Agree with him or not (I nearly always do agree with him), the Economist‘s Will Wilkinson is unfailingly worth reading and pondering. His latest essay is an excellent example. It’s on Paul Krugman’s bizarre (at least for an economist) lamentation that many people think it good that health-care provision be consumer-driven – or, as Krugman describes it, that health-care provision be “more responsive to consumer choice” (HT Tyler Cowen).
Will Wilkinson on Paul Krugman
Share
Previous post: Predatory Pricing, Product Improvements, and Wal-Mart
Next post: A Sad Anniversary
{ 210 comments }
Awesome article. The one thing that Will is always quick to mention or advocate is something that I personally support 100%:
It’s the distinction between government transfers to the poor and government interference in the market process. Like Will, I’m willing to support the former while finding interference in the latter to be the real stealth evil public policy.
Said Will:
“If the deep worry about certain forms of market exchange is that they put the poor at a disadvantage, we can address the worry by making certain that means-tested transfers are generous enough to ensure sufficient market power for all. But we can’t address concerns about market inequity in this way if market-based policy is preemptively ruled out of bounds by a misguided public theology of markets and politics.”
BRAVO!
You want to prop up spending power for XYZ policy among the poor? Fine. But for chrissakes, don’t mangle the market process! As long as that’s healthy and in tact, we’ll usually be on the right track toward better results for everyone.
Yeah let’s let Wall Street run our health care system… BRAVO!
I’m curious – Who would you say “runs” the food market…millions of consumers, producers, and distributors interacting within a market…or just Walmart?
I won’t even begin to touch the craziness that would result in implying the squeaky-clean image of almighty “government” as opposed to “Wall Street.”
ignore him.
Dear God, please!
You come across as seriously deficient in comprehension.
Bureaucrats or CEOs, are those the only two choices you can conceive?
Your world sucks.
Yeah but at least it’s the real world and not some make believe land that you fantasize about. I know you have a lot of great ideas but when we talk here most of us should be talking about things that pertain to the real world that we all live in.
“Yeah but at least it’s the real world and not some make believe land that you fantasize about. ”
You mean like a world where scarcity doesn’t exist?
Let’s get to the point here. If you’re going to make an actual case against something that was said, then make it. Your decrying of ideologues while lamenting the absence of your centrally-planned utopia isn’t yielding you any capital as far as your arguments go. You’re not going to win any fights with your brother by calling his parents “stupid”.
Do you suppose democracy existed before anyone conceived it?
People thought of using rockets to fly to the moon long before it was actually accomplished.
Lot’s of things were conceived before they came into existence, including the U.S. of A.
Your limitation is your inability to conceive anything different from what you already believe.
You envision for most people only two possibilities, serfdom toe CEOs or serfdom to bureaucracy.
Your vision sucks.
Has anyone raised the fact that the current insurance system, including medicare, discourages rational decision making and that is why the market does not work.
Due to third party payments making cost of visiting doctor not enough of rational tradeoffs.?
This part is also a thing a beauty near and dear to my heart:
“The policies that publicly express good will and mutual respect—that successfully broadcast that we care about one another—often are not the policies that would actually deliver the goods—the policies you’d favour if you cared more about people than signaling that you care about people.”
Very well said, Will!
Few things in politics strike me as being as despicable as the act of cheap, empty gestures to “show” you care via nice-sounding government policy that actually hurts in practice.
But be careful here. Some might think that advocating [non-voluntary] “generous means-tested transfers” might be one of those policies you’d favour if you cared more about signaling that you care about people than you care about people.
Well Tom,
Here’s the thing:
While I support markets 100%, I do not pretend and never try to pretend that markets fulfill every need of every person at every occasion. Nobody should really think that. One of our hosts’ colleagues, I believe it was Kling, once summed up my POV on this quite well. He said: “when markets fail, use more markets”. He said this as the “GMU way”, so to speak. This was in contrast to the Chicago school, which he claimed tried to show that “markets don’t fail, thus use more markets” and in contrast to the Keynesian School, which he claimed tried to show that “markets fail, thus use government.”
The point here is that while markets can be suboptimal (aka “fail” by some tastes), that’s not a good reason to use government interference because the cure can be often worse than the disease. I make a clear distinction between a handout to buy a needed good and perverting the market forces that deliver that good. That being said, ensuring the markets continue to work for crucial areas that are prone to capture by political stupidity by shoring up the ability of the least among us to participate through the market mechanism is better than trying to make the market work differently.
An example of this is Food stamps vs. some complex price control system on staple foods or some complex government program to keep food affordable and accessible to all. Yuck. Doesn’t that last one sound absolutely scary?? It does to me. I’d rather just slip the poor a monthly supplement to help buy groceries while preserving the freedom and efficiency of the market process. Wouldn’t you?
I don’t think that’s signaling. I think it’s an inexpensive, relatively un-intrusive, effective, specific and pretty safe way (“safe” meaning with minimal side effects) to directly help marginal consumers satisfy basic needs without hampering the power of the market process.
Astounding, I thought, the response to Krugman’s piece on patients as consumers. We all speak of healthcare as if we all agree on what constitutes good health. A hard living biker would certainly disagree with you on the need of going to the gym, his preference on quality healthcare might be a cold beer and a fist fight. I treated many such patients as an Emergency Room RN, and was surprised how unclear good health is if you just talk to people. The bikers I took care of had no expectation to living into their 70′s and certainly didn’t seem bothered by it much.
They consume differently than I, not certain if it’s different than Paul…
The comments to Will’s piece at the Economist are both a statement of how far left the magazine has moved in the last 20 years, as well as a signal of how high is the mountain of objection to freer health markets.
@WhiskeyJim: right you are; reading the comments was depressing. If you really want to get depressed read the comments (the 22 most recommended out of over 600) to Krugmans article.
We are sitting in the depths of the Marianas Trench looking up at Mount Everest.
It is Bush’s fault for not raising taxes on the top 2%.
Gene Callahan has probably the best response to this: http://gene-callahan.blogspot.com/2011/04/will-wilkinson-is-dumbfounded.html
Krugman may or may not be right, but there’s nothing that is of necessity bizarre about his point from an economist’s perspective.
Ah yes… it’s far better to have “certain important relationships” be dictated by Federal review boards than by individual choice. How “aristotelian”.
The fact that we “have to do something about healthcare costs”, as Paul puts it, means that the need to treat healthcare as a scarce good being traded with money prices, also known as “commerce”, to at least SOME extend. He’s masks his desire for technocratic tyranny by throwing the word “we” around, as if me or you can or should have some say over what other people can and can’t access. That “we” is a weasel word. It’s a smoke screen for “they”, meaning unelected technocrats with an eye on growing their budgets.
Paul Krugman is advocating top-down central planning at the most impersonal level regarding the most personal decisions. The socialist calculation debate happened. The socialists lost.
Who wants it to be dictated by federal review boards?
You need to re-read the post, review the socialist calculation debate (or at least re-evaluate your understanding of what “socialism” and “central planning” is), and chill out.
Daniel: What do you think is the practical implication of Krugman’s complaint? If health-care markets – oops, ‘sacred relationship’ – aren’t consumer-driven, what WILL drive them in Krugman’s Brave New World? They will inevitably be dictated by government officials.
I don’t understand where you and John are getting this “dictated by government officials” thing. He specifically talked about non-government payment. He never said that we don’t transact for medical services. Of course we do. You have to pay for medicine and equipment and doctors have to put food on the table – but if your relationship with your doctor is simply a consumer/producer relationship that seems somewhat impoverished to me (and apparently to Krugman and Callahan too).
Daniel,
A relationship with a doctor is fundamentally a consumer/producer relationship. If you choose to make it something else, that’s your business. Most of us are no more willing to give a doctor free rein over the care of our health than we are to give a clothing store free rein over our wardrobe.
How is my relationship impoverished when I simply pay my doctor for the services he provides? It seems insulting to me that doctors have some magical (at least, not really defined anywhere that I’ve seen) additional relationship beyond that of normal human beings who interact with each other on voluntary basises. I have a lot of clients whom I provide with services. And they pay me for them. I make small talk with them, ask about the weather, their family, and interests, and even sometimes go out to dinner with them. However, all of this is due to our commercial relationship. I would do none of those things if they weren’t paying me. Am I leading a life of impoverished relationships with my clients. Please let me know so I can change!
Remember a “consumer driven” decision is made by CEO’s and their slick lawyers who will find all sorts of ways to deny you the care you thought you were covered for.
but if your relationship with your doctor is simply a consumer/producer relationship that seems somewhat impoverished
What’s impoverished is pretending that it could be otherwise.
Remember a “consumer driven” decision is made by CEO’s and their slick lawyers who will find all sorts of ways to deny you the care you thought you were covered for.
As opposed to the arbitrary decisions of unelected bureaucrats doing the same thing.
Indeed. Doctors are not witchdoctors.
I read the post quite carefully and those quotes are all from the article. It’s quite clear that Krugman is advocating top-down command and control of healthcare spending within Medicare and Medicaid (half of all medical spending in the USA) via technocratic “expert” committees based on arbitrary spending targets. He is explicit about it. I don’t understand how you can take away something different from that post.
I read Krugman, John, exactly as you read him. Frankly, I can’t see any other possible (much less plausible) reading.
It’s the ratchet effect. Each intervention begets a new one. For a brief history of the absolutely goofy, torturously incompetent intervention by the state in medicine, listen to this:
http://www.npr.org/blogs/money/2009/11/podcast_paying_doctors.html
How anyone with knowledge of the way the market process discovers prices and balances resources can listen to this and not think “get the government out of medicine” is beyond me.
It’s top down bureaucratic controls made by government doctors and their panels or those made by CEO’s, boards of directors, their slick lawyers and willing physicians.
You chose your health care decisions to be made based on dividends. I suggest they are better made top down by democratically elected bureaucrats. All the world shows the latter system far more efficient.
Why do you guys so willingly ignore the efficiency of all the other systems in the developed world over ours?
