A Lesson from Passport Control

by Don Boudreaux on July 29, 2007

in Health, Myths and Fallacies, Reality Is Not Optional

Late Friday evening, Karol and I flew, on Delta Airlines, from Bucharest to New York’s JFK airport.  We had two hours to connect to our Delta flight to Washington’s Dulles airport.  We missed our flight.  And herein lies a lesson.

The reason we missed our flight is that nearly 50 minutes of our time after landing was consumed by waiting in a long and slow-moving line to clear passport control.  At that terminal on Friday evening, the TSA had only three agents to service the line of U.S. citizens returning from abroad.  Three.  That’s it.  Most of the passport-control-agent booths stood empty.

So as we silently fumed and inched forward in line, I couldn’t help but wonder why so many people want the same agency that cannot adequately staff one of the country’s busiest international airports (during the height of international-travel season) to run Americans’ health-care.  If government were to take over more completely the supply of medical services in the U.S., the same sorts of under-staffing (i.e., shortages of service) would occur.

In light of my recent experience — which isn’t unusual — at JFK, can anyone give me a plausible reason why I should be optimistic that government would adequately staff (and maintain – remember Walter Reed!) its hospitals and medical clinics?  With the same general set of incentives facing bureaucrats who now supply "passport control" facing bureaucrats who would supply medical care, it’s a childish fantasy to imagine that people needing medical care would not encounter unnecessarily long queues when seeking government-supplied medical care.

Those persons who think me cynical, or who think that I draw a mistaken lesson from my experience at passport control, should ask themselves as seriously as they can just why they suppose that government-supplied medical care will not be characterized by the kinds of frustrations that travelers and post-office patrons routinely suffer.

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SaulOhio July 29, 2007 at 5:25 am

I paraphrase Douglas Adams: It seems to me that all these government solutions to our healt care problems have to do with the movement of small green pieces of paper, which is odd, since it is not the small green pieces of paper that need health care.

What you need to do it encourage more people to train to become doctors and nurses, and no government program can do that. The profit motive, and the knowledge that you will be free to practice your career free from unneeded interference, in freedom, that can get people to go to school for eight or more years AFTER collegeand spend a few more years as an overworked, underpaid resident, then have to deal with all those sick people that hospitals seem to attract for some strange reason.

Flynn July 29, 2007 at 8:17 am

Consider the flip side, too. When I got back from abroad last September, there were at least 10 agents at that same passport control location, and the entire plane was through in less than 15 minutes. Then all the agents stood around chatting, getting coffee and stepping out for a smoke.

So the agents who could have made your process faster had already booked their overtime on some other shift, I suppose.

SteveSC July 29, 2007 at 8:55 am

As Flynn notes, the bureaucrats can sometimes overallocate resources. In the '50s, the VA system was stellar, but there was little investment in the next 30 years and VA services became a sad joke until the '90s when it became politically important to reinvest.

The problem with a government-run system is not that it CAN'T allocate enough, it is that the allocation is at best loosely coupled with the value provided. Thus you will get a few, politically important, areas where overallocation occurs (at least in the short run), while most areas suffer from lack of investment. Then add in the lack of incentives for operational efficiency…

cpurick July 29, 2007 at 10:06 am

Frankly, the folks who want socialized medicine do not care about shortages or quality. Their chief concern is equality; especially if it can be bought with the money of the rich.

These people love government schools — where you're required to buy two educations if you want to obtain a single good one. If your health care worked that way it would be perfectly fine with the left. You can buy your own as long as you're paying even more for the government plan that doesn't work.

muirgeo July 29, 2007 at 10:19 am

Wow…just think how those people stranded on an over pass in New Orleans after Katrina felt about this administrations poor planning.

One thing about people who don't believe government can work…..don't let them run it because they'll prove themselves correct every time. The current administration increased passport and security requirements with out planning to properly fund the need for increased workers. Bureaucracies like private companies work better when managed by a competent CEO.

Wealthy people who lobbied for more tax relief will do fine on their personal jets. The rest of us may now may miss connecting flights to support their tax cuts as the administration tries to trim the budget sometimes in areas that may actually need increased support.

