But Not Sufficiently Sacred for Physicians to Work for Free

by Don Boudreaux on April 22, 2011

in Uncategorized

Paul Krugman today sneeringly asks

How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’?  The relationship between patient and doctor used to be considered something special, almost sacred.  Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car.

Krugman here taps into the antediluvian hostility toward bourgeois modes of providing for one’s self and one’s family.  This ancient prejudice holds that ‘mere’ commerce might be acceptable to govern the production and distribution of trifles such as candy and cars, but it’s too crass for goods and services that tradition or elites declare should be untainted by such sordid, competitive activities.

If consumer choice isn’t the ultimate driver of health-care supply, however, what – or who – will be its ultimate driver?  Health-care suppliers?  Congress?  Government bureaucrats?  Princeton dons?

Admittedly, the politically engineered wedge separating the receipt of health-care services from the responsibility for paying for these services creates problems.  But the best way to address these problems is to remove the wedge rather than to arrogantly suggest that some mysterious transcendent force will more reliably look after individuals’ health-care needs than will those individuals themselves as they operate in markets in which insurers and physicians must compete for consumer dollars.

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{ 186 comments }

Floccina April 22, 2011 at 2:53 pm

Sarcasm follows:

Perhaps all medical workers and all people who work for companies that produce products for medical care should take vows of poverty.

JN Ellison, MD April 22, 2011 at 4:26 pm

Since Medicare and the insurance companies continue to ratchet down our fees, it seems we have.

muirgeo April 22, 2011 at 4:27 pm

That is EXACTLY what Don and the Libertarian folk are asking.
People of a better nature and less brutality will always be there unwilling to allow the elderly to die in their homes or to allow the poor to die on the streets outside of the hospital. They and the poor will suffer the consequences while the Libertarian society rewards the selfish and greedy who of course will come out on top concerned only with their own interest.

You libertarians need to admit that under your system hundreds of thousands will die and suffer severely from lack of access to health care. If you deny that you are a liar and if you are ok with that you are an uncivilized barbarian… there are not many options here for the libertarian.

Where in the hell do you guys see a market for appendectomies of the poor???

Methinks1776 April 22, 2011 at 4:41 pm

“appendectomies of the poor”?

Are you aware that appendectomies do not, in fact, extract the poor?

There can be nothing more barbaric than allowing a moron like you practice medicine.

Craig April 22, 2011 at 5:00 pm

Incredible. I didn’t realize muirgeo was a doctor when I wrote my other comment. Muirgeo, are you saying you wouldn’t give someone an appendectomy if they were poor?

muirgeo April 22, 2011 at 6:41 pm

No… I am saying there wouldn’t be enough doctors to do all the needed appendectomies and many doctors WOULD be doing of doing pro bono work rather than having the cost shared across society.

Ken April 22, 2011 at 7:40 pm

muirgeo,

“wouldn’t be enough doctors to do all the needed appendectomies”

The AMA lobbies the government to implement licensing for appendectomies in order to keep their wages high and discourage competition by creating a high entry barrier. The government does this, which means that there are less doctors to do appendectomies. In other words you’re a complete blithering idiot.

Shared costs NEVER bring costs down. Say I go out with some a group of 10 my friends. We end up going to Ruth’s Chris and we agree that when the check comes we’ll divide it evenly. Three people decide to split two bottles of wine at $35/bottle, adding $70 to the bill, only $30 of which is paid by the wine drinkers.

Most people get filets or ribeyes, so the average cost of the entree is close to $40. However, what happens if one of my friends isn’t that hungry and just gets a salad? Since the total cost divided by 10 bill be close to getting a full meal, this person decides to get a steak, then box it up, adding $40 to the total cost of the bill (meaning that this person gets a steak for $4 since it is split 10 ways).

If each of us paid individually, the wine drinkers may have only bought one bottle instead of two and the not so hungry friend wouldn’t have gotten a steak to box up for later. In other words because of the decision to simply split the bill, the total cost increased by $75.

The same principle works for EVERY resource, INCLUDING ALL MEDICAL RESOURCES. If it only costs an extra few dollars to get tens times more dollars worth of value (at everyone else’s expense) then you’ll do that. There is no reason to conserve, you only feel a part of the cost, since it’s spread out over a bunch of different people. The total cost goes up. However, if you are forced to support yourself at all times, you will be far more sensitive to the cost of the items you purchase, including medicine, reducing total costs.

Again, you’re a blithering idiot.

Regards,
Ken

Ken April 22, 2011 at 7:41 pm

Oops, only $21 of which is paid by the wine drinkers.

Ken April 22, 2011 at 7:45 pm

The point in muirgeo, the people who consume the most ALWAYS pay less than what they consume, while those who consume the least ALWAYS pay much more than they consume, by the law of averages (splitting costs). It is in these people’s interest (the ones who consume the least) to start consuming much more than they otherwise would (buying a steak in addition to a salad in my example).

The only way to reduce costs is to encourage those who consume the most to consume less. Splitting costs does the very opposite. It actually reduces the burden on those who consume the most and increases the burden on those who consume the least, thus encouraging those who consume the least to start consuming more.

Regards,
Ken

John V April 22, 2011 at 9:52 pm

I doubt he is.

dan April 23, 2011 at 1:47 pm

I know that next time, I would be ordering the most expensive stuff in the place to get most for my money and to make up for the losses I took last time……

vidyohs April 22, 2011 at 7:11 pm

M’lady, and Messr’s,

Good old muirduck’s hypocrisy is hi-lited in this:

“You libertarians need to admit that under your system hundreds of thousands will die and suffer severely from lack of access to health care.”

This is the typical lapse of intellect all looney lefties have, Krugman included.

If we ask the question, “Why would hundreds of thousands die and suffer severely from lack of access to health care?”

We get the answer, “Well, there would be no one to pay the doctors.”

So, the answer is that doctors work for money just like any other provider of service, and this is acknowledged by the verbiage of the looney left (muirduck & Krugman), which makes the doctor’s customer a consumer……..does it not? Yes, it does.

God! You just gotta love the way they nail their asses to the floor with their own words.

Craig April 22, 2011 at 4:54 pm

muirgeo, just curious, why do you continue to comment at cafehayek.com? Do you think insults and a seemingly total misunderstanding of libertarianism will convince people to become progressive?

Read: http://www.npr.org/templates/story/story.php?storyId=124090475

“The idea of a government-run health-insurance plan made doctors nervous, and Lyndon Johnson’s administration was worried that doctors wouldn’t take Medicare patients. So Joseph Califano, Johnson’s adviser for domestic affairs, made what seemed like a small concession: Medicare would pay doctors whatever they thought was reasonable.

That worked out well for doctors. They had been providing lots of free care for old people, and they started getting paid whatever they asked for, as long as it wasn’t wildly out of line with what others were charging.”

What’s that? “Lots of free care for old people?” Although you may not realize it, there is a ‘market’ for being human. Simply helping others to get get better, whether they can afford it or not, is often payment enough. Or at least it was, before the government got involved.

Ken April 22, 2011 at 5:04 pm

muirgeo,

Isn’t it just too crass for doctors to get paid to perform appendectomies for poor people? I mean if you were a good person, you would just do it out of the good of you heart wouldn’t you?

Regards,
Ken

Sandre April 22, 2011 at 5:41 pm

he won’t and he will call you selfish and greedy for it.

muirgeo April 22, 2011 at 6:46 pm

See this is you guys assuming an implicit tax just on the good natured among us… while the wicked profit without regard or contribution.

Capitalism is the astounding belief that the most wickedest of men will do the most wickedest of things for the greatest good of everyone?

J M Keynes

Marcus April 22, 2011 at 6:54 pm

Well, the wickedest of men are the political class so such a description can only describe some form of collectivism such as socialism or fascism.

Ken April 22, 2011 at 7:21 pm

Thanks muirgeo. As expected you delivered complete incoherence. Well done.

Ken April 22, 2011 at 7:55 pm

muirgeo,

You and Keynes seem to think there is no connection whatsoever between profit and doing the greatest good. When people realize you provide them with a product or service that betters their lives, they start to use that product more, increasing demand AND profits.

If your appendectomy patient really needs an appendectomy, but can’t afford it at the moment, nor has insurance, why can’t this person, with the assistance of the doctors, tap the capital markets to get a quick loan to pay for it? This keeps costs down. If the patient receives medical care free of cost TO THE PATIENT, this does not mean the care was cost free. That cost gets passed on to other patients. Patients who are even poorer than the appendectomy patient, because the price of EVERYTHING goes up. People now find themselves paying $25 for something, instead of $20. Or a service may no longer be offered because with the losses due to appendectomies now, these other services aren’t generating enough revenue for the hospital to stay in the black. The price of every other service provided by the hospital increases by some amount to cover the costs of the appendectomy.

The only way your appendectomy patient could EVER get a free operation is if everything else was more profitable. After all, if the hospital is to stay in business and lose money on appendectomies, it must make money elsewhere.

Regards,
Ken

crossofcrimson April 25, 2011 at 9:59 am

“See this is you guys assuming an implicit tax just on the good natured among us… while the wicked profit without regard or contribution.”

I won’t help him if you won’t help him!!

Yeah…that makes sense from a moral perspective.

Sam Grove April 22, 2011 at 7:00 pm

What do you mean there wouldn’t be enough doctors to do all the required appendectomies? Aren’t there enough now?

How many hours a year to you devote your medical expertise to helping those who can’t otherwise afford them?

What’s that? You’re too busy traipsing the Alaskan wilderness with your Sierra Club friends?

brotio April 23, 2011 at 12:48 am

Hey, Yasafi!

Happy Lenin’s Birthday Earth Day!

http://www.youtube.com/watch?v=BFuEp7y2d50&feature=player_embedded

dan April 23, 2011 at 12:11 pm

Think of the women and children…………dying in the streets…….elderly strewn all over the boulevards……..rotting corpses in landfills…………. plagues…………….. Oh, the humanity!!!!!

Krugman speaks of ‘The relationship between patient and doctor used to be considered something special, almost sacred’, yet we get a reform that has Govt having control of this relationship and preventing or mandating practices and care. Is Krugman running for office somewhere? He talks like a politician attempting to garner votes.

crossofcrimson April 25, 2011 at 9:56 am

“They and the poor will suffer the consequences while the Libertarian society rewards the selfish and greedy who of course will come out on top concerned only with their own interest.”

The terminology you employ is baffling. Rewards? By your definition(s), my car was a gift from you, I’d presume, simply because you haven’t managed to steal it yet. Absolutely remarkable.

“People of a better nature and less brutality will always be there unwilling to allow the elderly to die in their homes or to allow the poor to die on the streets outside of the hospital.”

……

“You libertarians need to admit that under your system hundreds of thousands will die and suffer severely from lack of access to health care.”

I wonder, after reading those two statements so close together in a single rebuttal, if there are any contradicting maxims you could possibly espouse that would ever result in some kind of cognitive dissonance.

kyle8 April 25, 2011 at 6:45 pm

Why should we have to admit anything so ridiculous? There are other societies, and have been in the past other societies in which health care was not administered in any way by government. The people got pretty good health care, with plenty of private charity for the poor.

In fact our own society was once like that.

SweetLiberty April 22, 2011 at 3:05 pm

Don,

In your view, should there be ANY government involvement to distribute taxpayer dollars to any part of the healthcare system at all – be it Medicare, Medicaid, R & D, etc., and if so, what or when should government intervene? If you believe in ZERO government involvement, then what should happen if the demand of “consumers” who cannot afford medical treatments exceeds the supply of charity?