How do you think you will ay for your health care in the free market system once you come down with kidney failure?
“I suggest they are better made top down by democratically elected bureaucrats.”
Bureaucrats are by definition not elected.
Your stupidity never ceases to amaze me.
Your stupidity never ceases to amaze me.
He appears to be the PT Barnum of stupidity.
p.s. – I have no problem with government healthcare programs being reigned in. That’s great. But we shouldn’t forget that Krugman was also a strong advocate of the “public option”, so his claim that we can use our own money for whatever we want is only a half-truth. If he had his way, we’d surely be on single-payer socialism with the “review board” dictating healthcare options for everyone just like the UK’s newspeak “NICE”. Not so nice, Paul.
Public option and single payor are two different things. We would only go to single payor from public option if it indeed was shown to much more efficient than paying CEO salaries and stockholder dividends… oh wait… your ARE right they ARE the same thing.
http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/
Did I say that a “public option” and single payer are the same thing? No, I did not. Paul Krugman’s ideal is single payer. The so-called “public option” was and remains an explicit trojan horse to usher in single payer. The public record by its advocates from Jacob Hacker to Barney Frank is quite clear.
So, yes, Krugman strongly advocated the public option and yes, if he had his way, we’d be on single-payer. So given that, his preference for top-down central planning shouldn’t be dismissed as a mere “cost controls” pragmatism limited to government programs.
‘Efficient’…….. You mean rationed? Instead of hip replacement, take aspirin, as Dr. Obama had prescribed. Businesses will be reined in by competition and consumer driven choices. Unelected bureaucrats will ‘rule’ by decree.
Central planning, especially of this magnitude, is filth.
Dealing with central planning zealots is like dealing with minions of hell. The filthy chairman Mao would be proud.
The enemies of the free market, and ultimately, individual freedom, constantly lay siege.
I’m baffled by Gene’s post. *Of course* not all relationships should be arm’s-length and commercial. It would be atrocious, for example, for parents to have such relationships with their children; for siblings to have such a relationship with each other; for husbands and wives to view each other chiefly as suppliers and as inputs into the enterprise called “marriage.”
But physicians and patients? I don’t *want* my physician involved in my life any more deeply than what I contract for. And I’m sure that my physician is relieved that he can go about his business without feeling that he has some obligation and connection to me that rivals the non-commercial obligations and connections that he has with his children, his friends, his wife.
Am I here exhibiting nothing more than an ideological gag reflex?
You’re entitled to think what you want to think. It’s not bizarre for an economist to feel differently. I personally appreciate the fact that my doctor feels an obligation to his patients that has nothing to do with his commercial relationship, and I like the fact that regardless of what he earns from my transaction my doctor genuinely wants me to be healthy. There’s nothing bizarre about that.
If you just look at doctors as service providers, that’s your business.
Painting commercial interaction as cold and calculating vs. some other interaction is absolutist nonsense. I’ve made most of my friends at work, as have most Americans. I get to know and care about the people with whom I trade and transact. My plumber. My contractor. My collaborators on video projects. This dichotomy between life and commerce is silly and false and appears to be the product of a view born in academia, not reality.
So… wouldn’t you agree that you have more than just a commercial relationship with these people with whom you do happen to have a commercial relationship?
You seem to be demonstrating Krugman’s point here – what’s the issue? Aren’t you describing precisely what he’s highlighting?
Daniel, do you not understand the difference between Krugman’s declaration that a relationship between doctor and patient is more than a consumer/producer relationship and the freedom of individuals to decide for themselves what that relationship should be?
Krugman opposes vouchers in his. Why? Because they leave the consumer to create his own special relationships instead forcing him into an imposed relationship between a panel of faceless health care professionals and their unknown patient. If there is any room to develop some kind of “sacred” relationship, it is broken by such an arrangement.
I don’t know about you, but I have been “treated” by idiots like Muirdiot in the past. The only thing sacred about those situations is the ability to get out of them.
Krugman’s point is that because medicine is “special” we should leave it to the easily corrupted technocratic overlords. My relationships with people are complex and loving and special precisely because they are real, voluntary relationships forged out of trust and mutual interest. Krugman’s post gives no play to civil society whatsoever. He simply assumes that we have two choices: cold market calculation vs. the state. I reject that as nonsense. Life exists on a spectrum and all human choices are guided by a mix of price signals, individual preferences, quirks, personal relationships (some calculating, some not), and countless other things. The state isn’t “us” and it’s men with guns aren’t “altruism” or “caring”. They aren’t the social alternative to anonymous commerce. They’re ANTI-social. They’re destructive of society.
The market vs. the state? No civil society? Where are you getting this stuff John?
Then again… thinking back to the nasty things you’ve attributed to me in the past, I suppose I shouldn’t be surprised.
Daniel,
Do you ever read or listen to Krugman? Either you don’t or you have a deep and strange psychological need to always engage in intellectually impoverished exercise of justifying (usually poorly) any garbage that he spews forth.
Daniel,
What “nasty” things have I attributed to you in the past? Please point them out so that I can have a chance to apologize. I never intend to be “nasty” and certainly not personal. I have a feeling that your definition of “nasty” may be a bit more broad than mine.
You did apologize on David Henderson’s post at the time… but you always seem to be quick to accuse other people of the same things you accused me of there.
Well – calling someone a proponent of central planning doesn’t seem all that nice to me.
Truth isn’t always nice, Danny. That fact does not make it less true and it is always worth it to meet reality with open eyes.
I don’t think accusing Keynesians of advocating central planning as being “nasty”, Daniel. “Nasty” is about making personal attacks and attacking the intentions of others… the way Krugman routinely does. He’s nasty. I haven’t done that to you. I’ve simply asked you again and again how the administrators of a Keynesian stimulus program can determine whether the enterprises they engage in are self-sustaining or whether they’re just boondoggles like corn-ethanol that would vanish as soon as the taxpayer largesse stopped.
Medicare is run by central planners. The stimulus was a central planning operation. Neither are totalitarian control over all of society, as was the aim of soviet central planning. But I’m not making that case. The scope of Keynesian central planning is narrowing, but no less top-down.
I do believe that you are honestly pursuing what you believe to be the best way to make the world a better place. I just disagree with some of your methodology and means.
Corn ethanol?
What does that have to do with anything?
What does Corn Ethanol have to do with anything? Well, here we are in a time of alleged debate over fiscal consolidation and yet there is no talk of ending this immoral, irrational subsidy. Even though food prices are sky high and corn ethanol which has no market absent government intervention is partially to blame, the subsidies continue.
Why anyone would expect better outcomes from these kinds of technocrats and politicians vs. individuals deciding how to spend their money and leverage their own insurance regarding healthcare is beyond me.
Krugman espouses the need for politically-directed resource allocation. The results of that suck. Keynesians demand management is no different. That’s the point.
Methinks,
If were all PK, he’d never argue with us because he’d always find the most agreeable interpretation of what we say.
and I like the fact that regardless of what he earns from my transaction my doctor genuinely wants me to be healthy.
Every successful business wants their customers to be happy with their transaction.
You doctor, if he or she is to be an efficient producer of health services, must have at least scores, likely hundreds of patients.
How deep of a relationship can your doctor afford with very many of them?
If only it were to continue to be only my business. But, the state is making it their business.
Dr. B.:
“But physicians and patients? I don’t *want* my physician involved in my life any more deeply than what I contract for. And I’m sure that my physician is relieved that he can go about his business without feeling that he has some obligation and connection to me that rivals the non-commercial obligations and connections that he has with his children, his friends, his wife.”
Excellent point.
Could it be we are misinterpreting Krugman? That Krugman is really referring to his own personal veterinarian. “That“ relationship needs to be sacred?
You do what you do for lots of non-pecuniary reasons and out of genuine empathy with the sort of lives that your fellow human beings live. People on here appreciate that and your relationship with people on here is grounded in that. Why do you find it so bizarre that people would appreciate the same sort of thing in a professional that potentially has their life in his hands?
A real life scenario that happened to me last week.
A young couple brings in their 3 days old baby to the ER because it is vomiting. Sometimes the vomit is green. Possibly a catastrophic bowel obstruction if untreated. But the baby looks good. It’s likely just a formula intolerance. The parents have a $500 dollar co-pay. I say maybe their is a 1 in 1000 chance that this is serious. Now the parent and myself are calculating odds and wagering money against an unlikely but uncertain outcome for their baby. Clearly I insist we take these odds and don’t admit the baby … if this were Vegas. They agree we admit and find there is nothing wrong with the baby ( ~ 3-5,000 dollars hospital stay) but sooner or later these considerations… these gambles are made by desperate patients or uncertain physicians and good monetary decisions result in bad medical outcomes. 999 times out of a thousand I could save $5000 in cost and ?500-1000 in co-pays.
No physicians nor patients in a civilized society should not be put into such circumstances. We are plenty wealthy to afford the care needed for all of our citizens. The protection from foreign invaders and disease invaders of life should be a right in any modern day civilized society.
So the incentives for both the doctor and the parents is to make the most expensive decision? In a world of scarcity, what is the logical outcome of such a system?
There is no scarcity. We have tens of millions of people sitting idle and many more who make a living denying health care. Put them to work and you will have plenty of health care providers and resources.
“Put them to work and you will have plenty of health care providers and resources.”
Yes Massa.
“There is no scarcity.”
That is, quite possibly, one of the dumbest things I’ve heard a “medical professional” say in my lifetime.
muirgeo,
“We have tens of millions of people sitting idle and many more who make a living denying health care. Put them to work and you will have plenty of health care providers and resources.”
I know at least a dozen people with nursing qualifications, all of whom aren’t getting hired; the hospitals in southern PA and MD are NOT hiring. These are the idle you’re talking about. They want to work… in the medical field… but no one’s hiring.
Any explanation muirgeo on why these hospitals aren’t hiring qualified medical personnel?
Regards,
Ken
Everything is limited in supply. If there were ‘no’ (i assume u meant little) scarcity, then the value of medical treatments would be the same as that of an ounce of seawater.