As regarding public health care. I say a single payer system will work fine by cutting cost by eliminating the health insurance middle man while still allowing for competition as people get to choose which health care provider they want to see. The evidence in the other 30 developed nations suggests it works well and the cost is much less.

Note that Walter Reed had many private contractors that were running the pitiful system that we all saw put profits ahead of the needs of our soldiers.

drtaxsacto July 29, 2007 at 10:23 am

I travel a lot internationally and found two things interesting about your post. First, at one point the Customs Service had something called Fastpass – which used biometrics to allow a person to get through the process very quickly. In exchange for giving up some personal information you got quicker service. The joke was the system only worked about 20% of the time. Every other identity system that I use (for example with my bank) it works flawlessly almost any place in the world.
Second, there is a certain randomness to the issue. When I came back from Mexico on Wednesday (in another airport) I went through in about 4 minutes. There were about 40 agents waiting for one plane. Any normal business would look at flight patterns and staff to the landings. But I suspect that does not happen in the Customs Service. The same pattern seems to work in the post office and in places like the Canadian health service so you must be on to something.

muirgeo July 29, 2007 at 10:28 am

Also regarding public health insurance;

" Nor is there any reason why the state should not assist the individuals in providing for the common hazards of life….Where, as in the case of sickness and accident,…..- the case for the state's helping to organize a comprehensive system of social insurance is very strong."

F. A. Hayek

True_liberal July 29, 2007 at 10:54 am

muirgeo – the problem with the state providing health care is that the cost is disconnected from the price. When a commodity costs the user nothing, there is ALWAYS waste and abuse, resulting in shortages and delayed care, with consequent poorer outcomes and EVEN HIGHER cost.

PS Don B. – even with the shortage of immigration agents on the working front, I'll bet there was no shortage of administrators in the back offices…

Chris O'Leary July 29, 2007 at 11:54 am

We're the government. We don't have to care.

Jim Morse July 29, 2007 at 1:39 pm

Democrats/liberals/leftists: why should I want to put my health care in the hands of Karl Rove and Dick Cheney?

Republicans/conservatives/right-wingers: why should I want to put my health care in the hands of Hillary Clinton?

True_liberal July 29, 2007 at 2:10 pm
Wojtek G July 29, 2007 at 2:45 pm

I don't understand how the notion that somehow the countries with public health stand as an example of success while it is so obvious to any of us, who actually live in them (Canada in this case), that sitting at 2 am with a bleeding infant in a nearly empty emergency ward for six (6) (yes, you read that correctly) hours while the few staff stand around having coffee is way beyond reproach. Then listening to our benevolent bureaucrats explain, on government radio, that the wait is justified in the name of keeping costs down, so long as the patient doesn't die, leaves me completely at a loss.

I would kill to be able to pay for better health for my children, even if it bankrupted me. But, thanks to our overwhelming egalitarian national sentiment, we are not permitted to purchase for ourselves what we can readily buy for our PETS, because that, my friends, would be truly unfair.

How many of us does it take to drill this point home. Public health is horrible, in even the 'best' of implementations. Don't need to go back to the soviet union to see that. Muirego, this IS aimed directly at you, because I'm thoroughly sick of these silly arguments that completely ignore the facts on the ground.

Brad July 29, 2007 at 3:13 pm

muirgeo, As a counterexample for you… California had Governor Gray Davis, perhaps the best prepared liberal politocrat in the history of government. A guy who believed in every program his administration had to implement… And he was a far bigger disaster than even Schwarzenegger. Another counterexample for you… No Child Left Behind is Bush's baby. And it's arguably a bigger failure than just throwing less money with fewer strings at education like we were prior to NCLB.