Ryan Vann April 22, 2011 at 3:17 pm

Price discrimination.

Craig April 22, 2011 at 5:04 pm

What if the demand of consumers who cannot afford medical treatments exceeds the supply of the government’s coffers? Or the supply of doctors (ie. Massachusetts)?

SweetLiberty April 22, 2011 at 6:31 pm

Any time demand for healthcare exceeds supply (at any price), then people will suffer and die. The question is, which system is most beneficial to the majority of citizens (or amasses the fewest casualties if you prefer)? 1) Zero government assistance, 2) Limited government interference, or 3) Total government control? Unless I missed something, those seem to be the three options open to any society.

Charity will define the limits of aid to the poor with 1) Zero government assistance. Charity PLUS government subsidies will define the limits of aid to the poor in with 2) Limited government interference. Government’s ability to subsidies the poor will define the limits of aid in 2) Total government control (though some charities may still continue to operate in certain areas).

Many have argued that charity would increase in the first zero government scenario, but would the increase be enough to at least equal if not exceed the other two options (limited and total take-over)? Unfortunately, no one can answer this because it hasn’t been tried in a modern major nation. That’s why I’m skeptical and ask the specific questions of Don and others to state their specific policies.

Methinks1776 April 22, 2011 at 6:52 pm

Of course it has. What do you think preceded Medicare and Medicaid?

SweetLiberty April 22, 2011 at 7:06 pm

Methinks,

Well, I was shooting for something more current than 1965 or so when Medicare was created. I don’t know the political climate then or the demand which prompted the movement, but clearly there were enough votes to pass the bill – something that enough people wanted (like Obamacare today) that seemed better than the status quo. So empirically, society rejects NO safety net, something they would have no reason to do if it worked perfectly.

Methinks1776 April 22, 2011 at 9:30 pm

SL,

Medicare: Lemme see…Lyndon Johnson said “I will give you free candy!” and the people said “Yes, please!”. Shocking, just shocking, I tell you.

But, we digress. Before the false promise of free candy, there was no medicare or medicaid. So, your claim that “no one can answer this because it hasn’t been tried in a modern major nation” is clearly false. Were people dying in the gutters before medicaid and medicare? No.

enough people wanted (like Obamacare today)

What? Where have you been. Two thirds of the country was against Obamacare. As The One pushed for it and people found out more, his ratings dropped like a rock. Obamessiah resorted to threats and bribes for force the quivering, cowering Democrats to vote for it. They got spanked in the November election because of it. How in hell are you now claiming that Obamacare is what the people wanted?

Chucklehead April 25, 2011 at 2:44 am

Don’t you remember the 50′s. There were so many people dying in the streets that you couldn’t go two blocks without hitting a “speed bump.”

Dr. T April 22, 2011 at 6:56 pm

You and many others appear to believe that medical care is a right, and that government should provide that right to those who cannot afford it. But, tangible goods and services are not rights. There is no right to food, to education, to health care, to clothing, or to a home. Needs don’t make rights.

Libertarians believe that people should make their own spending choices. If some people choose not to save money for medical care and not to buy health care insurance, then such people have no right to free health care and no right to force someone else to pay for their care.

Libertarians believe that people in poverty should be helped by voluntary charity, not by establishing government bureaucracies that rob others, rake off a big chunk, and then inefficiently distribute the remaining funds to people who may or may not need it.

Charity health care can be provided in three ways: 1. Providers reduce or waive fees for patients who lack the means to pay. 2. Providers spend some of their time staffing free clinics or charity hospitals. 3. Individuals donate money to health care charities that pay the bills of needy patients. These mechanisms are far more efficient that government transfer programs such as Medicaid with its onerous oversight and paperwork. I know plenty of physicians who would provide a substantial amount of charity care in a libertarian environment, because the absence of Medicaid and Medicare hassles would free up enough time to do charity work while caring for the same number of paying patients. Physicians would much rather spend time taking care of patients than wrestling with behemoth bureaucracies.

Sam Grove April 22, 2011 at 7:03 pm

When I ran for congress, I proposed 100% tax credits to anyone who contributes to medical charity. This could include doctors and hospitals who devote resources directly.

SweetLiberty April 22, 2011 at 7:27 pm

Dr. T,

I do NOT think healthcare is a right! Nor do I think national defense, law enforcement, or my life or ownership of property is a right. However, I PREFER – which is to say I vote for policies which protect my life and property – knowing full well that I am advocating and enabling government thugs to take from me and others for what I consider the collective (as well as my own selfish) good. Libertarians (at least the majority as I understand it) do NOT believe people should make their own spending choices when it comes to national and local defense and law enforcement. Most concede the need for at least limited government in these areas. If you do not, then you are not a libertarian but an anarchist (at least by my definition).

And asserting that you and other doctors would provide charitable care and be more efficient I’m sure applies to many. But would this charity be enough to equal or exceed the quantity of healthcare currently subsidized by Medicare and Medicaid? In other words, you would trade NO payment (charity) for some payment (with high bureaucratic overhead). While this may appeal to you, certainly it would not appeal to all. If government could subsidize those in need and eliminate much of the overhead, would that not be more optimal that pure charity?

dan April 23, 2011 at 12:20 pm

If only Doctors can get tax credit for charitable work. If they do, let me know. I am friends with a doctor who is currently unaware of any credits, so far as they have told me. But, nevertheless, he performs charitable work. And, this is not ‘checkups’ or ‘turn your head and cough’ work. Very expensive and time consuming charitable work. The purpose of sharing was to contradict any assumptions that a doctor would not or does not provide charitable work, at even the highest level of practice and some of the most costly work.
And Medicare/Medicaid are the biggest pains and obstacles to his practice.

Marcus April 22, 2011 at 7:03 pm

“Any time demand for healthcare exceeds supply (at any price), then people will suffer and die. The question is, which system is most beneficial to the majority of citizens…”

No, the question is which system most effectively signals low supply in such a way as to entice new suppliers and new innovations into the market to better meet demand.

Markets are not static, yet no where in your post was anything about innovation or any other dynamic market feature by which the market increases supply and drives down price.

We’ve seen some attempts with clinics opening up in Wal-mart, for example, yet such attempts meet with unbelievable resistance from political groups such as the AMA. Just one example that comes to mind off the top of my head.

Dr. T April 22, 2011 at 7:38 pm

“Markets are not static…”

Many people do not know that by using its “power of the purse” over medical schools (that get a substantial portion of operating funds from the federal government), the federal government has prevented existing schools from expanding and blocked the formation of new medical schools. This has been going on since the 1980s. The federal government believes that there are too many physicians and far too many specialists. It has artificially reduced the supply of physicians, which partly explains the high costs of medical care.

SweetLiberty April 22, 2011 at 7:42 pm

I HATE that those clinics were closed! And as for market forces and signals – you are right, they are at best highly skewed when government interferes. However, we DO have innovation now even with government interference. You assert it would be even more without it I’m sure. But again, it boils down to whether or not a complete lack of government subsidy will result in fewer lives lost (or prolonged if you prefer) than some measure of government assistance. Is there a sweet spot where, through limited taxation and redistribution, government subsidies could take up the slack where charity leaves off?

vidyohs April 22, 2011 at 9:51 pm

@SL
Why are you so determined and so cocksure that it is incumbent upon me to ensure that people I do not know, people to whom I have no relationship, people that I accept no responsibility for, People whom I will never even see, stay healthy and alive?

Why should I squander my own personal resources, which I compiled to solely dedicate to those for whom I take responsibility, on the people I mention in the last paragraph. Does that squandering improve the lot of any of us?

Is it really a good thing for all individuals to think like you? Can we not have a world in which you can squander away and I can horde, and we both suffer or benefit from our own personal individual decision?

No, it seems we can not.

BaltoSteve April 23, 2011 at 9:32 am

“Why are you so determined and so cocksure that it is incumbent upon me to ensure that people I do not know, people to whom I have no relationship, people that I accept no responsibility for, People whom I will never even see, stay healthy and alive?”

Wow. Seems you’re okay with theft, murder, genocide, so long as it doesn’t affect anyone you know. Nice.

brotio April 23, 2011 at 3:50 pm

Seems you’re okay with theft, murder, genocide, so long as it doesn’t affect anyone you know.

I reread Vidyohs’ reply to Sweet Liberty, and I couldn’t find anything suggesting what you assert.

However, from the tone of your response, I get the impression that if you object to the genocide in Rwanda, then you believe Vidyohs should be compelled at gunpoint to pay to do something about it. That is, I’m sure, far more compassionate then letting Vidyohs decide for himself if the Rwandan people should be on his charities list.

God knows Americans never respond to those televised pleas from the Christian Children’s Fund.

rmv April 22, 2011 at 7:28 pm

“Any time demand for healthcare exceeds supply (at any price), then people will suffer and die.”

RAND experiment?

WhiskeyJim April 23, 2011 at 12:57 am

I respectfully say this is the kind of idealist, leftist straw man we get in the news. And the choices are all wrong. Here are three more realistic choices:

1. No government assistance and few regulations, allowing the cost to decrease while quality rises, making health care more affordable to all. The poor would rely on charity.

2. Governments subsidize the poor with direct cash payments to purchase health care on the open market described above.

3. Limited or total government control of institutions and health care delivery through regulation, which drives up the cost of health care, rations medical treatment, and bankrupts the nation (e.g., every country with socialized health care).

Those are your real choices. Pick one.

Don Kenner April 23, 2011 at 5:24 pm

WhiskeyJim, you summed it up perfectly. People want option 3, but with the benefits of option 1 or 2. That dog won’t hunt.

crossofcrimson April 25, 2011 at 10:03 am

“The question is, which system is most beneficial to the majority of citizens (or amasses the fewest casualties if you prefer)?”

You’re already assuming the answer to your own question. If the only metric you’re using is “fewest casualties” then many of our answers to you will make little sense. Many of us have a problem with that premise.

Methinks1776 April 22, 2011 at 3:05 pm

How did it become normal, or for that matter even acceptable to refer to this hack as an “economist”?

gregw April 22, 2011 at 3:53 pm

When guvmint skools managed to brainwash a huge percentage of the population.

Crazy, it’s the new normal.

Mesa Econoguy April 22, 2011 at 4:03 pm

Indeed.

This is exceptionally ignorant, even for Kruggybaby.

Ryan Vann April 22, 2011 at 3:14 pm

When where those halycon days exactly? I can’t seem to remember any secret handshakes or loving gazes from my doctors at any point in my life. Though I did visit an urologist with remarkably soft hands once; he had some flattering remarks about the Vann family jewels, but I digress. Anyway, when has the doctor patient relationship ever been much more complex than the following?

Patient: I think there is something wrong with me.
Doc: Can you take a deep breath for me.

Les Wes April 22, 2011 at 3:17 pm

SL,

I’ve never heard of Charity and the needy being modeled by supply and demand. I’m having a hard time wrapping my head around it. Do you perhaps have an article or link on the subject?

Seems like Supply follows Demand because Supply stand to profit. But Charity supply isn’t motivated by profit. . . Charity Demand is motivated by profit.

Frank33328 April 22, 2011 at 3:43 pm

Not all “profit” is messured in dollars and cents.

