There are advantage to universal standards. The most important is economies of scale–once you learn the standard, it applies everywhere. But the disadvantages are subtle and usually much greater than the advantages.
I don’t want a single standard of health care, one standard of what’s “best.” Everyone is different and what is best for me may not be best for you. More importantly, what is best is unknowable to a committee of experts. Not hard to know. Not difficult to discover. Unknowable. What age should a women have a mammogram is not a question that has an answer. There are many answers. One reason is that women are different. A more important reason is that our knowledge evolves. What is thought to be “best” (wait until 40) may turn out to be different (wait till 50). But even more importantly, when power is centralized, the very idea of “best” no longer applies. The incentives aren’t there. When there is one standard set by the political process, the experts’ incentives on whatever committee determines the universal standard are inevitably going to be politicized. So give me “inefficient” competition among standards. Let different standards vie for attention.
I was thinking about these issues this afternoon when I spoke at a convention of international accountants. The topic was the crisis but there was a side issue of what they called “convergence,” the idea of a single international accounting standard. As one speaker put it, an investor examining a company in Beijing or Barcelona or Boston should be reading the same information that has been generated by the same standards.
It’s a nice idea. And convergence sounds good, doesn’t it? But I couldn’t help thinking about Basel II. Those were international standards and yes, it was good that they were the same everywhere. But they might not have been the right standard. Yousee, when you have only one standard, it really has to be very, very good or it’s really a disaster. And what is the incentive to come up with the “best” standard? When a standard has a monopoly, the incentive to manipulate it to make sure it complies with your desires is very strong. So rent-seeking is inevitable.
Rather than have a set of experts come up with the best standard, I would prefer competition among standards. Let investor dollars determine which are the best standards. Maybe tehre would be convergence, maybe not. And when there are lots of standards, you can get improvement as people learn over time. But those universal standards struggle to improve. The people who design them have a tendency to defend them even when they’re flawed.
At the end of the discussion, a committee was mentioned, I think it was part of the UN, that was looking at some accounting issue. It was mentioned that the committee represented the different regions of the world. There was a representative from Africa, South America, Asia, North America, and Latin America. Because every part of the world had a representative, it was assumed in the conversation that everyone’s interests would be heard.
The word “representative” is usually used that way, but it really has no meaning. The African “representative” on the commitee is not representing Africa in any meaningful way. There is no African “interest” or meaningful sense of the phrase “what is best for Africa.” Africa is a diverse place. Some rules or standards might benefit rich countries or small countries or multinational corporations or leaders or the people. To say that someone represents Africa is a meaningless phrase. But of course it’s worse than that. The person who is called the African representative has no real incentive to represent Africa or the people of Africa. That person is likely to respond to his or her political patrons. So the whole thing is a romantic illusion.
Give me more competition and less universality.
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Do not operate keyboard when stoned. You embarrass yourself.
But what the hell, so does your pals muirduck, Disingenuous Kuehn, et al., so have at it.
“I don't get this idea that dollar and investor driven outcomes will necessarily be better then a dedicated group of professionals driven by other goals and measures of success.”
Where did anyone one say “necessarily”? I see “prefer”. Straw man.
I too prefer market based outcomes. Dollars usually provide more reliable feedback of true individual preferences than measures of success that are subject to statistical manipulations, misinterpretation, invalidity, groupthink, bias and politics. But, it's not always the case. But, it doesn't have to always be the case, it just has to consistently be the case, which it is.
Are there exceptions? Sure. There always are. But, an exception doesn't necessarily rule out that the exception wouldn't have happened otherwise.
But it will become problematic when we have a single payer health system (which is the stated goal in inserting a “public option”) and women are PREVENTED from obtaining a mammogram before the age of 40 – regardless of family history. It is possible for women to be denied a mammogram even if they are paying out of pocket.
Are you sure? That sounds crazy. In Singapore we have both government run hospitals and private sector hospitals, but I dont see the private sector going out of business here. Also, I'm not sure that government hospitals can refuse to do mammograms for people who come in to do them either. (Of course Singapore may be different since government services in general are run is ways that net them a healthy profit and allowed to be subject to market forces. Which as part of a larger libertarian project, simply means that these aspects of the government are much closer to privatisation)
No, my discomfort is not just semantics. There is more there than just semantics. I may not be adequate to explain it but it is there.
I recognize that you said you agree with me, but I am still compelled to reply.
For instance, as I said, law, regs, rules, can theoretically all get us to convergence and probably much quicker than standards. In Russ's piece note that the people he mentioned as supporting standards to reach convergence were really talking about rules, regulations, and law, not standards; at least not in my lexicon and understanding of the word standards.
Standards, as I said, evolve more than are dictated. Again I go to examples of what I see as standards:
Consideration of others, a standard, can not be legislated.
Ambition to excel, a standard, can not be legislated.
Kindness, a standard, can not be legislated.
Honesty, a standard, can not be legislated.
Courage, a standard, can not be legislated.
Faithfulness, a standard, can not be legislated.
Responsibility, a standard, can not be legislated.
I am not fussing at you, just trying to articulate my thoughts on this subject, which by the way is not the first time I have thought long and hard about standards.
It is in my mind that we can have rules, regulations, or law without character, but no standards without character.
It is in my mind that if people have personal character and standards they can not be enslaved or controlled, no matter the rules, regulations, or laws they are subjected to.
Destroy the standards, you weaken or destroy the character, and then you can have your great collective.
Am I making sense to any one but me?
Sure those things can be legislated against vidyohs unless you want their counterparts (being inconsiderate, unambitious, unkind, dishonest, etc.) to co-exist and let people choose which way they want to go. If people were caught not practicising those virtues were severely punished then they'd be less likely to do it again. I'm sure you punched others for flinching until they stopped flinching.