I have to give you points for persistence from a position of ignorance though. Always entertaining…

Patrick R. Sullivan July 29, 2007 at 6:00 pm

Enterprising Canadians:

Based in Vancouver, B.C., Timely Medical Alternatives is Canada’s original medical brokerage organization, providing Canadians with medical alternatives to waiting for care in the public health care system. Founded in 2003, we have assisted individuals and families across Canada to obtain timely, private surgery as well as diagnostic imaging. We refer 90% of our clients to private health care providers within Canada for services such as knee and hip joint replacement, gall bladder removal, arthroscopic knee and shoulder surgeries, weight loss surgery and cataract surgery. Typical out-of-country procedures that the Company brokers on behalf of its clients include brain surgery, cardiac surgery, spinal neurosurgery, and cardiac intervention (angioplasties).

pinus July 29, 2007 at 6:00 pm

I think most of the foreigners already know this. Never use JFK to enter the U.S. if you have a connecting flight. The waiting times at the immigration control are totally unpredictable.

Chris Meisenzahl July 29, 2007 at 6:59 pm

Well-said as usual, Dr. Boudreaux!

brotio July 29, 2007 at 9:20 pm

Muirgeo's comment may be the best defense of private health care yet: Elect the wrong administrator and suffer four years of terrible service!

The idea that a person is somehow smart enough to run an automobile company, oil company, or doctor's office simply because they know how to get elected would be laughable if so many lives and livelihoods weren't at stake.

It's amazing that leftists believe that indifferent bureaucrats will provide better service than people who's livelihood depends on keeping the customer happy. If you get a snotty hotel clerk? Come back a month later and see if he still has a job. Get a snotty bureaucrat? Come back in 20 years and attend his retirement party.

Bart July 29, 2007 at 10:04 pm

What administration are you talking about, cprick? The Democratic administration of the Grand Nagin of New Orleans? The state of Louisiana Democratic administration? Surely this can't be yet another pointless and disconnected anti Bush rant.

Eric Crampton July 29, 2007 at 10:43 pm

The usual sort of answer I'd hear to the kind of question you asked, Don, is that the median voter cares more about health outcomes than she does about airport lines, since the median voter rarely needs clear customs and most of the costs will be borne by foreigners. The usual response is to point to a place like Canada where the waits for service can be long indeed.

Tom Corbin July 29, 2007 at 11:19 pm

And if the gov't can't manage to do this right, what makes anyone think they can handle a guest worker program?

jack lecou July 30, 2007 at 12:50 am

This experience is of course COMPLETELY unlike the long wait times I occasionally experience at the bank, or the supermarket…or to get an appointment with a doctor.

Greg July 30, 2007 at 1:22 am

Let's have the gubmint "fix" health care right after they fix the DMV. Grrrr.

brotio July 30, 2007 at 2:19 am

Jack Lecou,
"Occasionally" being the operative word in the private sector. Have you ever been in a supermarket queue where there were unmanned check stands and heard someone on the PA calling for clerks to come and man those check stands because of the long lines? I have. Have you ever been in a Post Office or DMV queue and had that happen? I haven't.

Russell Nelson July 30, 2007 at 2:33 am

muirgeo: why do you think Hayek is never wrong? I think he's wrong in spots.

muirgeo July 30, 2007 at 3:29 am

Surely this can't be yet another pointless and disconnected anti Bush rant.

Posted by: Bart

At this point any one who claims to be a traditional liberal and still some how supports this president is ….conflicted.

Waits in airport lines are bad enough. A president in multiple violations of the constitution with a lying AG covering for him make those lines to get through customs look pretty short to me.

ben July 30, 2007 at 3:57 am

Muirgeo

The evidence in the other 30 developed nations suggests it works well and the cost is much less.

New Zealand has a centralised health care system which rations access to medicine by queueing. You can literally wait years to get a hip replaced. You can literally sit on a waiting list for six months, then get bumped and sent to the back of the queue if your condition is deemed not to be too serious. You are unlikely to die while waiting, but the point is that the cost of waiting – all the extra suffering of the patient – is ignored by beaureaucrats.

Do not pretend for even one second that centralised health care is automatically better – those who cannot afford to go private and therefore pay for their health care twice (once via taxes, then again with private insurance) pay for your healthcare with loss of quality of life rather than dollars.

muirgeo July 30, 2007 at 4:00 am

muirgeo: why do you think Hayek is never wrong? I think he's wrong in spots.

Posted by: Russell Nelson

I don't know? I just read his book and I mostly agree with him.