Les Wes April 22, 2011 at 3:56 pm

Right, but those benefits don’t have any relation to cost and are hugely different for different givers. In the charity system, profit goes the other way, from suppliers to demanders. The suppliers “profit” is largely self-esteem, percieved fulfillment of social obligation, fellowship with the recipient. That’s why I asked about using supply and demand to talk about charity in the first place. . . I don’t understand how it makes sense.

Emil April 22, 2011 at 4:09 pm

Not all cost is measured in dollars and cents either

Les Wes April 22, 2011 at 4:21 pm

OK, now you’re just trolling.

Emil April 22, 2011 at 6:43 pm

No

John Sullivan April 22, 2011 at 3:20 pm

If the individual shouldn’t have to pay, then the society must pay through the socialization of the industry, but societies, still, can only pay for what they can afford, or what they can tax their people.

The way things work in this country is that the poor and middle classes will pay through the devaluation of their money.

John Sullivan April 22, 2011 at 3:22 pm

I’m not for the socialization of anything, but want to point out that whatever is done, nothing is ever free, or sacred, etc. We are already printing the money to pay for the entitlements we can’t afford.

Dave April 22, 2011 at 3:26 pm

Would Krugman deny that these “sacred” patients consume health care resources? Call them what you will, but the health care still comes down to a question of how scarce resources will be allocated for consumption.

A question for Don:

Do you think that hospital care for those in need should be compulsory by law as it is today? In other words, if the police find someone beaten up, unconscious, and near death, should an emergency room be obligated to save the patient without any consent from the patient or knowledge of his or her ability to pay?

I see this as one reason why “health care is different” at least to some small extent, as the current law stands. Many people are understandably comforted by this legal obligation of the medical community, but it raises questions of whether all health care can be treated the same as other normal goods. I see this as somewhat of a corner case that shouldn’t dominate the debate, but an important detail, none the less.

Matt April 22, 2011 at 4:24 pm

I would love to hear the response to this.

Matt April 22, 2011 at 4:26 pm

In a good way.

John Sullivan April 22, 2011 at 5:28 pm

Many things in society are socialized by democratic consent. Emergency care is a minor aspect of the category Health Care. It shouldn’t “raise questions” about whether or not ithe industry needs to be nationalized. What about food? Why wouldn’t “food care” be any different. We all need it to live and to be healthy. The fact that we have food stamp programs for people doesn’t “raise questions” of whether all food care should be treated the same as other ‘normal’ goods.

I could go to expensive restaurants every night of the week if you’d pay the tab.

Dave April 22, 2011 at 5:51 pm

John Sullivan,

I don’t think we are disagreeing here. Note that nowhere in my comment do I suggest health care needs to be nationalized. When I wrote, “it raises questions of whether all health care can be treated the same as other normal goods,” I meant that receiving compulsory emergency care without giving consent when unconscious is very clearly a different type of consumption than buying a bagel (or any other good or service), while other (most, I believe) forms of health care consumption are quite similar to purchasing other goods and services. Yes, such cases are relatively small compared to total health care expenditure, but I think this is the sort of thing people worry about when free marketeers want to liberalize (in the classical sense) health care.

Personally, I think health care costs would be more effectively contained through consumer choice and competition, taking away tax incentives that link insurance to employment, etc. But if you want a freer market for health care, you need to directly address tough, reasonable questions that the opposition will pose. I think questions of emergency care fall under that umbrella.

John Sullivan April 22, 2011 at 7:49 pm

In mentioning nationalization, I wasn’t refering to you. I should have made that clear, sorry.

These questions you want asked, in your last paragraph, aren’t really that relevant. Most of the people against socialized medicine aren’t just libertarians. Even most libertarians wouldn’t take the extreme positions you bring up. I mentioned food and food stamps. I could have also mentioned that the government provides free legal defense for people accused of crimes who can’t afford a lawyer. Not every libertarian is for a total voluntary society, and there are so few that do, that they don’t matter.

These things I mentioned above, food and legal welfare, and emergency care at hospitals, aren’t what’s bankrupting the country. There aren’t too many free market types who wake up every day looking to argue with people about these laws. There are far too many other areas where the government has violated our liberties with far less democratic consent than emergency hospital care.

The argument to allow the government to manage one sector of the economy could be made for every other sector too. Food is the classic example. Why shouldn’t the government be controlling our diets?

Dave April 22, 2011 at 8:07 pm

Again, I think we’re mostly in agreement… But Krugman does bring up the type of issue I mention when he states:

“Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.”

And you’re right that most libertarians probably aren’t so extreme about their health care positions as to want to deny compulsory emergency care, but Don is pretty extreme. I can’t remember reading an example of him defending any government regulation on commerce. That’s why I directed the question at him – I’m curious as to how extreme his positions get on this subject matter.

Methinks1776 April 22, 2011 at 10:56 pm

Dave,

In answer to Krugman’s hand wringing, I say – who cares?

A lot of the important decisions you make in your life will be made under stress, when immediate action is needed and where you are at an informational disadvantage. You are free to enlist the help of anyone you wish to help you make that decision. You can sign a health care proxy to allow a loved one you trust to make medical decisions for you if you are in that state. There are many possible solutions to these “scary” problems that you should be free to choose from.

Read Krazy-eyes Krugman again. He is arguing for the imposition of a single solution – a medical board that knows less than anyone about you and couldn’t possibly give less of a shit about you. All other options will be cut off to you. And you want to talk about Don’s “extremism”?

Edward Jenkins April 22, 2011 at 3:38 pm

When was the patient – doctor relationship ever “almost sacred”? Krugman is delusional.

Matrim April 22, 2011 at 3:41 pm

I read that article earlier today while I was out at lunch and found myself wondering what was going through Krugmans mind that he can’t wrap figure out why healthcare is a consumer good. He probably believes that’s a public good and/or an inherit right.

Economiser April 22, 2011 at 3:56 pm

The doctor-patient relationship may have been “almost sacred” back in the not-too-distant past when the only thing a doctor could do for a patient was to pray.

Methinks1776 April 22, 2011 at 3:59 pm

Amen.

gregw April 22, 2011 at 4:02 pm

“The relationship between patient and doctor used to be considered something special, almost sacred.”

I make a point of asking progressives to explain their various formulations of politico-mysticism in human affairs. They never can, or better, they pretend they were never asked.

Ironically, they always claim “science” and “logic” for themselves while routinely engaging in mysticism starting with some weird idea about a “general will” and “The People” as if “we” was a unit. (Did anyone hear Obamination talk about a Rousseau’s “social compact” they other day? Nary a deep thought shall ever cross the rank-and-file progressive’s shallow little grave of a mind.)

Andy Wagner April 22, 2011 at 4:16 pm

Perhaps, as this author argues, if doctors did treat patients as “customers”, the cost and quality problems in healthcare would diminish as they have in more consumer focused industries.

http://www.leanblog.org/2011/04/when-you-know-what-good-looks-like%E2%80%A6/

SweetLiberty April 22, 2011 at 4:29 pm

Les Wes,

Your question is tangential to the argument I’m making, but this is an excerpt I found from Miri Rubin that defines the notion better than I can, “In purely economic terms one can make a distinction between what may be called the demand for charity by the poor and its supply by the rich and by charitable institutions. Both the demand and the supply are influenced by economic factors: changes in a society’s prosperity and in the distribution of wealth affect the facility with which funds can be allocated for the help of strangers. Concurrently, they also affect the number of people experiencing the need to receive charitable relief.”

A wealthy society MAY have an abundance of charity to cover those truly in need – but IF it does not (because not enough people wish to contribute even though they could), IS there a role for government – or do we let those who could otherwise be cured simply perish?

It is my experience that pundits like Don won’t directly answer the question as to whether there should be any government involvement in healthcare, and if so, specifically what that involvement should be, because he will either alienate the ideologues who follow him, or he will cast himself into such a social minority as to be readily dismissed by the majority as a fringe anarchist.

But to me, the very real and pragmatic question of how society should fill in the healthcare gaps between charity and need is one that libertarians must address honestly. Either the government should never interfere – letting the chips (and bodies) fall where they may, or government should intervene under certain circumstances (or all circumstances from a liberal perspective).

Don may consider this as an “Open Letter” challenge to state his specific policy position, the kind of challenge he is found of offering others even though he, like I, don’t really expect a direct response to for the reasons I’ve stated.

SweetLiberty April 22, 2011 at 4:32 pm

EDIT: Make that “fond”, not “found” in my last paragraph.

Les Wes April 22, 2011 at 5:04 pm

Thanks for the exposition! The effects are perhaps more psychological than economical. There is maybe some hysteresis effect where more giving reduces need and thus reduces giving, which increases need. . .
I certainly don’t want to speak for Don, but I suspect the answer lies along the line of the mechanism of the “role for governement”. Namely, force. Should people be allowed to be selfish? If a man with groceries walks past a starving person, are you allowed to use force to take his food and give it to those in need?

Back in the real world it is difficult to defend this position because government so clearly helps certain people amass ridiculous amounts of ‘groceries’, but in tandem with eliminating the corporatist state, government itself could be reduced to executing Justice and not Charity.

The Libertarian position you see does seem brutal if you ignore all of the other related tenants of the Libertarian ideal.

SweetLiberty April 22, 2011 at 6:04 pm

“The Libertarian position you see does seem brutal if you ignore all of the other related tenants of the Libertarian ideal.”
The libertarian position IS brutal – every man for himself – charity based solely on whim, absolutely no government (collective) safety net. Yet I’m very open to the possibility that, relative to the alternatives, this just might be the path to greatest prosperity for the most people. But, as the increasingly obnoxious muirgeo points out, such a system of any significant scale has yet to be tried in modern civilization.

So on paper, it may sound good – but in practice, people won’t vote for it. They want to know that if they fall on hard times, there ARE options other than charity – government options. I myself wouldn’t be here today were it not for a government program which saw me through two bouts of cancer in my early twenties. So in principle, I’m philosophically on board with many libertarian ideals, but in practice – I just don’t know that they would pick up the slack the way a limited means-tested healthcare safety can. Is our current system (and the upcoming Obamacare) out of control? Seems obvious. But ZERO government safety net? I want to believe such a system could work as well if not better than what we currently have, but I’m having trouble seeing it.

Les Wes April 22, 2011 at 6:31 pm

I think you are conflating the government perspective with the personal perspective. With respect to justice, it *is* every man for himself. (you can serve someone else’s jail term for them). That doesn’t mean that everyone who expects justice from their government conducts the rest of their life in that Rorschach-ish manner. But of course no one has every tried it.
The other side of this is that the way government solutions are funded now is also brutal. It answers the question “Should people be allowed to be selfish?” with a firm “No!”. They are forced to contribute.
For partial disclosure’s sake, all these answers are relatively easy for me because I’ve been lucky enough to stay healthy. I don’t think there would ever be ZERO safety net, because people would still build one voluntarily, as a part of government or separately. If Medicare said, we will no longer be assessing taxes for our costs, we will only take donations. . .what do you think the result would be?

SweetLiberty April 22, 2011 at 6:57 pm

I think there would be donations – but they wouldn’t collect nearly as much or be able to help as many as they do now. Just my guess.

geoih April 22, 2011 at 6:24 pm

Qoute from SweetLiberty: ” IS there a role for government – or do we let those who could otherwise be cured simply perish?”

Where is this “government” you speak of? “Government” is only a word to describe a group of individuals that wield a monopoly on force. It is not some angel of mercy, some beneficent diety, capable of solving all problems. It is made up of individuals as capable of being selfish and self-intersted as any other individual, only these individuals in government have the added benefit of being able to act with virtually no consequences to their actions.