“No physicians nor patients in a civilized society should not be put into such circumstances.”
In a world of scarcity, there isn’t a policy that removes that reality, it merely posits the choice and cost to different parties.
Did you get that from a doctor’s blog?
No physicians nor patients in a civilized society should not be put into such circumstances.
Congratulations. Your typos are finally more correct than you are.
:^[)
Again it won’t be the physician… it will be the health care CEO, profits, and dividends that are balanced against your need for health care. You want Wall Street to decide how to deliver care and I think we’d all be sorry based on their historic ability to allocate resources and minimize risk.
“Again it won’t be the physician… it will be the health care CEO, profits, and dividends that are balanced against your need for health care. ”
Again, as far as I’m aware, people are free to join or start non-profit healthcare initiatives/pacts.
muirgeo,
My doctor runs his own business, as do almost all doctors with whom I interact. THEY are the CEOs deciding on how large the profits are going to be.
Regards,
Ken
Your imposition of an either or choice is false.
The only reason CEOs might be making such decisions is because government has altered health care markets such that many people are subscribers to HMOs rather than direct negotiators with physicians and other health care providers. This started in WWII.
You appear to be unable to consider the possibility of leaving money in the hands of mere “people” so they don’t have to rely on the discretion of CEOs or bureaucrats.
Your perspective offers only the choice between two forms of serfdom.
I don’t see that, DK.
I think Krugman’s point, at its charitable best, can simply be seen as a human criticism against crass commercialization. But that’s not really an “economist’s criticism” but rather simply a social commentator’s criticism. Unfortunately, I think Will’s take is far more accurate.
I think that’s exactly right – it’s a complaint against the extent of the commercialization of the relationship. And certainly that’s a “social criticism” more than an “economic criticism”. But (1.) concerns about commercialization are not the same as a complete rejection of commercialization, last I checked, and (2.) the fact that something is not an economic critique does not make the point “bizarre to an economist”. “I don’t like lukewarm coffee” (sitting in my mug right now, unfortunately). That’s a subjective criticism – it’s not an economics criticism. But you wouldn’t say it’s a bizarre position for an economist to have just because it’s not a criticism that emerges from economics.
DK:
Characterizing differing exchanges is fine. Sanctifying differing exchanges is politics.
What is bizarre is for an economist (or, really, anyone) to complain about the prospect of health-care provision being consumer-driven.
Like a physicians bad decision based on cost concerns a person might die…. a bad decision to arrange all of societies medicine on a consumer driven basis might cause hundreds of thousands to die or be harmed. Good doctors first think what if I am wrong before assuming they are right.
What if a physician is wrong and it cost his patient pain. suffering or even life.
An economist making a grand decision better be sure he has the right prescription. Because what if you are wrong Don and we switch over to consumer driven medicine and it turns out to be more expensive and cost many extra pain and suffering and even their lives.
We physicians WISH we had so much certainty in our decisions and their outcomes.
“An economist making a grand decision better be sure he has the right prescription.”
He isn’t trying to make a decision for anyone – you are. That’s the primary distinction.
muirgeo,
“consumer driven basis might cause hundreds of thousands to die or be harmed.”
Are you really claiming that the people MOST affected by medical care SHOULDN’T make the decision about the medical care they receive?
I would like for you to name ONE industry where the quality of the product or service declined as the consumer gained more control over the choice of that product or service.
Regards,
Ken
What is more bizarre is that people continue to think of Paul Krugman as an economist. He is not. He *was* one, but no longer is.
George,
It’s amazing how you keep revealing the superficiality anderror of your comprehension of economics.
If the consumer is driving, where does that put the government? Back seat? Shot gun? Not good enough.
DK,
“But you wouldn’t say it’s a bizarre position for an economist to have just because it’s not a criticism that emerges from economics.”
I would when it’s an economic policy topic. If PK wants to deplore the devouring of the poor gazelle by the lion, that’s his opinion as a human being on nature. But his take on this health care issue is somewhat bizarre because his training, you would think, would make him see this issue more “economically”. IOW, I do hold left-leaning economists to a higher standard than the “muirgeo type” leftist type. Knowledge of economics should skew the way in which he interprets the meaning of “consumer-driven” health care. Like Will said, he sounds like a sociologist when he complains like that.
Left-economists should still find the gumption to give the proverbial face-palm when they overhear stuffy, clueless econo-drivel from the sociologists and English professors in the coffee room….regardless of how similar their politics are.
But that’s just my opinion. People like PK encourage economic illiteracy among the Left when they refuse to take a stand against the void of even the most basic economic literacy and sense among their ranks. It’s shameful. But that’s neither here nor there…or is it? Someone like you would do us all much more good if you could quell some of looniness in people like muirgeo and the moonbats at DailyKos instead of always going tit for tat with libertarians. But that’s your choice. It’s just a suggestion.
What economic illiteracy is he not refuting here???
Do you think it’s economic illiteracy to note that the doctor-patient relationship is a lot more than a producer-consumer relationship?
How in the world is that an economically illiterate thing to say?
*face-palm*
Why do you pretend to not what I mean? You needlessly hamper discussion when you pull these stunts. You’re smarter than this. You alternatively choose to be “black and white” or a million shades of gray when it suits you.
No, I think it’s economic illiteracy to post the clownish crap that muirgeo does. Do you actually read his tripe? On this thread?
I think Will it summed nicely in his article. It’s idea of letting emotional priors and sensibilities cloud discussion of what PK knows to be true. He knows health care is still a consumer driven enterprise. It’s dry and simple.
This is quite simple: Paul Krugman is not an economist. He plays one every once in a while, but this particular blog post has nothing to do with economics. He may trick some followers into thinking it is, but it is not.
Do you think it’s economic illiteracy to note that the doctor-patient relationship is a lot more than a producer-consumer relationship?
I am friendly with the people at the bakery where I frequently purchase bagels. My friendly relationship with them is distinct from the commercial relationship I have with them.
With my health care provider, the interpersonal aspects that occur when I visit my doctor is distinct from the services they provide and the payments I make for those services.
Just because humans can be friendly in the midst of commercial transactions does not alter the consumer-producer nature of the transactions.
I am engaged in a business relationship with a very dear friend, but we are both aware of the distinction between our friendship and our commercial relationship. It does help that the friendship induces trust in the business aspect, but I engage in many commercial transactions where there is a presumption of trustworthiness, such as my banking service provider. I have a great deal of trust there, yet I don’t know anyone nor can I even name any of the people I have dealt with.
Where money is exchanged for goods and services, is is fundamentally a commercial relationship and the fact the the services may be health care does not alter that.
re: “No, I think it’s economic illiteracy to post the clownish crap that muirgeo does. Do you actually read his tripe? On this thread?”
Well what are you complaining to me about muirgeo for?
Talk to muirgeo about that.
I don’t speak for muirgeo any more than you do.
OK, Danny.
Fine. Read it all and then pick snippets to respond to so you avoid the larger point.
Again, you don’t foster good discussion by being coy and difficult.
Danny, stop paying your doctor and then come back and tell us if your relationship with him goes beyond mere producer/consumer.
Whatever John V – you’re never satisfied. Don critiqued Krugman and I critiqued the critique. Sorry I’m not preoccupied with muirgeo like others on here are.
Methinks -
It’s a market economy, and we have a market for medical services. To say “we’re not just consumers” is different from saying “we’re not consumers”. I’m not sure why you write “mere producer/consumer” either. Nobody is trying to trivialize the market here.
DK,
By “nobody” you surely don’t t mean Krugman and you surely don’t mean yourself.
DK: “but if your relationship with your doctor is simply a consumer/producer relationship that seems somewhat impoverished to me (and apparently to Krugman and Callahan too).”
Geez, Daniel.
You just did it again.
Actually, Methinks, Krugman and myself where who I had in mind.
You’re drawing an odd inference from my “impoverished” statement. My relationship with my doctor would be a lot less valuable if it were simply an exchange of money for services – if it were not characterized by genuine care on his part and a sense of calling to the sort of work he does. To say that without that it would be a lot less valuable is not to say that the exchange of money for services is somehow a trivial or non-valuable thing.
Jesus John V. Here I’ll go through point by point so you can’t complain anymore.
- “I would when it’s an economic policy topic. If PK wants to deplore the devouring of the poor gazelle by the lion, that’s his opinion as a human being on nature. But his take on this health care issue is somewhat bizarre because his training, you would think, would make him see this issue more “economically”.”
I don’t think that understanding the economics of health care overrules or negates a proper understanding of the social/personal aspects of it. Therefore, I disagree with the suggestion that looking at it the way he is is “bizarre” given his training. Economists don’t cease to be human upon receiving their training.
- ” IOW, I do hold left-leaning economists to a higher standard than the “muirgeo type” leftist type. Knowledge of economics should skew the way in which he interprets the meaning of “consumer-driven” health care.”
It seems to me that acknowledging the consumer-producer relationship in health care (which he has always seemed to acknowledge) does not prevent one from rebelling against the idea that that’s all there is to it. You’re pretty vague about what you think the “skewing” should be, but I don’t think his take on “consumer driven health care” is problematic here.
- “Like Will said, he sounds like a sociologist when he complains like that.”
OK, so? What’s wrong with sociologists?
- “Left-economists should still find the gumption to give the proverbial face-palm when they overhear stuffy, clueless econo-drivel from the sociologists and English professors in the coffee room….regardless of how similar their politics are.”
I think we should recognize the fact that you can only counter so much and Krugman’s time is probably better spent countering other economists as well as politicians – but with that in mind, I agree with you. That’s why I asked you what “econo-drivel” he’s neglecting. The econo-drivel from the right is more egregious right now than the econo-drivel from the left (which he spent more time countering back in the 90s). Regardless, there’s only so many hours in a day and I’m not sure why he or I or anyone else should care about the musings of English professors.