The book IMO is an affirmation of some of the arguments I've made here and yet have been attacked for by supposed Hayekians.

Hayeks views seem more conflicted with the Republican party's current course then with the Democratic Party. Although I understand he would be disgusted with the Democratic micromanagement I think he would today have to concede that 60+ years after his book was written none of the regulatory trends and "managed" economies have devolved into serfdom (totalitarianism).
I think he would be horrified more by this administration because he seemed to believe the road to serfdom could as easily be paved by the conservative right as by the "liberal" left.

ben July 30, 2007 at 4:04 am

Muirgeo, more mistakes:

I say a single payer system will work fine by cutting cost by eliminating the health insurance middle man while still allowing for competition as people get to choose which health care provider they want to see.

Actually this is backwards, at least in New Zealand. Under centralised funding, you get a fixed budget each year, that's your lot. So each extra patient you get adds costs but not revenue. For hospitals in NZ, doing a good job and growing your customer base actually makes your life harder.

The middle men you complain about actually have an especially important role to play in health, because information about quality and benefits per dollar spent are hard for laymen consumers like me to understand. Having people specialise in that area is likely to add value, provided there are differences in quality between hospitals for any give procedure (as undoubtedly there are), and information is hard to obtain or understand.

muirgeo July 30, 2007 at 4:18 am

Ben,

Sorry but you are the one who is wrong. Those "middle men" are experts at controlling cost while quality is a secondary issue. They too work with a fixed budget and the most effective way to increase your profits is to cut your cost. These statistician middle mens company value comes from figuring how best to deny a claim. Likewise they add administrative cost of as much as 25 cents for each dollar of health care you pay out compared to the bureaucratic systems with administrative cost of as little as 5%.

Dale July 30, 2007 at 7:48 am

The gov't health care system already in place, the Veteran's Administration health care system, is already broken. And…it only serves a small portion of this country's population. Extrapolate that to the broader population…

Alvin July 30, 2007 at 8:19 am

Just curious, did you also have to pick up your bags in New York (from Bucharest) or were they checked all the way through to Washington DC? And did you have to go through security again at JFK before getting to your gate to fly to Washington DC? That would take a lot of extra time. In Chicago O'hare, you leave the International Terminal and go through security again in the domestic terminal.

John Dewey July 30, 2007 at 8:29 am

muirgeo: "Likewise they add administrative cost of as much as 25 cents for each dollar of health care you pay out compared to the bureaucratic systems with administrative cost of as little as 5%."

Do you really believe that bureaucratic systems are more efficient than socialism? Do you honestly believe that?

Please show me the facts that support this belief.

cpurick July 30, 2007 at 9:02 am

muirgeo, (mis)quoting (read: paraphrasing poorly) Hayek:

" Nor is there any reason why the state should not assist the individuals in providing for the common hazards of life….Where, as in the case of sickness and accident,…..- the case for the state's helping to organize a comprehensive system of social insurance is very strong."

Hayek's very point was that if government attempted to structure a health care program such that the afflicted would be assured that they could fight devastating
illness without risk of personal bankruptcy, then in that case freedom would have been forfeited.

Since you advocate such a system you are in fact misrepresenting Hayek, who — I can assure you — would not be on your side in this matter.

Continuum July 30, 2007 at 10:05 am

I'm not sure using anything dealing with travel on airplanes is a good example.

I regularly flew American Airlines out of Kansas City, a relatively small airport, before any of the additional security checks.

I knew to allocate at least another hour to check in at the American desk. Their line always wound around the terminal, and was usually staffed by only 2 clerks. The clerks said that they had made the home office in Dallas aware of the problem (for years), but never seem to have any change.

Similarly, try checking into DeGaule on American for any flight. The lines go on for hours. Again, this is prior to any security checking. For the last 10 years, at least, this has been a nightmare.

Private enterprise has its own problems with meeting consumer demands.

Dave July 30, 2007 at 10:24 am

The same argument is used by Michael Moore: The Government works when it wants to, ie. That Social Security Check comes on the same day every month like clockwork. If the Government can be that good at doling out and collecting cash, it should also be good a running a social program.

All hail free markets and competition!