The idea that “government” can somehow provide medical services without scarcity and outside of the laws of supply and demand is simply fantasy. Tasking “government” with this responsibility will not change economic reality. In order to give away medical services, some individual has to give it or pay for it. “Government” can only ‘give’ what it has already taken from somebody else.

SweetLiberty April 22, 2011 at 6:54 pm

“Where is this ‘government’ you speak of?” Washington D.C. you idiot! (Just kidding – I do get your question.)

I’m not arguing that government takes from some to give to others – that’s a given – but whether or not this forced redistribution in the realm of healthcare, even on a limited basis, isn’t preferable to the alternative for the majority. Many libertarians already advocate that government “force” everyone to contribute to the national and local defense to protect their person and property via armies and courthouses, so is any additional forced contribution to further protect a person’s life by subsidizing their healthcare (when they cannot afford the full burden) completely out of the question? In other words, libertarians are willing for government to protect their lives from threats larger than themselves (foreign or domestic), so why not medical threats to their lives which are far more prevalent and likely than dying from a terrorist attack or getting robbed or mugged? Is ANY safety net provided by forced redistribution preferential to NO safety net? To gain the votes of the majority, you would need to demonstrate that indeed, no safety net would save more lives than a limited government (or total government) solution.

geoih April 23, 2011 at 5:22 pm

Quote from SweetLiberty: “… libertarians are willing for government to protect their lives from threats larger than themselves (foreign or domestic), so why not medical threats to their lives …”

Because medical threats are not the same as threats from foreign armies.

Your appeals to the majority, or to saving more lives, are not logical. At one time in the past the majority believed that slavery was a fine idea, but did that make it right? If we can save lives by confiscating a small amount of money for the safety net, why not a safety net for all (much like we are going to get with ObamaCare)? Utilitarianism is nothing but subjective opinion.

crossofcrimson April 25, 2011 at 10:24 am

Just food for thought (IE: maybe not a substantive point) – But, if most people won’t give of their own accord, how/why do we move forward to institutionalized such an act in a modern democracy? Its seems to me that if such a group already maintains a significant plurality, and if this plurality doesn’t simply consist wholly of the poor or needy, then the resources already exist to implement such program voluntarily. Surely we’re not saying that we can’t trust the people, in general, to give but we can trust them to elect people who will force them to give. It just strikes me as odd.

brotio April 25, 2011 at 6:51 pm

Excellent point. I hope you don’t expect a cogent answer from Ducktor Yasafi.

muirgeo April 22, 2011 at 4:33 pm

Remember not-an-economist… Don you are not-a-physician and you have no idea of the subject of which you are here speaking of. It is with out a doubt outside the field of simple economics. Not all of society will bend to the economists ideas and that is why and how we do live in a civilized world.

All the rest of the world prooves you wrong providing as good of care as us for less via varying degrees of government plannig. Your solution exist NO WHERE in the civilized world for good reason… there is NOTHING civilized about your position. In time you would have aas many deaths on your hands as all communist dictators combined. But I’m sure it would proove a very interesting experiment for the world of liberal economist.

Methinks1776 April 22, 2011 at 4:47 pm

I used to think you were a high functioning drug addict (not as uncommon among doctors as people would like to believe).

I am now certain I’m wrong.

You are not high functioning.

Slappy McFee April 22, 2011 at 4:48 pm

Ok, so how does it succeed? I have yet to have anyone actually point it out. How are you able to place price caps on medical services and not have shortages? Why is socialized medicine the only market place that this occurs?

SweetLiberty April 22, 2011 at 5:00 pm

“All the rest of the world prooves [sic] you wrong providing as good of care as us for less via varying degrees of government plannig [sic].”

All the rest of the world? Really? Africa, India, Russia, China, etc.. are all providing “as good of care” for less?

I’ll try to pin you down as well: Precisely what degrees of government planning do you advocate for? What country should the U.S. model ourselves after in your opinion? What irrefutable sources can you point us to that proves your case?

Ken April 22, 2011 at 5:17 pm

muirgeo,

Selling a product is selling a product. It doesn’t matter if you selling pens or penicillin, web development or medical consultation, trade is trade.

“providing as good of care as us for less”

The care does NOT cost these governments less, nor is it as good as care you get in the US. By definition, a product cannot indefinitely be sold at less than cost. Since medical COSTS are rising, medical PRICES rise as well. Government sponsored medical care costs more than medical care paid out of pocket for some pretty basic reasons. Here are three:

1. Instead of paying $150 for a doctor’s visit, people pay $500 in taxes, then pay a $20 copay. That’s not even including the additional employer sponsored insurance (my insurance costs $12K/year; I’d rather have that money diverted to a tax deferred account like an HSA rather than buy the “insurance” that I have; and thanks to government regulations surrounding medical insurance, my company offers only 10 or 11 different plans, none of which include an HSA).
2. Now that you only have to come up with $20 whenever you visit the doctor (you pay the balance later on April 15), you’ll see him more often for less demanding reasons, tying up precious resources.
3. Since the gov is “paying” for your medicine, you have to go to their approved doctors instead of shopping around.

There is absolutely nothing civilized about your position to increase medical costs, unnecessarily tie up medical resources, and incentivizing bright, young people to go into any profession except the medical. All of which makes everyone’s (except those in political favor) lives worse off.

Regards,
Ken

crossofcrimson April 25, 2011 at 10:26 am

“there is NOTHING civilized about your position”

Except for the whole non-violence thing. Or is that what you mean by “civilized?”

Slappy McFee April 22, 2011 at 4:43 pm

There are a few internal quarrels I do have regarding health care as a marketplace:

1) The consequences of my actions may take so long to become a detriment to my health, that the costs associated with those actions seem almost unrelated.

2) Since it seems that the bulk of medical spending seems to be keeping the almost dead alive, government rationing may be the least “immoral” option.

3) The unknown consequences of externalities (lead paint and whatever) make it difficult for an individual to take account of all the various costs of living.

4) Can an economy (yes, I apologize for making it an aggregate) absorb the inefficiency of a government health care system?

Methinks1776 April 22, 2011 at 4:56 pm

1.) For most diseases, those costs are less related than you think in the vast majority of cases.

2.) No, it isn’t. Keeping the almost dead alive is a decision that should rightly be made by the almost dead and their loved ones. They should also be the ones to pay for it, though. My bet is that they won’t find it worth it.

3.) Shit happens. Life is full of randomness. Why does that fact entitle you to force others (who are, incidentally, subject to the same random forces of life) to pay for your bad outcomes.

4.) It has been my experience that there is virtually nothing that human beings can’t absorb as a species. How pleasant your life will be is the only question.

Slappy McFee April 22, 2011 at 4:57 pm

Yeah — I agree with you on all counts, but I guess its still my soft underside.

Methinks1776 April 22, 2011 at 5:08 pm

Well, then do what the rest of us do (and I’m sure you have already done) – write a check and help someone in need. God only knows there is no shortage of people willing to help out folks in need in this country.

Don Boudreaux April 22, 2011 at 5:01 pm

You, my friend, are a natural economist – blessed with an instinct for the economic way of thinking.

WhiskeyJim April 22, 2011 at 4:49 pm

Mr. Krugman appears to commit another fallacy. Even if there is a transaction governed by ‘sacred’ religious overtones, it does not necessarily follow that governments erect institutions to mediate and control them.

On the contrary.

Much more logical that if a minority of the population can not afford such a (private) sacrament, that insistent governments subsidize the person rather than invade the relationship. After all, It is sacred.

muirgeo April 22, 2011 at 4:57 pm

You guys can not even begin to talk about this subject with any real world seriousness. You talk in your neat neoliberal sterile obsessive compulsive hyperbolic well detailed theories about how effecient and quaint YOUR free market medical care system would be… In fact none of you can give an answer to what happens in the real world DESIGNED by you. You can’t discuss what will happen to high risk elderly patients living off of their social security ( oh wait they don’t even get that in your world), or the poor child diagnosed with leukemia or diabetes, the pegnant preterm lady with twins and no insurance.

What happens to these people in your world to these poeple. I challenge one of you to admit that they should just die. But I bet what you think happens to them is the same thing that happens to our poor now…. you don’t even admit or recognized that they exist… because elike a tree falling in a forest if you are not there to see it it must not have happened.

Slappy McFee April 22, 2011 at 5:00 pm

You have the floor – how are the forces of supply and demand non-existant in the world of socialized medicine. If they do apply, then the end result of subsidizing others healthcare is total economic collapse. Just like empire building. Ask the Romans, or British, or etc….

muirgeo April 22, 2011 at 10:13 pm

No it’s not total economic collapse. We could easily provide the care everyone needs. We are already spending way more than we need to because insurance companies and their leion of health care deniers are all making billions of dollars denying care. We need to fire all the insurance company workers and retrain them to be health providers and not health care deniers. Wew can even pay them their sae salaries… the CEO’s areall shit out of luck as are the share holders.

The reason our health care is so expensive is because the privat e markets are screwing the public.

Methinks1776 April 23, 2011 at 8:53 am

So, idiot, are you aware that Medicare and Medicaid are the biggest “health care deniers”? Are you aware that they raise the amount we spend on health care because they not only raise the demand for health care but shift the cots to non-medicare, non-medicaid patients? Abolish Medicare and Medicaid.

Yes, I know you haven’t a clue what year it is. I write this in case someone with more brain power didn’t know this – like an amoeba, for instance.

tdp April 24, 2011 at 8:15 pm

Has anyone diagnosed you with diarrhea of the mouth yet?

Sam Grove April 22, 2011 at 5:20 pm

Actually, we’re going to require doctors to provide 20% of their practice to charitable cases.

Ken April 22, 2011 at 5:28 pm

muirgeo,

15 years ago I couldn’t even imagine never having to go to a store again to get the goods that I want. I wouldn’t have imagined that I could turn on a computer, order something that costs less than locally provided by the stores in my area, and have an unlimited amount of goods delivered to my house for the annual shipping cost of $79 dollars.

10 years ago I couldn’t imagine a device that allowed me to access information, store that information, play music, keep in touch with whomever I wanted no matter where in the country I was.

I do not let my limited imagination keep others from doing as they please. My life shouldn’t be limited because you’ve got shit for brains and zero imagination.

And the people you mentioned likely would do far better in a world without government regulation because medical technology would be moving at the pace of computer technology and COMING TO MARKET AT THE SAME PACE, so your leukemia patient would have more choices. Also, insurance would cost less (insurance generally can’t be sold across state lines and if I buy insurance independent of employer provided insurance I do not get a tax break), there would be more people providing services (government licensing keeps existing provider’s wages high by fucking over people who would be willing to see a less qualified practitioner because something is always better than nothing), so your uninsured lady now has no excuse to not have insurance since even now you can get a policy for around $100/mo. All this increased competition lowers prices, so over the course of a persons life that old person you mentioned won’t rely on SS for his retirement; he will have saved enough to pay for it himself.

You fail to realize that the most screwed up and ossified sectors of the US economy are the ones MOST heavily regulated by government.

Regards,
Ken

crossofcrimson April 25, 2011 at 10:28 am

“In fact none of you can give an answer to what happens in the real world DESIGNED by you.”

Apparently it’s difficult for you to escape the idea of central planning. Free != “DESIGNED”. I would hope that much is obvious, but then again…

muirgeo April 22, 2011 at 5:08 pm

OK so methinks is the owner of a rural hospital. She gets a call from the covering Emergency Room doctor explaining that a mother with 25 week gestation twins just arrived bleeding profusely and is about to deliver. She has no money and no insurance. In this methinltopia world she (methinks) has no legal liability to provide care and can not write off any care she delivers.