- “But that’s just my opinion. People like PK encourage economic illiteracy among the Left when they refuse to take a stand against the void of even the most basic economic literacy and sense among their ranks. It’s shameful. “
Again – like what? The most egregious economic illiteracy on display lately has been on the right and among libertarians. Every once in a while you get problematic points from the left, certainly. And from the Daily Kos left you get it even more, I’m sure. But Krugman seems to me to divide his time appropriately between the most serious economic illiteracy and the critiques he can make that will make the most difference. This has included critiques of the administration itself, and of course lots of critiques of the right and libertarians. Do you think there is something more egregious he is neglecting? What do you have in mind? The only thing you’ve mentioned is muirgeo and Daily Kos. Do you blame Krugman for not spending time on that? Who cares? I think his time is better spent correcting economic illiteracy among politicians, as he is doing in this column.
-“But that’s neither here nor there…or is it? Someone like you would do us all much more good if you could quell some of looniness in people like muirgeo and the moonbats at DailyKos instead of always going tit for tat with libertarians.”
muirgeo doesn’t command the sort of following that the libertarian blogosphere does. He’s sort of off on his own. And he’s got a lot of old school left anacrhonism ideas. And he doesn’t know much economics. I really don’t care much about his commentary. I’d rather confront people who (1.) have some knowledge of economics, and (2.) pose a more substantial risk. We’re not going to have a massive reinstatement of trade barriers or protectionism any time soon in response to muirgeo. We may have bad macroeconomic policy implemented or bad politicians elected as a result of the libertarian blogosphere. I’m going to concentrate my efforts on that economic illiteracy rather than on his.
I’ve addressed every single point now. If you’re going to do any more “*face palms*”s, follow it up with something more specific John V. Your tendency to see fault in everything I write while remaining completely vague about what’s so disconcerting to you is hard to contend with.
Daniel.
“My relationship with my doctor would be a lot less valuable if it were simply an exchange of money for services – if it were not characterized by genuine care on his part and a sense of calling to the sort of work he does. To say that without that it would be a lot less valuable is not to say that the exchange of money for services is somehow a trivial or non-valuable thing.”
So what? This statement you are making is not the issue in an economic sense. And calling patients consumers, as far as economics is concerned, is correct and the proper way to view the matter. That’s the whole point.
Beyond that, whatever matters to you on a personal level or whatever you cherish is BESIDE the economic issue. What PK is doing is seemingly trying to do is pretend that the dry and impersonal economic exchange at the heart of it all shouldn’t be there or can’t be there.
I own a restaurant. I am genuinely concerned that my customers are happy. I know many of the regulars and genuinely enjoy talking to them and making them feel at home. I want them to be happy and I try very hard to make sure that they are. I take problems seriously. I would be very alarmed on multiple levels if they got sick or something. I’m human. It’s business but it’s also people.
Granted, it’s not a doctor/patient relationship but the idea, on a commercial level is the same.
When my HVAC unit broke down last summer and I called my repairman, he was genuinely concerned for me as his customer and dropped what he was doing to get there ASAP. That’s genuine concern for my business. But it’s still business in the end. And that’s how it works. PERIOD. Let’s not pretend it’s something other than what it is. Other than paying the cashier in the minimart when you get gas and other impersonal transactions, many businesses are built on personal relationships on a deeper level. But it’s still business at the core.
The flack that PK is getting here is for pretending that business side of this whole thing is somehow not there or shouldn’t be there. That’s silly.
Danny, caring about patients is just part of the job. It’s part of the service you buy as a consumer. Doctors who don’t much care for patients leave the practice and go into research.
But, I’m curious – how do you reconcile in your own head Krugman’s cognitive dissonance? According to him, doctors and are not saints, yet a faceless panel of these non-saints must be given the power to interfere in the “sacred” relationship between you and your doctor to reduce costs borne by taxpayers. Vouchers, which would very effectively reduce costs to taxpayers and leave the patient to choose his own sacred relationships are derided by Krugman.
Thanks for the reply. Now, here;s the heart of the problem with you on this PK issue:
“It seems to me that acknowledging the consumer-producer relationship in health care (which he has always seemed to acknowledge) does not prevent one from rebelling against the idea that that’s all there is to it”
Nobody said that’s all there is to it. NOBODY. Not a one. So, in essence, you are talking past the criticism and you are arguing against a point that nobody is making.
PK seems to be basically and pointlessly deploring the fact that consumer/producer side of this lies at the heart of it all…as if this relationship cannot be what it really is at its core: business. Sure, it’s a special kind of business but business at its core nonetheless.
Now what do you disagree with?
BTW, I found what you said about libertarians in general to be really eye-popping….not that you should ignore the first part of my post to respond this quip.
John V – I appear to be missing this point in reading Krugman “The flack that PK is getting here is for pretending that business side of this whole thing is somehow not there or shouldn’t be there”
I spent a lunch break responding to you in detail above, but perhaps I can find time later to reread the column. If he was saying the business side shouldn’t be there then I completely missed that.
re: “Nobody said that’s all there is to it. NOBODY. Not a one.”
THEN WHAT IS SO “BIZARRE” (to use Don’s word)? If you aren’t saying that’s all there is to it, then that’s great. You seem to agree with him and me. I think it would be great if you agree with me. If you agree that’s not all there is to it, that’s fantastic. What’s your concern about my points and his point then? What do you disagree with?
Daniel,
“If he was saying the business side shouldn’t be there then I completely missed that.”
Let’s not be pedantic about this. Why else would PK express an indignant air of disgust at the idea of a patient being a consumer at the heart of at? I don’t need you to go back and predictably parse his words to find reasonable doubt.
I think Will nailed it quite well in that article.
“If you aren’t saying that’s all there is to it, then that’s great. You seem to agree with him and me. I think it would be great if you agree with me. If you agree that’s not all there is to it, that’s fantastic. What’s your concern about my points and his point then? What do you disagree with?”
There’s nothing to disagree about on that basic point. That’s part of what makes your insistence here so puzzling.
But that’s not the issue…like I already said.
Right – your issue is that you apparently think Krugman doesn’t like the market.
If you insist on that, I’m not sure what else to tell you. You apparently sincerely believe this.
As far as I can tell you and Krugman agree on every single point that has been raised here (presumably not on others that haven’t been raised) and that your remaining disagreement is based on the collective delusion of Krugman as some sort of market-hater simply because he countenances more government than you.
Neither you nor Krugman are not against markets. They have their place.
Krugman favours government control unless the government decides that a market should be allowed to exist.
Not at all different from V.I. Lenin’s NEP which forced top down planning on the population, but allotted collectivized peasants plots to grow their own crops and sell them to willing buyers.
Of course, Danny will be deeply wounded if such a reality should be pointed out to him and such an apt comparison made.
really miss the “edit” button.
I’m surprised you of all people would trivialize the depredations of Leninism like that, Methinks.
And I am not at all surprised that you, Danny, would fein outrage to distract from the ugly truth which stares you in the eye.
I don’t take you seriously enough to be outraged at that – I’m just a little surprised that you of all people would use something like that to score political points.
Particularly in such a transparent way. If you’re going to whip out Lenin to criticize an actual advocate of socialism, I suppose you’re entitled to that. But Krugman? You’re going to do that to score points in a discussion about a pretty typical if outspoken neoliberal economist with no sympathies for central planning? I’m not outraged at that. I do find you a little more pathetic than I did an hour ago, though. But no outrage.
Well, I see you’ve worked yourself up into a quite a tizzy, Danny.
If we’re on the topic of pathetic, kiddo, I suggest there’s nothing simultaneously more hilarious and pathetic than repeating the demonstrable lie that Krugman has no sympathies for central planning. I realize that you’ve blinded yourself to the realities of your heroes the way that ardent Bolsheviks blinded themselves, but your defect does not extend to the rest of us.
DK,
Whoah….
A little hyperbole now??? I never said nor do I think PK hates the market. However, I do think he’s too quick to apply suspect principles and reasons to abandon the market and/or apply overly rigorous standards to support free markets that he never applies to government. That of course is a fundamental and general disagreement that applies to many things. The problem in this particular issue is quite well summed up by Will W. It has to do with attitude toward health care while knowing better and refusing to acknowledge what he knows.
Look at the damn title:
“Patients are not consumers”
How about this:
“Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? ”
“What has gone wrong with us?”
OMG….while stick my finger down my throat. How much more contrived huffy-puffiness can this guy conjure up?
But you just can’t see this and call it what it is. You have to read deeply between the lines to make it something other than what it is. It’s all well discussed and, like I said, Will summed it up well in the description of the mentality behind that fake (or not fake) indignation at the thought of medical care falling under the umbrella of a consumed good.
We have government intervention to thank for a large part of the mechanization of Doctor-Patient relationships. Once you have a giant bureaucracy paying for care like Medicare, you have to systematize it. And so out of that emerged procedure-based billing and the coding system. Yuck. The bad incentives that induced begot more bad stuff.
Government “standards” don’t encourage complex relationships. They reduce them to lifeless paperwork.
Callahan’s response was weak and frankly, just dumb; PK’s column was the typical drivel he spews – not every statement was incorrect, but completely saturated with his blinding statist worldview nonetheless.
DK, you have VERY low quality standards for those with collectivist ideology similar to you own, and give them massively favorable consideration in your interpretations. In contrast, you’re nit-picky as hell to those with individualistic ideologies, and interpret them in the most bizarre oppositional ways – often seeming to willfully miss the point. What’s up with that?
You do realize Gene is a libertarian, don’t you?
Look I’m just reading what’s written. I’m not the one pulling central planning and dictation by the state out of thin air.
You seem to think that, like you, everyone else judges people’s statements by the label they choose to attach to themselves rather than by what ideas they espouse in their statements.
What? yetanotherdave accused me of treating people differently depending on their ideology, even when I charitably or favorably referenced both a progressive and a libertarian. Gene expresses libertarian ideas all the time and actually rarely applies any label to himself. Stop projecting.
Projecting what?
