A Question for Single-Payer Proponents

by Don Boudreaux on June 6, 2011

in Competition, Health

I have a question for anyone who believes that a single-payer health-care system (where the single payer is government) will reduce the quality-adjusted cost of health-care: will a single-payer pet-food system (where the single-payer for pet food is government) reduce the quality-adjusted cost of pet food?  That is, under a single-payer pet-food system (with government as the single payer) will consumers be better supplied, at a lower cost, with pet food than consumers are supplied today with a free market, myriad-payer system for the provision of pet food?

If not, why would a single-payer system for health-care reduce the quality-adjusted cost of health-care?  But if so, why not socialize the entire American economy given that a single-payer system (with government as the single payer) would clearly deserve the presumption of being a superior method of economic organization than myriad-payer free markets?

….

Although I’ve not seen such a question asked before, I have little doubt that I’m not the first person to ask it.

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{ 317 comments }

MarketJohnson June 6, 2011 at 5:24 pm

There are some who are willing to incur certain levels of inefficiency for the sake of living in a country where people don’t have to sell off everything they’ve worked their whole lives for or declare bankruptcy because they get sick.

Not everyone who wants single payer believes this, but some do.

Don Boudreaux June 6, 2011 at 5:29 pm

Well, this belief (be it correct or not) seems to suggest that its holders think that a single-payer system (with government as the single payer) reduces the quality-adjusted cost of health-care for the great bulk of society. So why don’t these people also support single-payer systems (with government as the single payer) for pet food, furniture, groceries, clothing, housing, etc.?

MarketJohnson June 6, 2011 at 5:36 pm

I don’t believe a single payer system would be cheaper than a true free market. But a true free market would necessarily find an equilibrium where some cannot afford to buy health insurance. So if it means chipping in a bit extra every year to not have to hear stories about people losing their homes, retirements, etc. because they get sick or get in an accident, I would do it.

I have no doubt some would recommend private donation, which is a fair direction to point. However I believe it suffers from the same pitfalls that a true free market system would have, in that some people would still just not get covered.

Craig S June 6, 2011 at 5:52 pm

“But a true free market would necessarily find an equilibrium where some cannot afford to buy health insurance.”

How many products are there that some cannot afford to buy some version? Because I can not afford a Ferrari, doesn’t mean I can not afford a car.

Also how often do people really face that choice? How often do people require medical treatment that would bankrupt them if they had to pay for it out of pocket?

Perhaps if we used insurance for only emergencies and not to pay for every trip to the Dr, it would be more affordable for more people. In any event, we do not have to go to a complete government monopoly for all, just because a few may not be able to afford basic care.

MarketJohnson June 6, 2011 at 6:13 pm

Agree on the “every trip to the Dr.” point. I do believe preventative care is very important, and probably something that should be covered in at least some fashion. But going for a physical or for a tummy ache is not something that needs to be covered by health insurance, which would help drive prices down.

As far as the car analogy, sure, most people can afford some type of car, and when you are driving to work, an ’85 Sentra is essentially the same as Ferrari. But when you need to get somewhere really fast (as in you need a expensive or rare treatment), the Sentra will often not do the job.

muirgeo June 6, 2011 at 9:10 pm

“How often do people require medical treatment that would bankrupt them if they had to pay for it out of pocket?”

Health care expenses are the number 2 cause of bankruptcy. That doesn’t happpen in ANY other civilized country.

Methinks1776 June 6, 2011 at 9:21 pm

You’re right, Muirdiot. In other countries they’re already bankrupt by the time they get on 12 month wait lists for fast growing, invasive breast cancer treatment.

muirgeo June 7, 2011 at 12:23 am

No methinks in other countries the average person has six weeks of paid vacation which they often spend in our National Parks…. free of the over worked locals.

Dan June 7, 2011 at 12:28 am

In those other nations, 7% to 8% unemployment is the norm. And their survival rate from cancers is a pittance to the US. In those other nations, most want to move to US or visit because their country sucks for vacation time.

vikingvista June 7, 2011 at 1:08 am

“I do believe preventative care is very important, and probably something that should be covered in at least some fashion.”