What does the CEO methinks say to the ER doc? What does she do? What happens to this mother and her babies? ANYONE?

Ken April 22, 2011 at 5:35 pm

muirgeo,

What do you do about the elderly man who fell down a flight of steps and nicked his femoral artery and now has at most 5 minutes of life left by the time he gets to the hospital? This man had the unfortunate circumstances to arrive at the same rural hospital as your pregnant woman. Since there now isn’t enough staff to care for both, what do you do?

You seem to not understand that prices reflect the REALITY that not all people can have all things all the time. Resources are finite and have to be allocated intelligently. A bureaucrat in DC has no idea what resources this rural hospital has, much less to whom to allocate them. But that bureaucrat gets paid the same with yearly salary increases whether or not that old man or the pregnant lady or both die.

Regards,
Ken

SweetLiberty April 22, 2011 at 5:43 pm

Why do you dodge a direct question, yet expect people to answer yours?

Here it is again, in case you missed it…

Precisely what degrees of government planning do you advocate for? What country should the U.S. model ourselves after in your opinion? What irrefutable sources can you point us to that proves your case?

muirgeo April 22, 2011 at 10:00 pm

We are the richest nation ever. We could very easiliy provide for all the care needs of our population. Almost…no not almost …. EVERY other developed nation has been providing as good of care or better care for ALL of their citizens for far less.

Medicare works, medicaid works the VA works…. we just need to fund them properly. There is p[lenty of excess money going to the military and plent ogf subsidizes and uncollected taxes that could easily fundeverything we need.

http://lamarguerite.files.wordpress.com/2008/07/obesity_rates_by_country.jpg

http://www.woodstockctcafe.com/wp-content/uploads/2009/07/who-ranking-of-health-systems-by-country.jpg

brotio April 23, 2011 at 3:11 am

Note that Yasafi answers BV four hours after your post, but he doesn’t answer your direct question.

This is nothing new. Yasafi has been ducking questions at the Cafe for over five years, now.

BV April 22, 2011 at 5:58 pm

I do the moral thing and give her the best care that I can.

Would you only treat her if someone else clubbed a few strangers on the streets and brought you the contents of their wallets?

Yeah … you’re the moral one.

muirgeo April 22, 2011 at 10:02 pm

You would quickly be out of business my friend. That one case could easiliy run into $500,000 dollars.

Ken April 23, 2011 at 1:46 pm

muirgeo,

Are you saying it’s better for this woman and baby to die, so that the hospital can stay open to treat many more others?

Regards,
Ken

muirgeo April 24, 2011 at 9:13 am

I am telling you that is what YOU are saying…wanting…promoting.

Ken April 24, 2011 at 12:28 pm

How am I promoting this? You said “You would quickly be out of business my friend. That one case could easiliy run into $500,000 dollars.”

Would you or would you not treat this person and go out of business guaranteeing that you wouldn’t be able to help anyone else?

muirgeo April 24, 2011 at 3:37 pm

Ken ,

My point is I would not want to be put into that position. Physicians and patients should NOT have to be and DO NOT have to be put in that positions. It is a lose-lose position. Either I sit and watch them die or I go out of business never being able to care for the next one that comes along.

brotio April 24, 2011 at 5:12 pm

You vicious little hypocrite.

On numerous occasions, you have idiotically claimed that human beings are born altruists. If this is the case, then the socialism you love and adore has weeded it completely out of you.

I doubt there is an individualist at this Cafe, upon seeing a pregnant woman helpless, and bleeding, who wouldn’t spring to action to do everything to save that woman’s life, and would worry about how she was going to pay AFTER the woman was stable – recognizing that it may take years for her to completely repay her debt. Yet you, Ducktor Compassion, stand there telling the world that you wouldn’t lift a finger to help her until you were sure you were going to be compensated in the lavish manner you are accustomed to. After all, you have booked another carbon-spewing vacation to Exit Glacier, and God damn anyone who would expect you to forsake your pilgrimage.

You are an ugly, mean little troll, with a heart darker than any man I’ve ever met, and you would fit in very nicely in the Soviet hospitals that Methinks describes, where nothing is done until the bribe is paid – regardless of the life-threatening urgency of the situation.

Please, regale us some more of the brilliance of Komrade Marx, and why his socialist altruism is superior to libertarian reality.

Methinks1776 April 24, 2011 at 5:46 pm

Well said, Brotio. Well said.

brotio April 24, 2011 at 6:42 pm

Thank you!

Ken April 24, 2011 at 7:46 pm

muirgeo,

“My point is I would not want to be put into that position. Physicians and patients should NOT have to be and DO NOT have to be put in that positions. It is a lose-lose position. Either I sit and watch them die or I go out of business never being able to care for the next one that comes along.”

What does this even mean? Are you really saying that there are no hard choices in life? YOU are the one who came up with this scenario. Either treat the woman and go bankrupt or do what you can, but probably not enough. Are you really so childish as to think that these things don’t happen. Or even worse live in some fantasy world and think they “shouldn’t” happen? Whatever the hell that means.

You are truly a dishonest person. You come up with a scenario that is likely to happen in any area of the world: do everything you can for one person and go bankrupt or concentrate on the many that you know you can save by staying in business. Then get all bent out of shape when it is pointed out that there is NO satisfying solution to this situation. Many situation or just that: unsolvable and tragic. Saying it “shouldn’t” happen is being a four year old, throwing a temper tantrum, then stomping around saying “Lalalalala!! I can’t hear you!!!”

Regards,
Ken

brotio April 24, 2011 at 9:00 pm

Saying it “shouldn’t” happen is being a four year old

He’s been mistreating four-year-olds for so long that he’s now become one.

Actually, that’s not fair to four-year-olds.

lamp3 April 22, 2011 at 6:20 pm

Methinks tells the ER doc to accept the patient, and records this story.

Patient gets well, kids are fine. Publicizing this incident opens up more donors in the community and reassures paying consumers because even the poor get good outcomes. Methink’s Medical Center publishes detailed reports of its charity care as a multipronged marketing strategy to shutdown the Muirgeo Clinic. MMC pulls patients away from Muirgeo Clinic by exploiting Muirgeo’s image of being focused on profits over patient care.

muirgeo April 22, 2011 at 10:09 pm

Again….. as i said… you will not be able to discuss this in any real life serious sort of way. How are you going to pay for the $500,000 in care this mother and her babies could easily cost?… without going out of business?

lamp3 April 25, 2011 at 3:13 pm

Presumably if future expected benefits outweigh current costs, it makes sense to do this. If it is unlikely and the resources involved in this person’s care is better used elsewhere, then of course this patient would die and another might live better. Decisionmakers at MMC would be the best people to know, and should choose accordingly.

It is always sad when outcomes are poor, and everyone’s push for profits would also mean that resources are used most effectively. This means the costs of care go down, allowing for greater competition and lower prices for consumers — making the calculus of risk and benefit favor saving the above woman’s life.

Do you propose that resources always be used even when the returns are poor, and steal wealth at an ever increasing rate to deal with diminishing returns?

Methinks1776 April 22, 2011 at 6:36 pm

What does the CEO methinks say to the ER doc?

“What the F**K are you doing on the phone with me when you have a patient bleeding do death?!!!”

What does she do?

Threatens to fire the attending and slams down the phone.

What happens to this mother and her babies?

Is Methinktopia in France? If it is, we deliver the 25 week preemies and see if they’ll make it without extraordinary care. Survival of the fittest and all. If they do, cool. If they don’t, we record it as a fetal death so it doesn’t count in our infant mortality statistics.

I’ll take the cost of this care out of the doctors’ and nurses’ compensation, of course. After all, you’re not engaging in this sacred work for mere dirty money, right? Dr. Methgeo?

muirgeo April 22, 2011 at 10:07 pm

Again you have no idea what you are talking about. How will you make up the $500,000 this could easily cost you??

Again… as I said… you can’t even begin to talk about this subject with any degreee of seriousness.

“I’ll take the cost of this care out of the doctors’ and nurses’ compensation, of course. After all, you’re not engaging in this sacred work for mere dirty money, right? Dr. Methgeo?”

See you don’t get to do this because again we are talking about Met=hinkstopia were doctors DO NOT work for free and you would quickly lose your staff if you didn’t pay them.

maximus April 22, 2011 at 10:40 pm

“See you don’t get to do this because again we are talking about Met=hinkstopia were doctors DO NOT work for free and you would quickly lose your staff if you didn’t pay them.”

You work for Kaiser. By your own admission. How is you have to worry about Kaiser’s staff being paid? That’s the corporation’s problem. Tell me why your responsible for making a payroll.

Methinks1776 April 22, 2011 at 11:07 pm

Moron,

I know for a fact that it doesn’t cost $500K to treat this woman – and that’s in NYC. Know how I know this? It actually happened to a friend of mine. Why do you – supposedly a doctor – not know this?

See you don’t get to do this because again we are talking about Met=hinkstopia were doctors DO NOT work for free and you would quickly lose your staff if you didn’t pay them.

Oh, I see. So, doctors are the only ones who need to be paid to work. We cannot ask doctors to sacrifice a single sheckle. Your solution is to not force doctors to pay for it but to club strangers on the street and rob them to pay for it so that they can’t feed their kids.

BTW, if you plan to club “The Evil Paper Pushing Rich”, you’re out of luck. They have guns.

So, what you’re basically saying is that if you can’t get the funds to treat all such women woman (and you won’t and they will come out of the woodwork claiming they can’t pay) by robbing someone else, you’re just going to let her bleed out on your table.

So compassionate, I can hardly stand it.

muirgeo April 23, 2011 at 6:41 am

See your solution is to force some one to pay for it as well. That is why EVERYONE pays for it… not just some stranger. We all pay and we all benefit. That’s precisely the best way to provide health care. That so called stranger you say I want to club for his money got free care before he ever contributed a dime to society. He will pay now during his productive life and will also benefit when he is older and no longer being clubbed but benefitting from some one else clubbing.

We ALL get clubbed and we ALL get cared for. But no one will be making billions of of stock options and for successfully denying care to those in need. Those people will now be available to be retrain as health care providers making something useful out of themselves rather then parasitizing society.

Methinks1776 April 23, 2011 at 8:27 am

Muirdiot,

You are a moron. The rugrats unfortunate enough to be assigned to you have better reasoning skills and a a better knowledge of history and, yes, understanding of options than you.

Ken April 24, 2011 at 1:35 am

So you are unwilling to perform free medical services, i.e., do something that doesn’t benefit you, but you see nothing wrong with forcing person A to pay you to perform medical services for B.

We do NOT all pay (as in your case you admit this women doesn’t pay, except with her life since you refuse to do anything for her if she can’t pay you), nor do we ALL benefit, when costs are split. See my example above.

Clown.

brotio April 24, 2011 at 5:24 pm

See your solution is to force some one to pay for it as well.

I expect HER to pay for it. If it takes $20-a-month for the rest of her life. You are a mean, despicable little Ducktor.

crossofcrimson April 25, 2011 at 10:35 am

“But no one will be making billions of of stock options and for successfully denying care to those in need. ”

I hear that this is also how grocery stores make their money. They make you pay for the food up-front and then don’t let you take it home. Amazingly, people keep coming back to that store. If only they were rationally self-interested…

crossofcrimson April 25, 2011 at 10:32 am

“Again you have no idea what you are talking about. How will you make up the $500,000 this could easily cost you??”

