health care policy; granted. All I’m saying is that it’s my opinion that, if I have to choose between a socialized system that favors private business interests and a socialized system that favors political power, I’ll at least go with the one that gives me a tiny say every four years over the one that gives me no say whatsoever. In fact, this has nothing to do with health care qua health care, really, but health care as a proxy for politics.
I prefer a free market, free of gov’t intervention of all sorts. Absent that, I have secondary preferences. They are just preferences. But to say that this is a choice between the free market and socialism is wrong. That’s why I criticize Radley even though I greatly admire the work he does.
Matt Moore: my solution is anarchism; getting privilege out of the equation and letting people deal amongst themselves as they will. If I have to deal with some sort of regulatory apparatus and a genuine free market is off the table, I’ll take the one that favors me as a human being over me as a customer. But that’s just my preference.