Preventive care is the epitome of the type of expense for which insurance makes absolutely no sense at all.

Herman June 7, 2011 at 1:46 am

If we could just redefine health care to mean handing the patient an aspirin and hitting him on the head with a mallet, everyone could afford it. (or the public could afford it for everyone) Is that the answer? Reduce services?

How do we decide what portion of the economy to allocate to health care, if not by some mechanism of the free market? It must be by government rationing and death panels.

Honestly though, I would hate to have to decide how much of my family’s money to use to prolong my life by 12 months. Or to put a price on my son. Whether the politicians decide, or an insurance adjuster, this seems exceptional compared to dog food. I don’t buy the analogy.

Gordon Richens June 7, 2011 at 7:48 am

“As far as the car analogy, sure, most people can afford some type of car, and when you are driving to work, an ’85 Sentra is essentially the same as Ferrari. But when you need to get somewhere really fast (as in you need a expensive or rare treatment), the Sentra will often not do the job.”

So single payer health care will give us all the equivalent of Ferraris. I’m in.

kyle8 June 7, 2011 at 7:48 am

The analogy is appropriate when you consider that the majority of “Market failures” of the health insurance industry in this country is caused not by the marketplace but by actions of government.

Merely allowing companies to draw from nationwide risk pools instead of being forced to go state by state would lower costs by about one third from some studies I have seen. Also not mandating all sorts of add-ons to a basic catastrophic policy would drive down costs as would tort reform.

Dan June 8, 2011 at 1:21 am

6 weeks of paid vacation? Who’s paying? Why is Europe always lagging In development? Why are they consistent in high unemployment? Why are our ‘poor’ wealthier than their working lowest wage earners?

John Dewey June 6, 2011 at 6:21 pm

MarketJohnson,

Health care and health insurance are unaffordable to some Americans exactly because governments have interfered so much in free markets. Governments have severely restricted who may provide health care. Governments have prevented the opening of health care facilities. Governments have imposed mandates on insurance companies. The “pitfalls” you claim exist in a free market system are not the result of a free market at all.

Governments have totally screwed up the markets for health care and health insurance in the U.S. Why do you want them to exercise even more control?

MarketJohnson June 6, 2011 at 7:57 pm

If you are making the argument that everyone would have health insurance in a purely free market, I don’t find it convincing. However, you are right in that government can and has made things worse at times. I find the free market handling all aspects of optional health care perfectly acceptable. But when it comes to preventative care, procedures that preserve the wholeness of a person’s body (such as the reattachment of a limb), or one’s very life, I don’t believe a free market, that invariably leaves some hanging out to dry, is the solution.

Methinks1776 June 6, 2011 at 8:10 pm

One more time – insurance is not health care.

You will have to come to terms with an inescapable reality – you can’t actually force anyone to pay to save anyone else’s life.

As you increase taxes, you create a disincentive to work. That results in less wealth to tax to pay for all this life saving you’re so impassioned about. It will, as it was in a free market, be rationed. Only now, it will be rationed to the politically connected.

There is no free lunch.

jeffrey neal June 6, 2011 at 10:45 pm

It’s simple – it takes money to provide health care services. That means a market can produce the best outcome – with absolute minimum government intervention.

Even the White House knows that as evidenced by pink ribbons. > http://wp.me/p1jTK0-5X

Methinks1776 June 6, 2011 at 6:27 pm

But a true free market would necessarily find an equilibrium where some cannot afford to buy health insurance.

There is where you make your biggest mistake. Health insurance is not health care and having health insurance does not insure you against all health care costs.

So if it means chipping in a bit extra every year to not have to hear stories about people losing their homes, retirements, etc. because they get sick or get in an accident, I would do it.

And I wouldn’t dream of stopping you. But, how does your willingness to reach into your own pocket justify you robbing others?

However I believe it suffers from the same pitfalls that a true free market system would have, in that some people would still just not get covered.