Out of curiosity, what do you call Krugman’s hatred of vouchers and advocacy for an unsaintly panel of doctors to decide patient care in light of his reverence for the “sacred” patient/non-saint doctor relationship and his deep embrace of free markets? You never touched that question.
Methinks,
I believe the answer to your question goes something like this:
Free Markets are great and we support them as long as there is perfect knowledge and perfect competition.
I know there’s actually even more to qualify the approval of markets but that’s the gist of the kind of impossible answer you’ll get.
John V,
Sounds about right. Markets have their place. Things certain Princeton Ekonomystics consider important require imposition by a team of experts with even less information but more perverted incentives than market participants. It’s all clear to me now, John V. We must submit to be free.
I’m not sure if he “hates” vouchers. The point he noted is that Medicare Advantage costs significantly more than traditional Medicare and that we can expect the same from vouchers. That isn’t exactly a news flash, and I suppose its relevant since we care about entitlement costs.
I don’t think he thinks and I certainly don’t think a panel should decide patient care. I do think he thinks (and I agree) that the government should make some decisions about how government program dollars get spent. I don’t see how that threatens a patient’s relationship with a doctor any more than a private insurer doing the exact same thing threatens that relationship. Insurance providers – public or private – will always be at the table. That’s part of life. That ought not to substantially cut into the medical care that would be provided, but at the same time that medical care ought not dictate to insurance providers. If the government or if a private insurer can’t countenance paying for what the doctor-patient pair consider necessary, then something else will have to be worked out between the doctor and the patient. Medical care isn’t free.
I’m not sure I feel as strongly as Krugman does about vouchers. I sympathize with Paul Ryan insofar as I’d agree vouchers will help patients more efficiently use Medicare funds, but I sympathize with Krugman insofar as I’d agree there’s not a ton of evidence suggesting it will help the budget concerns or the resources seniors have all that much. It gives seniors choice and that’s good, but experience suggests it raises the costs of those choices, which is bad. I don’t have a real stake in where to come down on that ambiguous result.
John V – you don’t need perfect competition or perfect knowledge for markets to work.
Methinks,
Yes. The double standard is astounding. I call it the “Perfection Paradox”. That’s my term. It hasn’t caught on yet. But I’m still hopeful.
I like that. I’m stealing it.
DK,
No point in telling ME that markets don’t need perfection. I’m simply repeating what I have read before from several keynesians.
John V – it’s good to see we’re agreeing so much today.
Here DK:
http://economistsview.typepad.com/economistsview/2008/10/competitive-mar.html
The “perfection paradox” on full display. Now, I am sure you will be able to read that and use your reading skills and imagination to make the point of that post out to be something more nuanced and stronger than the central point being conveyed or try to weaken the point I am making by using that those skills in reverse on what I am saying but there in that long post you see the mentality of the perfection paradox. You see how a liberal economist demands from markets while saying nothing and expecting little from the process to correct these “imperfections”.
John V -
I don’t have time to read the post in detail, but after reading the first portion I want to make one point.
There’s a difference between saying “if perfect competition and perfect knowledge don’t apply it’s possible that the market will not be as efficient as a theoretical, pencil-and-paper market where those conditions do apply”. This statement is true. But it’s really meaningless. Who cares how it compares to a pencil-and-paper model? In some ways it’s a nice benchmark when you do theoretical work, but it has no real practical significance. We know the threat of entry is relevant when there isn’t perfect competition. We know signaling and reputation is relevant when there isn’t perfect knowledge – etc. etc.
But by the same token, you don’t just ignore factors that have welfare implications. It’s wrong to say “if you don’t have perfect knowledge, markets don’t work” – but it’s right to say “systematic asymmetries in knowledge can impact market efficiency”. For this reason you also can’t cut-and-paste simple theoretical conclusions and just say markets are always going to work how we want them to work.
That’s not the “perfection paradox” as you’ve described it, and there’s a big difference in those two ways of talking about departing from “perfect” competition (which is just an abstract concept to begin with).
DK,
Medicare Advantage costs significantly more than traditional Medicare and that we can expect the same from vouchers.
Nonsense. Medicare Advantage is loaded with government mandates which significantly raise the cost of the program – as they raise the price of insurance for non-medicare insurance buyers. Vouchers are written for a finite amount and allow the recipient to choose form any number of insurance programs. Seniors will be free to purchase any additional medical care out of pocket.
In fact, this is in essence similar to Singapore’s program (which applies to all). The government caps how much it will pay and the rest is up to the health care (dare I say it?) consumer. Providers compete for consumer dollars.
In fact, vouchers would perform exactly the function Krugman claims to favour. A board will be a.) more expensive than vouchers and b.) subject to political incentives.
I do think he thinks (and I agree) that the government should make some decisions about how government program dollars get spent.
Excellent. So, once the government destroys the private market, making itself the only alternative, it then must dictate how money is spent. I cannot imagine why I keep making comparisons to Soviet policies. Can you?
Insurance providers – public or private – will always be at the table.
On the one hand, I agree on the other, the issue is more complicated. In the case of Medicare, the government has supplanted the health insurance market, giving seniors little choice. Both medicaid and medicare shift costs to the private sector, artificially raising the cost of health care for the private market. And even the private market isn’t really private. Insurance companies are subject to government imposed mandates and consumers are subject to restrictions of competition in health insurance (mostly resulting from lack of portability). Worse, health insurance companies negotiate prices with doctors. State law, however, prevents those doctors from negotiating on their own with cash-paying patients. There is a lot of cost shifting in health care, artificially raising the price of care for cash payers. So, paying out of pocket is made artificially much more expensive and telling people to just suck it up is just cruel. Yet, weirdly, this cruelty is not what concerns Krugman. He is happy to find another top-down “solution” to a problem created by top-down solutions.
It gives seniors choice and that’s good, but experience suggests it raises the costs of those choices, which is bad.
Yes, but that’s a function of cost shifting and mandates and those are functions of government interference.
As far as I’m concerned, the voucher program doesn’t go far enough. It needs to be extended to Medicaid because in Medicaid, patients don’t even have the option to pay their doctors out of pocket.
BTW, DK, I completely agree with krugman on one thing – taxpayers should not be forced to pay an unlimited amount. Ideally, if they should be required to provide any health care at all, it should either be a pre-set limit, eliminating the discretion of a panel.
DK,
“But by the same token, you don’t just ignore factors that have welfare implications. It’s wrong to say “if you don’t have perfect knowledge, markets don’t work” – but it’s right to say “systematic asymmetries in knowledge can impact market efficiency”. For this reason you also can’t cut-and-paste simple theoretical conclusions and just say markets are always going to work how we want them to work.”
The idea isn’t that markets are always going to work as we want them to work. What matters is what is hidden dangling at the end of what you said about asymmetries and market efficiency. The follow up to that is: What to do? And how?
When the answers involve a competency to dictate the solution via government we run into problems with that mechanism that are more problematic than the market inefficiency itself. The amount of work put in by economists to identify and develop these points about where markets don’t work as well as we would like, is totally missing on the implementation side involving public policy. THAT, is the “perfection paradox”.
markets are always going to work how we want them to work.
Who is “we”? I consider a market working as I want it to work as long as the participants are uncoerced.
There exists in nature such a thing as market inefficiencies. There also exists in nature those people who are motivated by profit to exploit those inefficiencies and in doing so, reduce those inefficiencies.
There are some economists and students of economics who view inefficiencies in any given market as permanent fixtures. That can also happen – but making inefficiencies permanent usually requires government assistance. Government intervention institutionalizes market inefficiencies.
Any market inefficiencies means there is room for more money to be made thru new innovations. there are no market failures, save distortions due to govt interventions.
DK,
Here’s the thing: This is nothing new. You habitually come here and get into these little tom-ay-to, tom-ah-to spats because you think libertarians are so wrong….yet you go to such absurd lengths to disagree. Take this PK issue. The point made by Don and Will before him still stands. You haven’t exactly shown anything to refute that point. Rather you have simply taken great pains and effort to make PK’s issue out to be something other than what it was.
IOW, YES, PK’s huffy-puffy complaint (or lament) that is embodied in those quotes I provided is bizarre coming out an economist’s mind. The issue is not that he finds something “special” about the doctor/patient relationship but rather that he even finds the desire the decry the idea of a patient as a consumer. It’s still there. You can’t take that out of his mouth.
DK,
Look at how you deal with PK in that long post above:
I don’t think he thinks …..
I do think he thinks…
I’m sure if he hates….
My God, Danny. You will stare and deliberate in your mind as long as it takes to find the meaning you want or to put the meaning you DON’T want in a shred of reasonable doubt. YET, you look for holes in what we all say at all costs. WHY DO YOU DO THIS???
I can’t read his mind but I can read his words. You’re clearly going to read whatever you want in them. Just don’t respond to my posts anymore if it has you this riled. I’m going to continue reading plain English.
John,
As unbelievable as it is, he is evidently blissfully ignorant that he does it.
yet another dave –
I clearly know what you guys think he said, so I know when you think I do it. You can call me “blissfully ignorant” and I can call you “blissfully ignorant” right back, but it seems more reasonable to just say we disagree and find the other absurd. But there’s certainly no ignorance on my part that I read him differently than you all regularly do.
By the same token, I think Don is riddled with errors too and obviously I’m not shy when I think that’s the case. I could call you guys “blissfully ignorant” when you fail to call him out on these cases, but it seems more appropriate to just call you “wrong”.
danny,
I’ve been exceedingly kind in my depiction of you on this blog out of respect for the proprietors, but I’ve never before encountered anybody who’s so astonishingly dense as you are on certain things. Think what you will – I couldn’t care less.
I’m fine if we disagree, but that’s not what’s going on. You blatantly miss more points than are in the entire Pointed Village while simultaneously fabricating favorable interpretations of the likes of Krugman out of thin air. It’s astonishing.
I do realize I’m wasting my keystrokes because your ego won’t allow you to consider the possibility, so please just keep doing what you do completely unaware of what’s really going on. I’d hate for you to suddenly be less confused about what poeple are saying to you here.