Are you claiming that you care about money more than another person? Tisk Tisk. We’re supposed to be the selfish ones. You’re not doing this right.

JohnK April 25, 2011 at 10:41 am

It’s a matter of fairness.

If the muirdiot helps someone of his own free will, and the office down the street chooses not to help, then it isn’t fair to the muridiot.

He helped someone but the other guy didn’t.

That gives the other guy a leg up, which isn’t fair.

It’s not fair you see.
It’s just not fair.
It’s so not fair.
Don’t you get it?
It’s not fair!
*stomp stomp stomp*

For this reason the muirdiot will not help the needy unless the government forces the guy down the street to help the needy as well.

It’s only fair.

Jason April 22, 2011 at 6:53 pm

What do you do if the demand of free government-run health care exceeded the supply of beds, personnel, and equipment? Rationing has to take place, either through prices or denying people care. How would you solve the above?

muirgeo April 22, 2011 at 10:08 pm

Well like when the demand for highways or police officers increases you hire more of them.

Methinks1776 April 22, 2011 at 11:22 pm

Is that right? If you’re treating non-paying patients, who is going to pay for it? If you’re trying to keep “costs” down, how does hiring more doctors going to achieve that?

Here’s what’s going to happen, you obese mental midget – demand will rise, M.D. comp will drop (check out M.D. comp in European countries – read it and weep), fewer M.D.’s will find the cost of becoming an M.D. worth the newly reduced comp. M.D.’s will either refuse medicare and medicaid patients (as so many already do) or they will severely limit the number of these patients in their practice. This means that as demand for “free” health care rises, supply falls. Your little pregnant lady will bleed out in the waiting room. She’ll die in the gutter – unless you volunteer to save her (which I realize you can’t – but let’s pretend you’re a real doctor). But, of course, that means that you’ll have to deny someone else “free” health care. Know why? Because resources are scarce and, generally, the lower you drop the price of something the more of it people are going to want. Overwhelmed, you will have to decide whether to provide a lot of very shitty care or chose to whom you provide pretty good care. Either way, your pregnant lady is dead.

Now, I realize that you have been trolling this blog for five years and you’ve heard all this before. You have done everything in your power to convince us that you are far too stupid to understand a word of what I just said and I ‘m coming to realize that I may know as much about medicine as you (scary), but I’m saying it anyway because it just needs to be said.

brotio April 23, 2011 at 3:14 am

*like* x 1000

muirgeo April 23, 2011 at 6:49 am

Well again EVERY other developed nation that is providing care for ALL of its citizens for far less is proving you wrong each and every day.

http://images.huffingtonpost.com/2011-04-04-OECD.health.expenditures.jpg

What is it like to be proved wrong 30 times each and every day of your life on just ONE subject? What’s that like?

And yes premie twins easily will cost into the hundreds of thousands of dollars in even the most efficient system.

Methinks1776 April 23, 2011 at 8:31 am

And yes premie twins easily will cost into the hundreds of thousands of dollars in even the most efficient system.

Not in your precious European Utopias. They are allowed to die there. No extraordinary care. There, preemies are cheap – as is life in general.

Ken April 24, 2011 at 7:55 pm

muirgeo,

“Well again EVERY other developed nation that is providing care for ALL of its citizens for far less is proving you wrong each and every day.”

This is lie. Many of these other countries do tax their citizens at a very high rate, all to pay for this “free” medicine. Except this “free” medicine comes at an incredibly high fee: 98% of ALL medical advances occur here in the US because it is illegal to earn a profit on medicine in most other countries; survival rates for almost all types of cancer, heart disease, and other major killers are higher here in the US than those other countries; wait times are so long in these other countries that many people’s diseases become far more severe, including death, than they other wise would have been.

“What is it like to be proved wrong 30 times each and every day of your life on just ONE subject? What’s that like?”

I have yet to see you prove one person wrong anywhere or anytime on this site. Throwing up a graph showing that quality care actually costs money isn’t proving anyone on this site wrong. Claiming that these other countries have comparable levels of care is just lying.

“And yes premie twins easily will cost into the hundreds of thousands of dollars in even the most efficient system.”

So why do you want to make the system inefficient reducing the probability of their survival?

Regards,
Ken

WhiskeyJim April 24, 2011 at 10:49 pm

Muirgeo,

every other nation providing ‘free’ health care is going broke because of it even without supporting a military. I’m not sure how you have missed this in the news.

Many of them are trying to unwind their health systems, although by now the populace is in denial. You know, like you are.

muirgeo April 23, 2011 at 7:34 am

OK so it looks like all the libertarians would provide her care and somehow figure out how to pay for it presumably from the profits they made off of other paying customers.

But now another rural hospital ( actually a branch of the corporate mega huge conglomerate Libertarian Health Care System) builds near Methinks Hospital and they do not provide such indigent care and they pay their doctors and nurses MORE while charging their customers less because he does not take on the cost methinks does in providing such care. That doctor she yelled at and fired now works at Libertarian General.

How’s this scenario going to work out?

You do agree the other provider of care has no legal liability to take on these indigent patients of course, even if you disagreed morally with their decision to allow the pregnant mom to deliver out in the street. I mean you don’t even have any choice but to agree that no one can be forced to provide care against their will… because otherwise you’ve just made my argument for me.

Anyway…so again how does methinks hospital work out against this new competitor, Libertarian General, in the rugged world of individual liberty ?

I think what happens is her hospital goes bankrupt… of course there will be no bankruptcy laws so basically methinks loses all her possessions and then turns to the bottle becomes herself pregnant with twins and shows up herself 25 weeks later on the doors of the Libertarian General looking for care… ewwww not so pretty. So hows the individual liberty rugged individualistic thingy working for you now? Hummm?

Ken April 24, 2011 at 2:12 am

muirgeo,

I am not claiming that I would provide her care. I’m saying that each person’s life is their own responsibility and not anyone else’s. If I was a doctor and I thought that I could do something for this woman without sacrificing too many of my resources that I know she will never be replaced by her I may try to help her. As is the case with EVERYTHING in the real world, there are trade offs. Can you live with consuming valuable resources for this woman, knowing that they can never be used for someone else because she will not replace those resources? That someone else who will replace those resources has a life just as valuable as this woman, but you would sacrifice this person’s life for the woman because you can’t see passed the her and recognize that there are others in the world who need these resources just as badly as this woman.

You like to throw around the word morality, but how does bankrupting a hospital, a municipality, a state, and ultimately the country help anyone out. Someone has to say no when resources aren’t available. Taking resources from St. Louis to give to the rural hospital to help this woman live means someone in St. Louis dies.

No problem you say, we’ll take money from other businesses and call them taxes and that’ll solve the problem. Wrong. Because what we’re talking about are medical resources. It doesn’t matter where you get tax money from, only medical resources count when supplying medical care. Which means that taking money from other sectors to buy more medical supplies means driving up prices for medical supplies, thus reducing medical purchases elsewhere. In other words, no matter what you think you are doing, you are simply moving a fixed amount of resources around geographically. For everyone you save in that rural hospital using this method of taking medical resources from else where, you are causing death in those other places.

In a libertarian world people recognize the tragic nature of the world. That sometimes shit happens and the only thing you can do about it is nash your teeth and deal with it. In your mind you get all spun into a tizzy and blame everyone else because you live, quite litarally in a dream world.

There are no utopias, despite your clownish and rather embarrassing temper tantrums. People will always get sick and die. People will always get tragically maimed and endure massive traumas. Some of these people will simply be victims of circumstances and nothing else. For example, it’s far better to have a heart attack in a casino in Las Vegas than it is to have one in a hospital. The response times are faster in Las Vegas casinos. However, people have heart attacks in hospitals all the time. You don’t choose where to have a heart attack anymore than that pregnant woman chose to have severe bleeding in rural wherever.

These things happen to everyone regardless of race, creed, or income. The primary difference is that there are those who act responsibly seeing their own life is theirs, preparing the best they can, and enduring when their preparations fail. Then there are those like you who don’t think anyone should take responsibility, by saying everyone is everyone’s responsibility. A childish sentiment. A sentiment any doctor should know isn’t morally right.

In other words, despite the fact that you are a full grown adult and claim to be a doctor meaning you’re probably at least 30, you have pathetic two year old’s outlook on life.

Regards,
Ken

muirgeo April 24, 2011 at 9:23 am

Thanks for an honest look at Libertarian Health Care….

“In a libertarian world people recognize the tragic nature of the world. That sometimes shit happens and the only thing you can do about it is nash your teeth and deal with it.”

Yep there’d be a whole lot of teeth gnashing going on in a libertarian world…. dental care cost would apparently be spiraling out of control too. Mean while the rest of the world would be providing comprehensive health care to all its citizens like they already do…. for far less. Allowing all the future geniuses and researchers to survive and thrive and give back to the system that allowed them to make it rather then gnashing its teeth while watching a preventable tragedy unfold all because of some stupid selfish short-sighted belief in the price of everything.

Ken April 24, 2011 at 12:38 pm

muirgeo,

“dental care cost would apparently be spiraling out of control too.”

How do costs spiral out of control in free markets? Name one sector of the economy that has very little regulation and a small government presence where costs are spirally out of control.

Look at the costs of health care. Trillions of dollars a year are spent just on medicaid and medicare and costs are spiralling out of control. Looks like, again, you don’t know what you’re talking about.

“Mean while the rest of the world would be providing comprehensive health care to all its citizens like they already do”

This is an out and out lie. The costs of health care in those countries are captured through taxes and wait times, i.e., medical shortages. What does it matter to a woman with operable breast cancer how cheap diangosis and treatment might be if her wait times for diagnosis and treatment cause the cancer to grow past medical control? Survival rates for all serious diseases are better in the US than any other country. This is because death panels are real and despite treatment being “cheaper” treatement is denied so these people die. The word cheaper is in quotes because total costs are much higher in some place like Canada than the US.

“Allowing all the future geniuses and researchers to survive and thrive and give back to the system that allowed them to make it rather then gnashing its teeth while watching a preventable tragedy unfold all because of some stupid selfish short-sighted belief in the price of everything.”

As just discussed this is a patent lie, also. Fewer people live using socialized health care rather than free market provided health care.

As my previous post explained to you, at any given time there is only a fixed amount of resources in the world. Increasing resource availability in one area reduces resources in another.

Did you read the entirety of my previous comment or just the first paragraph? Or are you just too stupid to understand the rest of that comment?

Regards,
Ken

Ken April 24, 2011 at 12:40 pm

muirgeo,

Also, not recognizing “the tragic nature of the world. That sometimes shit happens and the only thing you can do about it is nash your teeth and deal with it” only means you are living in a fantasy world.

Regards,
Ken

Ken April 24, 2011 at 1:05 pm

muirgeo,

Finally, if the free market is so bad at delivering medical care, why is it better to have a heart attack in a Las Vegas casino rather than a hospital?

It looks bad for the casino if someone dies on site, so they do the best they can to keep their customers alive. With cameras everywhere and security guards ready to respond immediately, even to supply basic medical care like CPR and administering a defibrillator, care arrives faster at a casino than at a hospital.

On the other hand, people are simply expected to die at a hospital, so it doesn’t look bad if a patient has a heart attack and dies. It’s simply a tragic tail.

Please explain to me why survival rates are better in a Las Vegas casino for heart attacks rather than a hospital if the free market is so bad at delivering positive results for people.