And that problem is still not solved by government health care. People are all technically covered, but die or at least suffer on wait lists or are just flatly denied any kind of care at all.

Government does not and cannot make resources less scarce – which means that someone will always have less of the resource than they wish they had if price were no issue. The only difference between a government system and a market system is who allocates the resources. Usually, government resources are allocated politically and the guy you’re worried about always gets the raw end of the deal. He won’t even have the option to trade stuff for life.

notalawyer June 6, 2011 at 6:35 pm

“Government does not and cannot make resources less scarce – which means that someone will always have less of the resource than they wish they had if price were no issue.”

The issue isn’t with them being less scarce but being unfairly acquired/distributed. Many believe that your ability to pay shouldn’t affect your ability to receive necessary health treatment; just as a child’s ability to receive public education has nothing to do with his parents ability to pay for it.

Methinks1776 June 6, 2011 at 6:44 pm

Great. How do those people feel about how government allocates resources – to the politically connected. Is that more fair in your estimation?

Dan June 7, 2011 at 12:37 am

Unfair? What’s fair about taking my property and giving it to another? That is theft. What is fair about me waiting hours for a service I pay more for than the freeloader? What’s fair about me working 50 hours a week to secure sustenance, shelter, transportation, clothing, etc.,….. And the ‘poor getting it for ‘free’, without working or by working very little? By govt stealing from me to give to another?
How is my compensation to one service provider for a service unfairly acquired?
The free or reduced payment of the freeloader is acquiring the scarce resource unfairly. I paid…. They didn’t.

vikingvista June 7, 2011 at 1:54 am

“And I wouldn’t dream of stopping you. But, how does your willingness to reach into your own pocket justify you robbing others?”

There really must be a colorful term that we can popularize to describe this common diversion. Whenever someone uses their own voluntary willingness to justify the imposition of brute force against others, we should be able to simply say…

“Agree-or-else rule”, or
“Heads I win, so tails you will choose”, or
“It’s a free country–you are free to agree with the dictator”, or
“My choice will be your choice”, or
“So this is what it feels like to be king!” or
“I don’t mind if I agree, so why should you mind if you don’t?”

Richard Stands June 8, 2011 at 2:01 am

How about simply avoiding singular person pronouns, thinking in the collective, and eliminating the intransitive form of the verb “volunteer”?

“We are a rich enough nation to fix this. I’ll volunteer you.”

rpl June 8, 2011 at 9:28 am

Government does not and cannot make resources less scarce – which means that someone will always have less of the resource than they wish they had if price were no issue. The only difference between a government system and a market system is who allocates the resources.

No, there is another important difference. In a market system the prices serve not only to determine where resources are allocated today, but also where we should invest to produce more resources tomorrow. High prices for a product today induce people to invest in creating more of the product tomorrow, so that in the future prices won’t be so high. This mechanism is entirely absent in a political allocation system.

vikingvista June 8, 2011 at 10:21 am

rpl–

Except that it encourages people to invest more in politics.

Andrew_M_Garland June 6, 2011 at 6:33 pm

To MarketJohnson,
You write “I don’t believe a single payer system would be cheaper than a true free market.”

So, you could have said equivalently “A true free market would be cheaper (or as cheap) as a single payer system”. And I say that the free market system would be much less bureacratic and provide for many more choices for most people.

Your objection is that some people would not be able to afford the insurance they want, even in this less expensive, free market system.

It seems to me that you would advocate for a free market in medical care, and a government subsidy to the poor to buy health insurance.

Why would you advocate for a more expensive medical system? The subsidy would be more expensive in such a system, and so there would be a less adaquate subsidy to the poor?

MarketJohnson June 6, 2011 at 6:48 pm

I’m not necessarily advocating a more expensive medical system, so much as advocating one that covers more people more thoroughly, and accepting the fact that it may be more expensive.

MarketJohnson June 6, 2011 at 7:01 pm

Sorry, maybe I misunderstood a little bit. I should say that in the current medical SYSTEM we have, insurance is often too expensive for some. If the system were more efficient, logic dictates that prices would and it would become affordable to more people. However, efficiency in markets does not always translate to quality. To me, and I’d guess some others, health insurance ought not be a “you get what you pay for” commodity.