DK,
“I can’t read his mind but I can read his words. You’re clearly going to read whatever you want in them. Just don’t respond to my posts anymore if it has you this riled. I’m going to continue reading plain English”
First, I’m not riled up. Your ability to decipher tone in typed words is as weird as your deciphering of PK at times.
And speaking of PK, you say you can’t read his mind and will just continue to read plain English. What parts of those quotes from his article are so hard to read or understand then?
From PK:
————————————————————–
““Patients are not consumers” (Point Blank)
“Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”?….What has gone wrong with us?”
————————————————————————
hello?? Plain English. No mind-reading needed.
sigh…
In response to your unrelated tangent: I haven’t seen anything that supports your claim that Gene is a libertarian. I just read through a random sample of a dozen or two of his posts and not even one of them struck me as libertarian. You carry a number of bizarre notions, and it seems a misunderstanding of libertarianism is among them.
Now, off your tangent: Of course, as expected, you completely missed the point. I didn’t accuse you of anything – I just described what you very consistently do. It is a much broader observation than just this thread – you do it all the time and it’s really obvious.
My suspicion its that your bias is so overpowering you don’t even realize you do it, and your ego is so big you cannot allow yourself to consider the possibility. Several people here have called your attention to this problem of yours on many occasions, and you’ve yet to figure it out.
He’s not a typical libertarian – he doesn’t talk like most libertarians which is probably one of the reasons why I like him. But he’s definitely a libertarian. Check out his book or look at some of the stuff he did when he was at the Mises Institute.
Daniel, the argument is very clear:
1. The doctor / patient relationship is sacred (different than cash transactions.)
2. Therefore the government should invade and control that sacred relationship.
3. Implied; Money is too crass a medium; better that government bureaucrats do it.
How 2 follows from 1 is beyond me since 3 does not imply 2 either.
BTW: Since econ 101 teaches us that incentives always govern, what would Krugman say about bureaucrat incentives, especially in light of 200+ exemptions for Obamacare?
Remember the “perfection paradox”.
Simply stated, it is the double standard applied by left of center economists whereby markets need to pass a battery of stringent (near perfect) standards and theoretical modeling to be considered adequate while the corrective measure to the imperfections (government) needs none.
If doctor-patient relationships are so sacred, how will bureaucratic control of health care provide a more “sacred” relationship than a free market system in which a patient may choose his or her own doctor and voluntarily engage in that relationship with the person of their choosing? You don’t get to choose your doctor or, frequently, your treatment in a government run system; you get what they give you. In a free market in which the consumer has control over their own health care, you are free to leave and find another doctor if you feel your relationship is not “sacred” enough. If your insurance plan isn’t filled with ridiculous government mandates (which it wouldn’t be if there was a free market), there is no reason they would deny you the right to choose your own doctor.
Krugman’s argument is tantamount to saying that the relationship between husband and wife is best regulated by the government because it is “too sacred” a relationship for people to choose who they want to marry.
Personally, I didn’t see anything in the article written by Krugman that I could agree with, nor do I see anything in Wilkinson’s.
This: “Market exchange is fine, in it’s place. But there are some things to which we are entitled as human beings and/or citizens, and putting those things on the market dishonours our rights and diminishes our dignity as persons and Americans (or whatever nationality you may be).” The gist of it is particularly to far to the left for me to swallow. Plus, it seems to be more gobbledegook than actual good sense.
I’d ask Mr. Wilinson just exactly what it is that “we are entitled to as human beings”. Note I challenge the word entitled and not the word rights.
Then, I’d like to ask Krugman to specifically point out a time in this nation’s history when the average American did not have to cement that relationship with his healthcare provider by agreed upon amounts of cash, or acceptable goods in barter, for service.
Certainly health care involved a more sacred relationship in the past, as seen in this account: http://nailheadtom.blogspot.com/2010/02/death.html
Crazy old uncle Paul is at it again.
Lets see, apparently there is mutual beneficial exchange, where both parties perceive a benefit, and the pie grows larger…..then there are certain “Krugman exchanges”. In the Krugman exchange, mutual benefit of two freely thinking parties engaging in exchange is an error. You see, certain exchanges must be “sacred”.
“Krugman exchange” is not based upon mutual benefit. Nay. Nay. In Krugman exchange sanctification replaces mutual self-interest at the point of exchange. One need not consider self interest nor mutual self interest, one merely focuses on sanctification.
Where shall one go to find these sanctification parameters? Mutual beneficial exchange is basically mundane knowledge available to all. However, sanctification is “special knowledge”. You see, only a few self appointed intellectuals have the capacity to tell the masses what is sanctified and hence good, right, righteous, and best for you. They and only they have the “special knowledge”.
Yes, crazy old uncle Paul is at it again.
In a free market, buyers and sellers should come to an agreement and reach a price level which benefits both parties of a transaction.
When a buyer is dying, a seller who can prevent this gets enormous leverage on his goods, this might be an argument why free markets are not favorable here.
Anyways, what do people here think of the argument that the US has the worst average healthcare for twice the costs (% of GDP) of other developed nations.
Or in other words, the healthcare system allowing the most free market mechanisms to work is not only the worst of the whole developed world but also the most expensive.
Victor:
Your argument above is notional. There is empirical evidence to refute your claim. You are making the old per capita vs. household argument.
Also, should consumers expend resources in some other area? Does your implicit central plan decide up consumer expenditures in differing sectors? Do you decide what is the best expendature for consumers?
From http://en.wikipedia.org/wiki/Health_care_compared#Cross-country_comparisons
And has the logical conclusion that health care in the US is the most expensive and severely underperforms. Lowest life expectancy, highest infant mortality, highest costs as percent of GDP or as per capita expenditure.
Country Life expectancy Infant mortality rate Physicians per 1000 people Nurses per 1000 people Per capita expenditure on health (USD) Healthcare costs as a percent of GDP % of government revenue spent on health % of health costs paid by government?
Australia 81.4 4.2 2.8 9.7 3,137 8.7 17.7 67.7
Canada 81.3 5 2.2 9 3,895 10.1 16.7 69.8
France 81 4 3.4 7.7 3,601 11 14.2 79
Germany 79.8 3.8 3.5 9.9 3,588 10.4 17.6 76.9
Japan 82.6 2.6 2.1 9.4 2,581 8.1 16.8 81.3
Norway 80 3 3.8 16.2 5,910 9 17.9 83.6
Sweden 81 2.5 3.6 10.8 3,323 9.2 13.6 81.7
UK 79.1 4.8 2.5 10 2,992 8.4 15.8 81.7
USA 78.1 6.7 2.4 10.6 7,290 16 18.5 45.4
I do not understand the per capita vs household argument.
I hail the markets, I hail the wealth creating abilities of the market, but I do not need a health care system that creates wealth, I want a health care system that saves lives.
If consumer choice needs to be smaller, so more lives are saved, I except that. If some wealth have to be sacrificed, I except that as well.
The way I see it, the (former) lack of universal healthcare brings the average down a lot (white people from the US apparently enjoy similar health statistics as in Europe). At the same time, the more well-off spend a lot on state of the art healthcare with private nurses and all that (which in itself is not a problem for me, commercial activities can totally exist akin to universal health care), which brings the total expenditure up. Together with the whole “suing your doctor” culture, which might be somewhat free market related as well (or not? Nobody seems to sue firemen when they fail).
You seem to be a bright enough lot and I always have had a weak spot for the libertarian view; make this ‘socialist’ dutchman understand why the free market should reign in health care.
So how would the US cut costs to match the GDP/Healthcare ratio of other countries? Government provided healthcare already accounts for half of all healthcare expenditures yet covers less than half the population. Are you going to ration health care for the sick or for the healthy? Remember in your response, health insurance is not healthcare, so eliminating insurance CEO salaries won’t reduce costs.
I do not know, but since for all healthcare systems in the developed world, that of the US has the most free market and is the most expensive; I find it illogical to expect it to become less expensive when even more free market mechanisms are allowed. It seems to me that more free market will not provide better health care for the average american, but will provide better health care for those consumers willing to spent on it. So health as a service will go up, compete, provide better care for fewer bucks. Alas, this service will be gobbled up by the relatively wealthy, who will not be stingy on their personal well being, they will spend ever more on it, even if it gets cheaper; a billionaire would buy the service of a whole hospital if it could prevent him from dying.
Now, rich people spending more on health is not necessarily a bad thing, they then can invest, improve and research, so you might not even want to bring costs down (and so you keep consumer choice). Normally, the rich are first to use a new service or product, and eventually products become so cheap and people so wealthy, that everyone can afford them (e.g. a car or tv). But we can’t wait for open heart surgeries to become available for the poor, they need to be available now.
What I would do is tax the rich some more and spend it on health for the poor. I would destroy wealth and save lives.
“What I would do is tax the rich some more and spend it on health for the poor. I would destroy wealth and save lives.”
What happens when there is no more wealth left for you to destroy?
What happens when there is nobody willing to create wealth since they know it will be forcibly confiscated from them?
What is so glamorous about poverty?
Vicky,
The U.S. doesn’t have the most free market health care system in the world. By far not. You may want to do a bit of comparative analysis between health care systems before you embarrass yourself further.
For (just one) instance, Singapore has a much more free market health care system and it has both better health care outcomes, spends just over 4% of GDP on health care.
In the parts of the U.S. health care market untouched by third party payer – plastic surgery and Lasik eye surgery – price has declined precipitously as outcomes, safety and technology all increased.
Not so incidentally, Vicky, “poor” Americans can now afford plastic boobs and perfect teeth. They also receive a level of health care that is unimaginable in your Denmark.
Sorry, Holland.
Infant mortality rates and life expectancy are clumsy way of judging healthcare quality.
Those things are more indicative of certain social phenomena than health care.
@ John V
I dare say that universal healthcare will improve both statistics.
@ JohnK
That’s a reductio ad absurdum which seems to be more a mental exercise than a serious reply and shall be ignored as such.