Sam Grove July 30, 2007 at 10:31 am

Muirgeo is simply attempting to use a common source for free market advocates to either counter their stance or discredit their source.

Of course, those of us with actual experience with government health care, such as the Canadians that speak here, could not hope to match their actual experience with muirgeo's assertions for the superiority of bureaucratic health care.

Now, where do the stats for supposed costs of political management of health care come from?

What do they actually measure and are those the only costs associated with government management of health care?

One of the costs we can associate with government provided anything is the rest of the system, for if government can be thought of as our medical savior, it will also be thought of as our nutritional, employment, disaster, external threat, whatever savior. We'll see this when the dems take over when they aspire to have the government provide health care but will also perpetuate U.S. military dominance around the world. You don't get one without the other. They won't be satisfied with control of just one area of our lives, they must manage it all.

Should we ask old people in government managed systems what they think of their system when they are deemed no longer worth the expenditure of public funds?

My friends mother experienced a taste of this under medicare when it was suggested to her that her use of the resources was takingaway from other, younger participants.

Sometimes I begin to wonder if there are moles who come to sites such as this whose purpose is to undermine opposition to the bureaucratic state.

muirgeo July 30, 2007 at 10:42 am

Here is a chance for all readers to witness an actual case of cognitive dissonance. Read cpuricks explaination of what he claims Hayek to have said then read the full quote.

From The Road To Serfdom, Chapter 9 Security and Freedom page 133-4

"Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance-where, in short, we deal with genuinely insurable risk- the case for the state's helping to organize a comprehensive system of social insurance is very strong."

True_liberal July 30, 2007 at 11:31 am

The government's interest legitimately extends to public health issues wherein a single virus or contaminant can affect large numbers of its citizens.

But when a motorcyclist causes himself grevious injury (either by his actions or his failure to protect himself), is that not his own personal behavior that makes him perhaps a permanent invalid? Why should taxpayer funds keep this Darwin Award candidate "alive"?

Eric July 30, 2007 at 11:31 am

Muirgeo,

What Hayek is talking about in that passage is TRUE health insurance, not the kind of system we have today in which routine medical expenses are paid for by third parties.

I do not believe that Hayek's statement in this case supports government-provided health care.

Tom July 30, 2007 at 11:57 am

"No Child Left Behind is Bush's baby. And it's arguably a bigger failure than just throwing less money with fewer strings at education like we were prior to NCLB."

Bizarre statement. Where else would having at least minimal accountability be considered bad? The fact that scores seemed to have responded well to the testing suggests it has been the best money spent in public education in many years.

muirgeo July 30, 2007 at 12:13 pm

"Why should taxpayer funds keep this Darwin Award candidate "alive"?"
True_liberal

I think that is a perfectly legitamate question. Just as legitamate as my questions as to why we should allow for corporate charters, why should we have to pay for a patent office, why should we set up rules to allow corporations to off shore their accounts and avoid paying taxes?

Until you realize your question is no more legitimate then the ones I've asked you can hardly be said to be consistent in any position you hold on the purpose of government in a democracy.

Sam Grove July 30, 2007 at 12:34 pm

Muirgeo threatens the foundations of minarchy. Where do we stop and why stop there?

Let us propose a no income tax state…as before 1913 and let the government be funded from non-specific tariffs.

Let the people, as individuals and in voluntary collective associations, accumulate their rightfully earned wealth, that it not be squandered in maintaining an empire of influence, so that we can control our expenditures on health care, etc., and we can form associations to provide charity hospitals to provide for those who are unable to accumulate the wealth to care for themselves, among other worthy projects we care to contribute to both profitable and charitable.

Chasten those that believe we cannot accomplish worthwhile objectives whithout pointing the collective guns at people.

Jon July 30, 2007 at 12:52 pm

On the contrary, as I remember, those questions have been delt with on this blog before as I specifically remember the discussion involving the act of incorportation.

The more correct question to ask is "Why shouldn't we allow organizations to off-shore their accounts to avoid being raped by the gov't?"

As to patents… meh, it's largely a much less relevent question than the issue of healthcare and whether or not we should socialize it.