Yes, in Singapore things actually work and the public sector works very differently than it does in Europe and Canada. In Canada, it is illegal to pay out of pocket for services that are provided by government. It's illegal to set up a private clinic – although, distressed by patients dying on waiting lists, Canadian doctors have now started breaking that law.
In Britain, women are denied yearly mammograms after a certain age – can't remember if it's 65 or 69. After that age, they can only get them every 3 years. Unfortunately, breast cancer is highly correlated to age.
In the U.S., if you're on Medicare (government health care), and you need a root canal, you won't get one. It's cheaper to extract the tooth. That would be okay if you could just pay the same doctor to do the root canal, but you can't. It's illegal to pay out of pocket to a doctor who has accepted you as a medicare patient.
My understanding of the Singapore system is that government will pay the amount that it would cost to extract the tooth and if you want the more expensive root canal, then you have to pay the difference (usually, out of the HSA account everyone is required to contribute to). Also, the Singapore government runs like a business – in general. There's very little bureaucracy, very few entitlement programs in need of funding and very little interest in killing the private sector. At least, that's my impression. This is a government that understands the importance of markets. I believe Singapore recently legalized a market in kidneys.
Things work very differently in Singapore. Things work. I've been trying to learn more about the medical system there, so if you can provide insight, I'd love it.
BTW, Murali, I agree that government doesn't have to crowd out the private sector. Singapore is a great example of that. Singapore spends roughly 4% of GDP on health care, but gets as good or better outcomes as in the U.S. All the latest medical and pharmaceutical technology is available and there are no wait lists. Singapore achieves this largely by maintaining a free market health care system of which HSA's are a big part.
If the U.S. congress were really interested in reforming our health care system, they would at least take a look at Singapore's. But, health care reform in this country has nothing at all to do with reforming health care. It has everything to do with nationalizing a critical sector which is 16% of the U.S. economy in order to grow the power of politicians – and to divert attention from the fact that government run medicare is bankrupt.
Do not operate keyboard when stoned. You embarrass yourself.
But what the hell, so does your pals muirduck, Disingenuous Kuehn, et al., so have at it.
Excellent point. Thank you.
excellent post!
Excellent point. Thank you.
excellent post!
It appears that you are one who would rather lose and be right than win and be wrong.
If that is the case, how do you allow yourself to work with lawyers?
Thank you for your reply, Murali. Interesting. I don't think there is a libertarian paradise anywhere. Governments have no incentive to provide one. But, it seems to me that Singapore's ruling party understands that its strength lies in allowing the economy to work by not molesting business too much. This is not something that is well understood by our government – anymore.
Are you here or in Singapore?
Thank you for your reply, Murali. Interesting. I don't think there is a libertarian paradise anywhere. Governments have no incentive to provide one. But, it seems to me that Singapore's ruling party understands that its strength lies in allowing the economy to work by not molesting business too much. This is not something that is well understood by our government – anymore.
Are you here or in Singapore?
You're right, temperature scales other than F, C, and K are no commonly used. That's the entire point: people are capable on individually deciding which scale best suites them. In most cases it is one of F, C, or K, but not all.
You're missing the point in the Kelvin scale being codified into law. Yes, it is formally defined by the CGPM, but that's separate issue than the one here. I have no objection to the governments setting an exact definition for the Kelvin scale. After all if I don't like the Kelvin, I can always use a different one, or invent my own and use that. A better analogy to the issue here would be government regulations saying that every temperature scale must conform with certain guidelines. There is no way for anyone to know what the desired properties of a temperature scale will be for every application. The same holds for health care; there is no way to know what what makes up a desirable health care plan for every person.
You're right, temperature scales other than F, C, and K are no commonly used. That's the entire point: people are capable on individually deciding which scale best suites them. In most cases it is one of F, C, or K, but not all.
You're missing the point in the Kelvin scale being codified into law. Yes, it is formally defined by the CGPM, but that's separate issue than the one here. I have no objection to the governments setting an exact definition for the Kelvin scale. After all if I don't like the Kelvin, I can always use a different one, or invent my own and use that. A better analogy to the issue here would be government regulations saying that every temperature scale must conform with certain guidelines. There is no way for anyone to know what the desired properties of a temperature scale will be for every application. The same holds for health care; there is no way to know what what makes up a desirable health care plan for every person.
I'm in Singapore now, but I'm thinking of visiting the US for a week in june after I've handed in my Honours thesis. Go to some libertarian seminars maybe, visit some of my relatives or something.
I hate to agree with muirgeo, but the D / C / AA / AAA universal battery sizes are an excellent proof of the value of universal standards. Thank goodness we have muirgeo around to point out things like that, because the rest of us are too stupid to notice real-life things like that. We've all just got our heads up our ideological economic asses, and need down-to-earth sensible people like muirgeo.
Thanks again for pointing that out, Muirgeo!
I hate to agree with muirgeo, but the D / C / AA / AAA universal battery sizes are an excellent proof of the value of universal standards. Thank goodness we have muirgeo around to point out things like that, because the rest of us are too stupid to notice real-life things like that. We've all just got our heads up our ideological economic asses, and need down-to-earth sensible people like muirgeo.
Thanks again for pointing that out, Muirgeo!
I hate to agree with muirgeo, but the D / C / AA / AAA universal battery sizes are an excellent proof of the value of universal standards. Thank goodness we have muirgeo around to point out things like that, because the rest of us are too stupid to notice real-life things like that. We've all just got our heads up our ideological economic asses, and need down-to-earth sensible people like muirgeo.
Thanks again for pointing that out, Muirgeo!
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