Victor,
And I dare this:
Enforcing a strict curfew via the military for all citizens to be in their homes by 7pm will lower crime.
You may or not think that’s relevant but it is.
Moreover, your response side-steps the issue I brought up.
“That’s a reductio ad absurdum”
It’s taking your argument to its logical conclusion.
When you destroy something you have less of it, right?
Please correct me if I am wrong.
When you raise the cost of an activity you get less of it, right?
Please correct me if I am wrong.
If that something is wealth, and that activity is creating wealth, will the result be less wealth and less wealth being created?
How can the result of destroying wealth while disincentivizing the creation of more wealth be anything other than the poverty?
“which seems to be more a mental exercise than a serious reply”
I see. You feel exercising your mind to be a waste of time.
It shows.
Actually,
I do not think that will lower crime at all.
But I do understand your point, although I wish you would not see every government enforced rule which undermines freedom of choice, as the equivalent of a military curfew.
And I do know that social phenomena come into play, phenomena that, imo, are all linked to inequality; thus the real solutions I almost not dare to say here…
No JohnK
I really dont advocate to sacrifice all wealth for health care, only a little.
Think Scandinavia, both richer and more equal and with way better health care than the US
“I really dont advocate to sacrifice all wealth for health care, only a little.”
It’s never enough. The rich never pay their fair share. We know this because they are rich. If they paid their fair share then they wouldn’t be rich.
“Think Scandinavia, both richer and more equal and with way better health care than the US”
You lost me at “equal”.
Equality and fairness are for people who value emotion over reason.
Victor, I don’t think you did see my point.
My point was that you can zero in on one narrow factor and claim plausibility toward improving it with XYZ measure. But it misses a lot of unmeasured and unseen effects along the way.
You lost me at “better health care” and “richer”.
Not only is their standard of living lower, but this doctors are on vacation for a large part of the year because of confiscatory taxes. Idiotic.
Victor,
“Think Scandinavia, both richer and more equal and with way better health care than the US”
Apples and oranges. Think about that. Do you really think applying the Scandinavian system is going to yield the same results? The Scandinavian system works in so far as it works because the demographics help make the system appear more successful than it would be elsewhere.
A relevant analogy would be to look at how a school in wealthy suburbia operates and then apply that system, without regard to the student body, to an inner city school. Do you expect the same results? No way. You wouldn’t.
Using a relatively tiny and pristine country like in Scandinavia with demographics and culture that make certain appealing ideas seem attainable….and then simply pretending that that same model can work here because you like the results is lazy thinking.
Obesity rates in the U.S. versus other countries:
Japan: 3.2%
Australia: 18%
Canada: 23.1%
UK: 23%
U.S.: 33-36%
————————————
Homicide Rates by Country:
Germany: 0.98 per 100,000 inhabitants
France: 1.64 per 100,000 inhabitants
Canada: 1.95 per 100,000 inhabitants
U.S.: 5.9 per 100,000 inhabitants
————————————-
Motor Vehicle Fatalities by Country:
Germany: 6.19 per 100,000 people
France: 7.4 per 100,000 people
Canada: 9.25 per 100,000 people
U.S.: 14.24 per 100,000 people
“Indeed, Robert Ohsfeldt of Texas A&M University and John Schneider
of the University of Iowa recently concluded that Americans
who don’t die from homicides or in car accidents outlive
people in every other Western country.39″
-39 Robert L. Ohsfeldt and John E. Schneider, The Business of Health:
The Role of Competition, Markets, and Regulation, Washington,
DC, AEI Press, October 3, 2006, http://www.aei.org/publications/
spubID.24974,filter.all/pub_detail.asp; David Gratzer, “A Canadian
Doctor Describes How Socialized Medicine Doesn’t Work” Investor’s
Business Daily, July 26, 2007, http://ibdeditorials.com/IBDArticles.
aspx?id=270338135202343
Finally, Cancer survival rates by country:
American Women (5 year rate): 63%
European Women (5 year rate): 56%
American Men (5 year rate): 66%
European Men (5 year rate): 47%
U.S. vs. Canada using overall survival rate (not just 5 year survival rate) for all types of cancers:
US Men: 57%
US Women:61%
Canadian Men: 53%
Canadian Women: 58%
“Survival Rates for Specific Cancers. U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology , confirming the results of previous studies. As Figure II shows:
* Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher. 2
* Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.
* The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular).
Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent. ”
http://www.ncpa.org/pub/ba596
These, unlike life expectancy and infant mortality, are accurate measures of the quality of care provided. Why? Americans receive better early diagnosis as well as access to more drugs and considerably shorter wait times for every type of procedure.
“Another reason for the higher cancer survival rates in the United States is that Americans can get new, effective drugs long before they are available in most other countries. A report in the Annals of Oncology by two Swedish scientists found: 7
* Cancer patients have the most access to 67 new drugs in France, the United States, Switzerland and Austria.
* Erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the United States than in Europe.
One of the report’s authors, Nils Wilking, from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the United States in the 1990s was due to “the introduction of new oncology drugs,” and he urged other countries to make new drugs available faster. ”
and
” It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government. 4
* In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.
* The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.”
These things hold even though 36 million US CITIZENS have no health insurance at some point during the year. According to Canadian health care researcher Sally Pipes, many of these people can afford insurance but choose not to buy it. 18 million of the uninsured earn $50,000 or more a year, enough for a healthy person to purchase basic coverage. 14 million of the uninsured qualify for Medicare or Medicaid but are not registered. These people can be covered with simple free market reforms that lower the cost of insurance and allow people to pick and choose the coverage that is best tailored to their individual needs. The one place where you can justify some intervention is in exchanges for those with pre-existing conditions. About 180,000 people a year are denied insurance (0.059% of the US population).
@ John V
No, lazy thinking would be discarding statistics in favor of political ideas, when these statistics don’t validate your thinking. Scandinavia, although not a country, has 25 million inhabitants and is not tiny.
One might even add the Netherlands, western Germany and Austria, and you could see a real world political experiment over varied cultural entities with similar and good results. Many parts are as urbanized and culturally diverse as the US.
And cultures can change, it is people like you who make it impossible, because they see any governemental intervention as failed to begin with. When Americans would see that there is such a thing as intelligent governing, maybe then they would understand why people in the above countries are healthier, less violent, live longer, recycle more, weigh less, rape less, murder less, have more nobel prices per head, have more big international companies per head, are smarter, work less hours, have more holidays, have better health care and do not earn less, but often earn more than in America. Instead of discarding statistics and implying that Americans just can’t do any better, because they can and they should.
@JohnK
When emotional people are disgruntled at the lack of opportunities they got from the system, because they did not receive the same education or have the same job opportunity as their richer fellow countrymen, and join gangs and shoot people, equality suddenly becomes a political reality which should not be excluded from any reasoning.
Point being; human emotions are real, many people act emotional, equality and fairness are hardwired human needs, and any political ideology should care about the impact of their policies on the emotional well being of the people who value emotion over reason.
“and any political ideology should care about the impact of their policies on the emotional well being of the people who value emotion over reason.”
You can find sympathy in the dictionary between shit and syphilis.
And Cold-hearted between cocksucker and cunt.
Not to mention, each nation has a different qualifying system for the stats.
Lowest life expectancy, highest infant mortality, highest costs as percent of GDP or as per capita expenditure.
Pure, unadulterated crap.
You have literally no idea what you’re talking about.
And I say this, Dutchman, from the perspective of someone who spent year churning through a socialized medicine “utopia” as a patient and one who has actually looked into your statistical canards.
Those are just facts, man.
No need to go bananas
They are only facts in your uneducated imagination. No need to spew garbage, man.
Dupe: one who accepts politically produced statistics as informative.
@ Methinks and sam grove
Disappointing, I was expecting more of this crowd.
Victor, the health statistics debate has already been worked through quite thoroughly on this site.
You didn’t bring anything new to the table and so you only get scraps. If you are interested in the arguments and citations, you’ll have to expend more of your own effort.
Vicky,
I corrected you as much as I’m willing to. If you’re too lazy or stupid to do your homework, I see that as your problem, not mine.
It is impossible to take seriously an argument that uses life expectancy and infant mortality to assess health care quality between countries. These 2 statistics have virtually nothing to do with quality of health care – both are dominated by numerous unrelated factors (such as lifestyle choices, genetics, definition differences, etc).
Also, your assertion that US health care is close to free market is completely incorrect – most of the market is stifled with government intervention. The (few) portions of the market which are more free have seen continuous improvements in quality, availability and affordability over time.
Regarding your claim that Scandinavian countries are richer: not when you take into account cost of living. Purchasing Power Parity (PPP) is a more accurate indicator of relative wealth than per capita GDP. According to the IMF, CIA World Factbook, and World Bank,. the only European countries with better PPP than the US are Luxembourg and Norway. Luxembourg has fewer than 500,000 people, Norway has about 4 million people, and the US has over 300 million people. Luxembourg and Norway do not have enormous minority populations still reeling from the effects of 1) past discrimination and 2) utterly ineffective government social programs designed to help them.
Regarding income inequality, the Cato Institute has two thorough, data filled studies on both the rise of income inequality in the US and the effects of income inequality.
http://www.cato.org/pub_display.php?pub_id=10351
(by Will Wilkinson, incidentally)
and
http://www.cato.org/pub_display.php?pub_id=9941
(concerning claims made by Paul Krugman, incidentally)
So, yes, 1/3 (or 1/4 or 1/5, depending on your definition of “Scandinavia”) of Scandinavia is a tiny bit richer than the U.S.
You should take note on the discrepancies on keeping such stats. The US counts the deaths of all life that leaves the womb with any sign of life into it’s IMR ( infant mortality rate), while the other nations make a series of exceptions skewing stats. Another example of the misleading stats you cite is how the UK conveniently do not count accidental deaths such as traffic fatalities into their life expectancy stat. I would luv for the US to exclude traffic fatalities from our LER stat.