Regards,
Ken

JT April 22, 2011 at 5:11 pm

“subsidize the person rather than invade the relationship” Exactly so; But this policy would deny the government the opportunity of appropriating the relationship and thereby rendering the persons on the providing side of the relationship dependent upon and, accordingly, subservient to the government. It would also confront the government with the uncomfortable task of deciding on a person by person basis how much subsidy to provide and what to do when the person spends the subsidy on the same bad habits which made him indigent and ill to begin with rather than on his medical rehabilitation.

vikram April 22, 2011 at 5:21 pm

The relationship between patient and doctor used to be considered something special, almost sacred.

If that is so then why is Govt. perfectly eligible to regulate the “sacred” relationship ?

Economiser April 22, 2011 at 5:46 pm

I’d like to ask Mr. Krugman a few simple questions: why is medical care today so much better than it was back in the halcyon days of the sacred doctor-patient relationship? Which statute created all that growth?

As a related matter, why is healthcare in the US so much better than it is in third-world countries? Why don’t those governments simply pass a law and create American-quality healthcare in their homelands?

nailheadtom April 22, 2011 at 6:43 pm

If we assume it is a societal obligation to pay for the emergency treatment of impoverished accident victims, what are the corresponding obligations of the indigent? Couldn’t the MD that removes the ruptured appendix of a mendicant justifiably require that individual to mow his lawn weekly for the next five years? Or couldn’t any taxpayer reasonably request a similar service from the recipient of the benefits provided by any of a number of social welfare programs? If society owes something to the less fortunate, what do the less fortunate owe to the individuals that make up society, in concrete terms?

Scott G April 22, 2011 at 10:30 pm

I have to admit that Krugman’s post makes me both angry and sad.

I’m so tired of people like him.

Party of me wants to understand him so I can change him. I know that’s futile however.

Nothing we say at this website will change him. He will always think the way he does. He will always say the things he does.

The only hope freedom loving individuals have is that the masses of rationally uninformed people learn that he’s wrong, and that’s not an easy problem to correct. It’s hard for me to accept that.

When I get into moods like this I try to remind myself that the world is not perfect and never will be. I will sometimes be disappointed with the state of the world. I will be disappointed with people like Krugman. Ignoring him doesn’t work. Trying to change him doesn’t work.

When I feel like this, I ask myself what I should do with my anger. Usually my anger motivates me to find a solution. I’m not sure there is a solution yet. There may not be one, at least not right now.

I sometimes blame academic economists for failing to educate the rationally uninformed masses. Educating the rationally uninformed is not an easy task however.

At least Don and Russ (and other libertarian types) are here to share this with me. It would be a whole lot worse if I was alone.

Does anyone know of a 12 step program for libertarians who have been negatively affected by rationally uninformed people?

I didn’t cause Krugman.
I can’t control Krugman.
I can’t cure Krugman.

Krugman being the pseudonym for his audience. (Hey that might make a fun t-shirt)!

I’m going to go read my favorite Hayek quote now and then look at cameras so I can one day make rap videos shaming Krugman. Maybe that will work.

“Altruism is an instinct that we’ve inherited from the small society where we know for whom we work, for whom we serve. When you pass from this, as I like to call, from a concrete society where we are guided by what we see, to an abstract society which far transcends our range of vision, it becomes necessary that we are guided not by the knowledge of the effect of what we do, but by abstract symbols. Now the only symbol which tells us where we can make the best contribution is profit. In fact by pursuing profit we are as altruistic as we can possibly be because we extend our concern to people who are beyond our range of personal conception. This is the condition which makes it possible to even produce what I call an extended order, an order which is not determined by our aim, by our knowing what are the most urgent means, but by impersonal mechanisms who by a system of communication which puts a label on certain things which is wholly impersonal. Now it’s exactly this where the conflict between the traditional moral, which is not altruistic which emphasizes private property and the instinctive moral, which is altruistic comes in constant conflict. The very tradition from a concrete society where each serves the needs of other people whom he knows to an extended, abstract society where most people serve the needs of others whom they do not know, whose existence they are not even aware was only made possible by the abandonment of altruism and solidarity as the main guiding factors, which I admit are still the main factors dominating our instincts, and, but restrains our instincts is the tradition of private property, and the family, the two traditional rules of morals, which are in conflict with instinct.” F.A. Hayek

Thank you F.A. Hayek.

Marcus April 23, 2011 at 12:05 am

I have several liberal friends who all react negatively to the word ‘consumer’. They seem to be of the misguided belief that being ‘labeled’ a consumer somehow dehumanizes them.

Krugman knows who his audience is and he’s appealing to them in terminology they’ll relate to.

More interesting is this line by Krugman: “In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends.”

Am I reading that right? Krugman apparently believes that medical innovation results only in costlier medical care. I find that very interesting because that’s exactly what I’d expect to find in an industry that is heavily subsidized by the government or has in some other way had the consumption divorced from the payment.

Krugman has, in fact, in inadvertently admitted to the problem but avoids drawing the proper conclusions.

Even more interesting is this line: “And the last time I looked at it, the Declaration of Independence didn’t declare that we had the right to life, liberty, and the all-expenses-paid pursuit of happiness.”

Just wow! He just said you don’t have a right government provided health care. Revealing this fact: the health care bill isn’t about access, it’s about rationing and who will do the rationing.

WhiskeyJim April 23, 2011 at 1:06 am

Health care is the only industry where innovation is driving costs up instead of down.

No one can figure out why:) And I am serious; some of the biggest consulting companies in the world, (e.g., McKinsey) making 100s of millions per year on government contracts, can not tell the government that if they would only back off, health care costs would drop like a stone.

Methinks1776 April 23, 2011 at 12:08 pm

Health care is the only industry where innovation is driving costs up instead of down.

Except this is not really the case.

New technology in plastic surgery and Lasik eye surgery is driving up quality and safety while driving down costs.

The difference is that plastic surgery and Lasik is not covered by any third party payer. It is a completely free market.

dan April 23, 2011 at 12:29 pm

The newest innovation is costly, but have older techs remained high in costs? Defibrillators? X-Rays? Sonograms? If I am not mistaken, these products are going down in costs and are becoming more portable. We are still innovating and creating. We are still far off from where we will be. Medical Imaging is getting better, but we are still not to the point of where a medical professional would like us to be……….. no guesses, but exact images that bring quality of pictures that a 20yr old with no medical education can pinpoint the problem. Possible? don’t know. But, is that not the goal? Less guessing……

WhiskeyJim April 23, 2011 at 1:47 pm

As usual, I was being too subtle. Thanks Methinks.

Is medical costs 100%+ higher than it would be in a free market without clear pricing feedback? It could easily be as the examples of plastic surgery and Lasik show us.

If you look at business consultant suggestions to the government on how to contain health care costs, they are in effect introducing market properties within the cocoon of government control. Strange isn’t it?

Methinks1776 April 23, 2011 at 2:52 pm

It was obvious where you were going in your comment, I just “went there”.

Mao_Dung April 23, 2011 at 12:56 am

I tend to agree with Don on his blog post. People want the best quality medical care at the best price, unless of course you are rich. Then you want the best care with much less regard for the price. I just want to report on one recent instance where doctor did something to drive up medical costs. I was a the bridge club when a 90 year old gentleman apparently suffered a stroke. The paramedics hauled him away to hospital. The doctors performed 2 brain surgeries on him. Naturally, he died as you would expect for someone so old. I cannot believe that the huge fees the doctors and hospitals received weren’t a factor in his care. How can what they did be allowed? Something is amiss here.

Jeff Neal April 23, 2011 at 1:10 am

Sorry so lengthy, but I wrote this during the HCR debate.

Who can argue with wanting the most affordable, high-quality health care for the most people? An abundant supply of a good thing is a desire that is unassailable by any one who wants to be a welcome participant in the public discourse. So, we’re left to discover the means of providing the inarguably good thing, right?

Mental exercise: With the following items in mind, imagine a rough line-graph with (Y) level of government regulation on the vertical axis and (X) availability (i.e. affordability) on the horizontal axis:

Hula hoops Cheeseburgers DVD players
Flat-screen TVs Breast augmentation surgery Video games
Lasik surgery Heart transplants Dialysis treatment
Automobiles Barbie dolls Firearms
Air travel Recorded music Television programming
Gasoline Cell phones Kidney transplants
Cigarettes Women’s lingerie Denim Jeans
Candy bars Pornographic movies Prescription drugs
Harley Davidsons TV news shows Bicycles
Coffee or espresso Bottled water Neck ties
“Affordable” housing “Market-rate” housing Quality education
Public education Obama figurines at National Airport

One’s mind will produce a left-to-right, downward sloping curve. Capitalism applied to the delivery of a product or a service is near miraculous in its efficiency.

A second mental exercise: How many of the 37 million people without health care insurance (or other method of obtaining health care services) DO have:

- A cell phone - an automobile
- indoor plumbing - a roof over their head
- membership to a health club - a recent visit to MacDonald’s
- a flat-screen TV - Cable TV subscription
- more than a six-pack of beer in the refrigerator

I’d wager that more than 75% of the uninsured have 6 out of 9 those discretionary items.

If we turn the capitalist animal loose on the health care “problem” it will be solved overnight. It’s not that the government bureaucrats are incompetent or have bad or dishonorable intentions. It’s that human nature is unalterably productive when properly situated in a capitalist system (just look around – none of what you see materialized spontaneously) and human nature is on occasion charitable. If it were otherwise, Microsoft would ask for money from the American Cancer Society, not the other way around. That productive nature is, properly, not at home in the government. The government is definitively and intentionally NOT productive – it is (as it should be) administrative, clerical, custodial and cumbersome in nature. It should be small and unimportant in our daily life, not in control of 25% of GDP (pre-health care reform – add 17%) and intrusive, because political decisions invariably reflect a bias and favoritism that may or may not reflect what is in the interest of the general population. Office-holders and staffers do not give contacts or favors to complete strangers – they reward campaign contributors and political cronies.

The point about the power and need for capitalism, and a slightly more subtle point, were made a few months ago during a stroll past the North Portico of the White House, where one sees a giant pink ribbon hanging between two white columns.

We all know that symbol – it announces and symbolizes solidarity with victims of the disease and those involved in the effort to cure breast cancer. It represents a very successful “branding” of a charitable cause. Putting aside the question of why this particular cause is worthy, over all others, of the imprimatur of the White House and whether this is a scandalous private use of public property – (What more prominent “billboard” is there? Is there any doubt someone, somewhere is making money off of the pink ribbon? {For the record, I don’t impugn anyone’s integrity or sincerity, especially Nancy Brinker’s – just making a point.)) Neither would I suggest that it’s part of the Obama Administration’s armor against criticism – “Hey, look, we’re for curing breast cancer, so how can you be against us?!”

The point is – it takes money. Curing breast cancer (or heart disease, acne or athlete’s foot) takes money. That’s why every Saturday night there is a 1000-person, $10,000 per table fund-raising event at the Washington Hilton. And that money doesn’t sit in piggy-banks, Benjamins talking to Hamiltons and Lincolns. The money is put to work, paying the salaries of researchers, the rent on labs and office space, and buying computers and books and files and paper and pens and paper-clips and test tubes and beakers and bunson burners and . . .