Sam Grove June 6, 2011 at 9:35 pm

To me, and I’d guess some others, health insurance ought not be a “you get what you pay for” commodity.

Why not?
How could it be otherwise?

Methinks1776 June 6, 2011 at 9:42 pm

Because, Sam, MarketJohnson is clearly in favour of a system of government insurance where you never get what you pay for.

Andrew_M_Garland June 6, 2011 at 9:51 pm

It seems that you are “not necessarily” advocating anything. You split the point saying that “efficiency in markets does not always translate to quality”. As if government run systems always translate to quality.

You also change the meaning of “cost”. In a free market, cost is quality adjusted cost. For the government, cost is whatever it chooses to pay. It seems to me that you redefine what you are sayihng when you don’t like what you have said.

This “not necessarily” tactic means that you aren’t having a real discussion. You are not attached to anything you say.

MarketJohnson June 6, 2011 at 11:47 pm

Methinks1776,

Yes. Exactly right. Like every other dirty communist lefty pig, I just want to ruin everyone else’s lives and let the government run mine so I don’t have to work, or think, or breathe for myself. You nailed it. Congratulations.

Andrew,

My “splitting of the point” only occurs when I say I don’t want X, so you and others immediately claim then I must want NOT X. That is, there are only polar opposites, no compromise, no middle ground. Then when I say “Well, I don’t necessarily want NOT X either”, you make the sort of comment to which I am now retorting.

My original, and for all intents and purpose, sole point in this whole discussion is that not everyone who is at the very least sympathetic to the view that a single payer system might be an improvement is either a power-hungry leftist who wants to destroy America and take over everyone’s lives, or a deadbeat, welfare-statist who just wants to live off the government and coast till their death. Unfortunately, in my short time here, that is a point that many, MANY of you seem to have a difficult time grasping.

And if I had to outline my own personal off-the-top-of-my-head idea for a way to ensure nearly all Americans have health care in one sentence, it would be a single payer system that covers catastrophic injury or illness, with minor illness, routine visits, and things of that nature left to either private firms who provide insurance, or make them out of pocket expenses, or both. That’s the short and simple version, which would obviously would require a great deal of detail and fleshing out, but feel free to tell me all the ways it would destroy our freedom and enslave the human race.

Dan June 7, 2011 at 12:47 am

Why is it so hard for single payer advocates to just voluntarily submit themselves and leave ALL who dissent from participating?
You want some govt authoritative distribution of healthcare. Then gather up your like-minded brethren and volunteer yourselves into it. The entire system would be on the backs of those who volunteer.
If it is so fantastic, most will concede and join.

But, none of you will ever do so. None of you will ever jump without first forcing others, by threat of govt, to do so.

You want windmills? Then buy one and live off of it or solar. Leave all others to purchase the cheapest market can provide.

You want govt issued or controlled health services? Then you and others who want it can volunteer yourselves. Leave all others to find their best system.

Why do libs insist ALL others must participate in their schemes and theories rather than prove it by voluntary experimentation?

vikingvista June 7, 2011 at 1:56 am

“health insurance ought not be a “you get what you pay for” commodity.”

It should be a “you get what someone else pays for” commodity?

MarketJohnson June 7, 2011 at 7:26 am

Dan,

You are assuming that I wouldn’t volunteer for such a thing. Of course I would.

Second, there is a perfectly good voluntary experiment in this case. If our health care system were good for anyone other than those who can afford to pay for whatever they needed, either through insurance or out of pocket, then the entirety of the civilized world would be flocking here. Last I checked those countries aren’t emptying.

Vikingvista,

Once again, I make a statement condemning X, and you then make up your own version of NOT X and assume that’s what I want.