It might do u a bit of good to compare cancer survival rates of the US to other nations…….. For instance, survival rate in the UK of prostate cancer is just over 50%. The US survival rate for prostate cancer patients is over 93%. This discrepancy and exceptionalism of US medical successes far exceed the rest of the world in the medical industry. The cost of saving lives and advancing medicine has not been cheap. Allowing for a far greater free market in the medical industry will ‘bend’ the cost curve down.
The worst in the world? I have heard this claim over and over again over the last 3 years. Unfortunately it doesn’t match reality. For if it did, future spending on Medicare and Social Security wouldn’t be a concern since the population will not be living long enough to take advantage of those benefits.
On the prior post, But Not Sufficiently Sacred for Physicians to Work for Free, I posited a scenario where one was the owner of a rural hospital in a libertopian society. The owner receives an urgent call from the covering ED doctor that an indigent mother with pre-mature twins was bleeding out. They all three would die without immediate help and a likely huge financial commitment on you and your hospitals part.
Almost ALL the libertarian commenters their chose to treat the patient over taking a rational market and cost based approach that might eventually put themselves out of business if a competitor chooses regularly to deny such care preferring to increase staff salaries and decrease premiums instead.
What would Will do?
PS I am a physician who has regularly seen this scenario play out on a smaller version when patients consider the advice of a physician and contrast it with a hospital co-pay they would rather avoid. Through chance eventually they will chose wrongly to save money against medical advice and have themselves or their children an adverse outcome. Sometimes as a physician I may find myself waging a $500 co-pay to a struggling family against a 1 to 1000 odds of something devastating possibly going wrong if I try to save them the money.
“PS I am a physician who has regularly seen this scenario play out on a smaller version when patients consider the advice of a physician and contrast it with a hospital co-pay they would rather avoid. Through chance eventually they will chose wrongly to save money against medical advice and have themselves or their children an adverse outcome. Sometimes as a physician I may find myself waging a $500 co-pay to a struggling family against a 1 to 1000 odds of something devastating possibly going wrong if I try to save them the money.”
Hmmm. Then over utilization is the best course in muirgeo’s dystopia. Very nice!
So you don’t admit??? That’s a very wise financial decision indeed…. until the 1 in 1000 event shows up as a dead baby brought back top your ER the next morning. How much did you save after 1000 such decisions?
Ah, debate points based on vilification, delivered through verbal virtuosity, along with notional propositions. Very, very nice.
You better stay over there —> on the side lines with the third string. You might suffer debate injuries out here on the economics field.
After the the 40million abortions, can the central planner really be too upset over ome more life expiring?
The real question remains, why do you accept compensation for your services at all? Just think of all the people you could save.
He won’t answer that question because he can’t. He also can’t explain, further, how he can spend disposable income on any luxury for himself (above subsistence) , or why he doesn’t spend every hour of his free time slaving under his labor for the benefit of the dying and needy, or even how/why he would push for public monies to be spent on American healthcare as opposed to being distributed to those suffering from a more truly dire poverty in third world countries.
The Singerian (ie: Peter Singer) analogy seems morally effective under the presumption of one child drowning. But when the world is full of an endless amount of drowning children, what conclusion does such an ethical hypothetical draw you to? Are you morally bound to spend every waking moment saving these children? Maybe this is the logical conclusion – but if so, even the people who tout that line of logic (including muirgeo I’d imagine) don’t follow it. They talk of absolute morality but only act upon it nominally and ambiguously.
If he really believed in what he’s espoused, then every single moment spent writing his inane responses on this blog could comprise a great moral assault on humanity in that all those moments could have been used to save those he professes to care so much about.
He wants to government to handle these things to alleviate his personal guilt for his own unwillingness to sacrifice wilderness trips for the sake of the needy.
Does he recognize the opportunity cost of trolling around economic blogs instead of researching newer and better ways to treat his patients? Maybe inventing a technique/technology that would drive down the costs of providing medicine?
That requires imagination, something he has yet to manifest.
“Almost ALL the libertarian commenters their chose to treat the patient over taking a rational market and cost based approach that might eventually put themselves out of business if a competitor chooses regularly to deny such care preferring to increase staff salaries and decrease premiums instead.”
You’re not condemning libertarians for acting “selflessly” are you?
Strange world.
Some people habitually step outside their field and pretend that they are equally as competent in another.
I’ve lost track – What is Krugman supposed to be again?
Nailed it.
There are times when PK should be taken seriously and refuted on economic grounds; this is not one of them. Mockery would probably be a better route to take.
However, it is interesting to see PK worshippers do logical backflips in an effort to agree with him.
Yes. And yet they refuse even slightest bend to see an opposing point and acknowledge it.
Consumers are easily duped. Never more so than when it comes to MD’s, the AMA, and big Pharma, hospitals, convalescent homes, etc. In this backward, fawning, instant-fix culture, doctors are put on a pedestal that is totally undeserving for the limited things that they can do, or do well. Many are overpaid, and rip off the insurance companies. Hospitals rip off even more. I also blame the consumer because they feed the “sick” system. Doctors and flu shots don’t cure cold, for instance. And you’re better off taking vitamins and herbs for many things rather than toxic drugs.
I will say, too, that consumers will rip off the system if allowed to do so. My Mexican carpenter thinks that cesareans are the way to go when it comes to childbirth. Never mind that it is painful abdominal surgery with attendant risks, and possible complications. I also wondered how they pay for these expensive procedures. My friend said that they get a 90% discount on the bill by simply filling out form for people with low income and resources. I guess the hospital doesn’t bother to ask how he can pay his $2,000 a month house rent.
I’m sure the doctors, and hospitals love to do cesareans, and circumcisions, etc. because they are big profit centers. Really, medicine is profit driven with the consumer being victimized and ripped off. That doesn’t let the consumer off the hook for their ignorance though. Children are victims of their parents’ stupidity, and they are the ones who need the most protection. How can a baby consent to a circumcision for example?
How can the emergency room get away with charging $1,600, or more, for someone who decides to go there for a stomachache? Take some over-the-counter antacid for 50 cents, and be careful in the future as to what garbage you eat.
Dung,
“How can the emergency room get away with charging $1,600, or more, for someone who decides to go there for a stomachache?”
Because ER’s are REQUIRED to treat ANYONE for ANY reason. The poor, uninsured, illegal aliens, and dishonest people know this and take advantage. These people show up to have even minor ailments treated and never pay. Even those with real injuries have no incentive to use less costly resources because they don’t or won’t pay anyway. This sets up the need to have those that do actually pay cover their own costs as well as those who don’t pay.
Regards,
Ken
“Consumers are easily duped. Never more so than when it comes to MD’s, the AMA, and big Pharma, hospitals, convalescent homes, etc. In this backward, fawning, instant-fix culture, doctors are put on a pedestal that is totally undeserving for the limited things that they can do, or do well.”
I think the elitist tinge of this comment doesn’t do liberals well in the rhetoric department (although it has arguably spawned an even more disconcerting effort to harangue intellectuals in opposing political circles). But let’s go ahead and assume the “people are too stupid to think for themselves” line of thought. How exactly is that solved from moving the burden of such decisions away from private agents and onto other private agents whom they publicly elect? They’re too stupid to figure out how they’re being shafted but they’re smart enough to elect people who will “fix” that problem?
Even if we, further, make this second presumption, it doesn’t follow that advisory services could not be provided by agencies outside of the government (for profit or otherwise).
“They’re too stupid to figure out how they’re being shafted but they’re smart enough to elect people who will “fix” that problem?”
Absolutely the most brilliant response on this site I have ever seen.
Reminds me of this: http://ike4.me/4arg
Okay, young ‘uns, let me try to clarify matters (well, I haven’t read most of the “conversation” because I couldn’t care less what a bunch of argumentative whippersnappers think, but work with me. I’m old).
Basically, the whole issue is, as I demonstrated in my classic 1963 paper, is that the health care market is marked by an unusually high amount of risk and uncertainty. Here’s a simple example. Say my doctor takes a look at me and says I have cancer. Well…do I? I have no idea. Say he tells me that I need chemotherapy or I’ll die in a week. Should I take the chemotherapy? I have no idea. On the one hand, it seems like quite a risk not to take the chemo. On the other hand, if I just accept anything he says unquestioningly, I’m a sap. He’ll push all kinds of nonsense on me and I’ll end up broke with nothing to show for it.
Sure, I could go to a second doctor, ask his opinion. But I can’t evaluate his opinion either, so I would need a third doctor, and then a fourth, and so on…. Or I could do my own research, but that defeats the whole point of the division of labor. I don’t have the time, energy, or money to learn enough to match a professional doctor. That’s what professional doctors are for.
Long story short, I can’t rely on a doctor’s self-interest to bring me high-quality, low-cost results the way I can rely on the self-interest of the butcher to serve me well. I need something else, some other reason to trust him. Like friendship. That’s why doctors weren’t just sellers of health care. They were important members of the community. They were almost part of the family. That’s why they paid house visits and got paid in meat pies. Those things, aside from being convenient, solidify the social relationships. Some jerk who’s just in it for money might give me terrible health care and I’ll never know the difference, but my best friend for thirty years never would.
That’s why patients care more about the doctor’s bedside manner that the particular quality of their treatment—and why a doctor who is emotionally distant is far more likely to be sued that a less competent but friendlier colleague. This also explains why, as I remark upon in my genius 1963 paper, the public has been very accepting of the various government interventions in the health care industry.
So all this yapping back and forth about whether the doctor is your pal or your business acquaintance totally misses the point. He’s both, and he has to be both. Same with this nonsense about whether the, uh, health care receiver is a patient or a consumer. He’s both, and he has to be both.
You kids. Always giving me a headache.
Isn’t this just the latest attempt to redefine the issue? When plan A fails, which is ‘ women, children, and elderly dying in the streets’ fails, plan B of reshuffling money around and double counting billions of dollars fails to fool the public, etc.,……. The next round of trying to sell the public on more bad govt and more collectivism.