You are trivializing matters here by trying to play philosophical games of give and take. I hate to break it to you but it isn't going to fly.

cpurick July 30, 2007 at 12:57 pm

Look at Boudreaux's take on Hayek. Don quotes some of the same passages.

If we apply Hayek as explained by Boudreaux, free universal health care falls under "absolute security." Under such a plan, an individual expects to consume health care without becoming poorer, maintaining his standard of living and relative wealth. Those

Personally, I don't view the need for health care as an "uncertainty;" I see it as an eventual certainty for each of us. I'm not sure it's an insurance problem at all as much as it's an investment problem. As such, I'm not even sure a health care plan qualifies as "limited security" in Hayek's terms.

I'm pretty sure that if you wanted a government health care assistance that Hayek would not consider tyranny, it would have to be something means-tested — a true safety net. Hayek believed the government could (not should) safely protect poor people from having to die because they couldn't afford catastrophic medical problems.

It's quite a stretch to get from there to claiming that Hayek would have supported universal health care.

Sudha Shenoy July 30, 2007 at 1:31 pm

Re American Airlines: the US govt 'protects' US airlines against foreign competition. Nor are foreigners permitted to buy 'US' airlines.

Brad July 30, 2007 at 2:13 pm

Tom, NCLB further federalizes education. It adds expense to an already expensive system at precisely the wrong level. It demands scientific validation of methods in a field (teaching) that is much more art than science. Improving teaching is generally much more of a marketing exercise than a physics experiment. You have to get the teachers excited, not the electrons. Same with the kids. NCLB is Tayloristic while those of us with careers have already realized it's an anachronistic and dehumanizing way to manage. It's funny how most of us wouldn't accept this kind of BS at work, and yet our federal government imposes it on our kids at school.

But here's the real rub about No Child Left Behind. It doesn't even work. I live in a pretty wealthy suburb in South Orange County, CA. And I know three kids in the 10 to 13 age range who are being dragged behind the bus so as not to be left behind. They get shuffled on without skills just like before, except in a way that doesn't screw up their schools' test scores. Many teachers and administrators have come to the conclusion, and other than as a source of money, there is a lack of enthusiasm and even some hostility for renewing NCLB.

If you want accountability, you need vouchers. The parents of the kids I know don't want their kids to grow up and have to compete with undocumented aliens for space digging through neighborhood garbage bins, but they have no control over what happens at school.

Wojtek G July 30, 2007 at 2:17 pm

Something I noticed recently:

While we wait for five hours to get our passport picture taken, six to seven hours in emergency to see a doctor, two months for an MRI of a stroke, three years for a transplant, and almost never receive knee replacements, my car does not wait but TWO minutes after my parking meter has run out before a government official runs up to it to charge me $30 for the offense of not dropping coins into a post on time.

I received six tickets last month, with an average of 3.3 minutes infraction. Whoever said you need a profit motive to guarantee great service is a dolt.

I_am_a_lead_pencil July 30, 2007 at 4:25 pm

Wojtek G,

You live in Santa Monica?

http://www.lalatimes.com/newsfea/me_2_metergross.php?PHPSESSID=f297048ca43681da

Even the folks at the DMV might give quicker service if they were given hefty commissions based on transactions processed.

It is all about incentives….

Tom July 30, 2007 at 4:37 pm

Brad,

Of course there is hostility to NCLB. The teachers are not used to accountability, and are chaffing under it. It has improved test scores.

I don't like federal involvement and would favor vouchers; but if we are spending federal dollars, I want to see accountability.

"NCLB is Tayloristic while those of us with careers have already realized it's an anachronistic and dehumanizing way to manage."

I don't care about the teachers' complaints. NCLB is a minimum. These kids should be able to pass without a problem. When teachers have a problem about teaching the basics, a tougher stance is necessary. I find nothing anachronistic about a child learning math and english or expecting a teacher to do his job.

The need for more funds is also a farce. NCLB is a way to verify the money we are spending isn't being wasted.

Wojtek G July 30, 2007 at 5:03 pm

Nope, not Santa Monica, Toronto, and boy am I glad of THAT.

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