It takes money and its genesis – the oft-reviled but indestructible and sine qua non of our life-style – the profit motive. Some of the researchers, I’m sure, work on a volunteer basis and some of the doctors make less money than they could in other practice areas, trading cash for fulfillment of another form. And there are likely among the principals some number who will GIVE their cure away when/if they discover it. But the vast majority of the work is conducted with the expectation of compensation and profit. As kind-hearted and well-intended as the efforts are, they would cease within a very short time after the money spigot dries up.

Yet, one of the not-very-well-hidden objectives of the Obama/Pelosi/Reid, Progressive/Democrat health care reform program is the demonization of the money-makers in the medical and insurance industries and the elimination of “fat-cat bonuses and obscene profits” in favor of a lower cost (not really) government program that is run with the more pure, seemingly more humane and admirable objective of helping the poor get better care.

“Making a profit” vs. “helping the poor” is not the choice we face any more than “making hula hoops” vs “curing breast cancer” is a choice. We’re not dealing with limited resources or lack of caring or lack of capital. Invention and innovation don’t happen based on how earnestly and fervently we wish for the answer. They happen as a result of human endeavors supported by monetary incentives.

We can win the debate if we expose the false choices. The pink ribbon on the White House is the administrations unknowing confession that their program presents a false choice in that the program asks and answers the wrong questions.

How do we get more health care? Let the profit-motive animal loose, and watch the flood.

Terry Noel April 23, 2011 at 7:58 am

Don,

I saw this and will be blogging on it next week. Have mercy. Is anyone more consistently and egregiously wrong than Krugman?

Best,

Terry

ajlenze April 23, 2011 at 11:45 am

Does Krugman ever read his own words? Early in his piece, he admits that doctors and hospitals aren’t saints to justifiy Obama’s health advisory board. Then towards the end of the article, he champions the ideas of heroic doctors and medical ethics to rail against the idea of treating health care as a mere consumer good. It’s amazing how he uses diametrically opposed justifications for his positions.

Methinks1776 April 23, 2011 at 12:19 pm

He also whines that costs paid by taxpayers must be contained. Yet, he rages against the proposed vouchers (which would contain costs). It’s not the cost containment that concerns him – it’s how the costs are contained. Krazy-eyes insists that only a panel of these unsaintly saints can make life and death decisions on behalf of strangers. Giving individuals a limited amount of money to spend on on the healthcare they prefer is anathema. In Rasputin Krugman’s understanding, central authority is always better equipped to make decisions for the peasants.

Of course, the government employing a panel would be more costly than not employing a panel, but whatever!

dan April 23, 2011 at 12:32 pm

It was probably Krugamn who offered up the ‘reform of spending in the tax code’ or ‘to reduce the spending in the tax code’ or whatever the hell Obama has put forth to explain that any dollar not confiscated by Govt is ‘spending’. What crap!!!

Methinks1776 April 23, 2011 at 12:32 pm

BTW…he also doesn’t seem to understand how these government programs work.

Once a doctor accepts a medicaid patient, that doctor can no longer accept an out of pocket payment from that patient. To pay out of pocket, the patient must find another doctor and start over.

For instance, medicaid won’t pay for root canals. It will pay for tooth extraction instead. Either the patient must go to another dentist and pay for the procedure completely out of pocket (including the evaluation the new dentist will have to perform) or he must submit to the tooth extraction. At no time will medicaid just pay the amount it would have paid for the tooth extraction and allow the patient to make up the difference. Obamacare does not change that.

So, either Krazy-eyes has no clue what he’s talking about (I’m highly confident he doesn’t) or he’s suggesting that these incapacitated, stressed out, informationally disadvantaged patients should be moved to another hospital and start all over with another team of doctors (also not a scenario inconsistent with Kugnut’s lojick). This is the kind of patient care we can look forward to when Princeton Ekonomysts run the show.

Anneke April 23, 2011 at 1:14 pm

“How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’?”

Patients became “consumers” thanks to Ralph Nader and other consumer rights advocates who wanted to give patients justification to agitate for changes in their care and their health plans. It’s ironic that Krugman now questions the policy that he and his pals helped fashion and implement.

Thomas A. Coss April 23, 2011 at 1:23 pm

A casual walk through the history of medicine would prove that patients have always been ‘consumers’, and it’s a good thing. Not healthcare problems are associated with pain, an excellent motivator for getting treatment, indeed most tragic diseases involve little pain.

Like it or not, and I do, the future of healthcare will look a great deal more like the 1950′s than the 1990′s, higher deductibles and the consumer driven behaviors that come with one’s paying for healthcare with their own money.

Non-consumer driven healthcare (doing only what’s necessary at the direction of physicians) works well when that physician has few choices, such as in the middle of the last century; today, not so much.

We need to view some of the decisions we make in healthcare through that lens on occasion, at least ask ourselves, “what would have happened if one of my great grand parents had this problem?” and evaluate those choices.

T.A. Coss, RN

John Kannarr April 23, 2011 at 1:30 pm

“Men with guns” is the answer to the question raised in paragraph 3 (“If consumer choice isn’t the ultimate driver of health-care supply …”).

muirgeo April 24, 2011 at 11:26 pm

brotio April 24, 2011 at 5:12 pm

“I doubt there is an individualist at this Cafe, upon seeing a pregnant woman helpless, and bleeding, who wouldn’t spring to action to do everything to save that woman’s life, and would worry about how she was going to pay AFTER the woman was stable – recognizing that it may take years for her to completely repay her debt. Yet you, Ducktor Compassion, stand there telling the world that you wouldn’t lift a finger to help her until you were sure you were going to be compensated in the lavish manner you are accustomed to.”

Thank you Brotio… thank you for standing up for socialized medicine. Thank you for backing yourself into the only logical corner you could end up in. You have just made my point for me.

I assume since ALL libertarians would provide care without a contract or an agreed upon price you all all agreeing that health care is a right. If not you are assuming it’s ok for some to deny such a pregnant women care even if you morally object. You can not have it both ways. In the real world we already see insurance companies denying care based on cost. But you are asking for more of the same even though you wouldn’t do such a thing yourself. In the real world these evil people will run you out of business.

First of all you assumed I would not take care of her unless I was sure to be paid. I didn’t say that. I did say it was a lose lose proposition which you chose to ignore. I did point you to the real world reality that if one always paid for the indigent they themselves would go broke. There are tons of them out there and would be many more in your society. You assume this women would be able to pay you back…. on what basis would you make that assumption?

Socialized medicine does exactly what you recommended. It treats ALL the patients regardless of current ability to pay. It provides care without knowing if that person can pay or will ever pay back the system. We assume that one day they will. But your action to treat her was completely NOT A MARKET BASED decision. YOU LOSE THE ARGUMENT because you acted altruistically because you are a human being. Libertarian medicine offers the possibility that some one could deny care and run people like you OUT OF BUSINESS….

DO YOU GET IT NOW!!!!

How often in the free market do you “spring into action” and give away a car, a house, a gun food or clothing without concern for the “consumers” ability to pay????

NOW YOU DUMB FSOB maybe NOW YOU CAN SEE what is sacred about the doctor patient relationship. PRICE IS NOT A FACTOR…THANK YOU FOR STATING IT SO.

Methinks1776 April 25, 2011 at 8:32 am

How often in the free market do you “spring into action” and give away a car, a house, a gun food or clothing without concern for the “consumers” ability to pay????

All the goddamn time, idiot. Have you ever met any people other than the thieves you hang out with?

muirgeo April 25, 2011 at 9:47 am

Looks like you’ve been reduced to babble. A now homeless premie twin carrying former hospital CEO kicked to the streets by the ideology she used to fight for. And that one ER doctor you screamed and fired now laughs at you out on the street from his hospital window. And you babble at the passers by.

JohnK April 25, 2011 at 9:51 am

Are you drunk?

muirgeo April 25, 2011 at 12:17 pm

Not drunk… but it feels good to see that I was able to back you guys into the corner with no way out but to see the illogic and the implications of your positions if allowed to permeate the real world. It was great to get YOU guys to admit that standard market forces do not apply to health care issues and that indeed the doctor patient relationship is special…sacred. You guys… your very own replies to my scenario were completely against all basis of market principles to which you hold so dear. It’s good to know that when the rubber hits the road you will all drop you libertarian bullshit and act like decent human beings (even ol Cruella de Methinks) not completely controlled by market forces. The Invisible Hand God is DEAD!

JohnK April 25, 2011 at 2:12 pm

You really should stop prescribing painkillers to yourself.

Methinks1776 April 25, 2011 at 2:38 pm

Once again…OMG. Every time I see one of Muirdiot’s posts, I have an image of an unstoppable train of manure slamming into a concrete wall.

Methinks1776 April 25, 2011 at 10:43 am

OMG

muirgeo April 25, 2011 at 12:10 pm

That’s right…OYG. When you think this libertarian thing through to its real world implications that’s all you are left with… OYG.

Methinks1776 April 25, 2011 at 2:33 pm

No, imbecile. I was rendered speechless by what you vomited from your bottomless pit of stupidity.

JohnK April 25, 2011 at 9:44 am

“Libertarian medicine offers the possibility that some one could deny care”

That is correct.

While you would deny care on the grounds that no government agency is forcing everyone to give care to the needy, some dumb libertarian SOB could of their own free will choose to help the needy even though no government agency is telling them to.

That is what separates libertarians from leftist med school flunkies like you.

Libertarians don’t need to be told to be nice. We can do it of our own free will.

Holy shit you’re stupid.

brotio April 25, 2011 at 7:04 pm

Holy shit you’re stupid.

It just occurred to me that Yasafi doesn’t have a middle name. How about a contraction of that sentence, which is very appropriately placed at the end of most of your replies to our Dear Ducktor.

Holyshitcherdum?

brotio April 25, 2011 at 6:59 pm

I reread my post, just to be extra-super-duper-doubly-sure, and I was right. There was not one point in that post where I indicated that anyone other than the pregnant woman should pay for the services rendered to save her life.

muirgeo April 25, 2011 at 8:54 pm

Yeah YOU do… and eventually you have to ask your staff to pay for her and the next one by cutting their pay… while the unethical bastard down the street will deny care being the smart business man he is, lower rates, increase salaries and run your ass out of business…

There is no illogic on my part the illogic is you acting alturistically and not like homo economist and running yourself out of business while the dredges of life take the spoils and all the profits….WOW isn’t libertarianism GREATTTTTT!!!!!????

brotio April 26, 2011 at 12:46 am

You are too socialist to understand this, but I’ll answer anyway.

The only person responsible for payment for services rendered is the person receiving service. If she cannot pay – and by that I mean; if she has no cell phone service, no telephone service, and no cablevision to cancel in order to meet a monthly payment, or no car or home to sell, then she had better be prepared to ask for charity from her family, friends, and church. If she has exhausted all of those avenues and still can’t come up with a way to make a minimum monthly payment, then I’ll have to absorb the cost – which is far more likely to be around $10,000-to-$20,000, not the half-mill you so idiotically spouted.

However, scenarios of someone that destitute in the United States needing emergency care are rare, and I guess it’s just the risk I’ll have to take, but you can damn well bet that I’m going to make sure that she has exhausted every means of repayment before I eat the cost.

You have made it plain that you believe that everyone except the person receiving service is liable for her medical bills.

muirgeo April 25, 2011 at 8:55 pm

You have NO REPLY do you…. you’ve been back into a corner by your own humanity… you friggin socialist stalinist marxist bastard.

brotio April 26, 2011 at 12:49 am

Stupid.

Go back and answer all of the questions you have ducked for the last five years before you start prancing around like a peacock.

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