Health care should not, in my opinion, be dependent on your income. Everyone ought to have access to certain, necessary procedures, and the rest left up to markets. If you want to now cry on about how bureaucrats are going to decide what procedures are covered and which aren’t, go ahead. If you want to claim that I’m a socialist because I support this type of system in this specific case (and really, only this case), then go ahead. But don’t invent your own silly alternative to everything I say just to make it sound like I’m some sort of nut when from what I can tell, I’m just about the only one in this discussion that can see even a single shade of gray.

crossofcrimson June 7, 2011 at 8:28 am

“My original, and for all intents and purpose, sole point in this whole discussion is that not everyone who is at the very least sympathetic to the view that a single payer system might be an improvement is either a power-hungry leftist who wants to destroy America and take over everyone’s lives, or a deadbeat, welfare-statist who just wants to live off the government and coast till their death.”

I can’t speak for everyone else here, but in the context of justice and maybe ethics more broadly, the problem is the means being pushed, not the intentions.

crossofcrimson June 7, 2011 at 9:39 am

“Health care should not, in my opinion, be dependent on your income.”

It need not be. Certainly there is course for us to be more egalitarian in regards to supplying people with things (whether it’s health care, education, etc.). The problem arises, however, when you you start viewing goods and services explicitly as positive rights. Then, by definition, you have a conflict of liberty. If you want to detach these things from voluntary trade then you are, necessarily, giving sanction to either theft or forced labor to support it (presumably the first if a distinction is to be made).

This is largely why you see such moral indignation among commenters here when the idea of positive rights is thrown about so carelessly. They’re addressing a very real injustice that emanates largely from the idea of self-ownership itself. Proclaiming the right to have people give you things conflicts with the right to have those things in the first place.

Imagine, for instance, that you could cure some strange disease that one person is infected with by punching another innocent person in the face. You could make a strong consequentialist argument that we, unfortunately, need to punch innocent people to save the diseased (although, I’d disagree with this). But why would we be shocked by someone’s moral outrage upon being punched (possibly repeatedly); certainly it’s an injustice – whether necessary or otherwise. Ignoring that injustice altogether, or even further taking such an action and posing it as a right on behalf of the diseased…..that’s going to breed vitriol.

vikingvista June 8, 2011 at 12:11 am

“Health care should not, in my opinion, be dependent on your income.”

It is necessarily dependent upon someone’s income. So what you mean is, it should be dependent upon someone ELSE’s income. Fine, except you seem also to mean that to be the case whether or not some else agrees to it.

Dan June 8, 2011 at 1:16 am

MJ,

You are assuming that I wouldn’t volunteer for such a thing.Of course I would.

Second, there is a perfectly good voluntary experiment in this case. If our health care system were good for anyone other than those who can afford to pay for whatever they needed,
either through insurance or out of pocket, then the entirety of
the civilized world would be flocking here. Last I checked
those countries aren’t emptying.

So, you mean Free. If your not paying for it, than you are getting it free….. And yes it’s called the emergency room of a hospital. And Mexico is emptying out to get here, along with any other foreign national who can get to Mexico. The illegal aliens are not just of central and south American heritage.
Soooooooooo, are you call in your brethren or legislator and letting them know that govt mandated medical system is not what you want and that a strictly volunteer system of single payer is what should be put together?
FREE me from the bondages of liberal and progressive collectivism……PLEASE. I will choose. I know how much liberals hate the thought of individual choices.

Pom-Pom June 8, 2011 at 6:24 pm

“But a true free market would necessarily find an equilibrium where some cannot afford to buy health insurance.”

Americans are way overinsured today when it comes to the health care application. In a “free market,” history shows “we” would have a lot less of it than we otherwise currently do. It happened because of distorted tax incentives in WWII. The numbers of people with “health insurance” (always these days conflated with “health care”) exploded after the tax incentive was invoked.

This in turn created the dominant attendence of a third party payer — much more so than it would ever be otherwise. That is how the major screwing of health care consumers came about. Dominance of a third party payer cools the sensitivity of health care consumers to price. With the obvious effect: higher prices.

Pom-Pom June 8, 2011 at 6:28 pm

Conclusion: “We” likely “need” much less health insurance. Not more.

Methinks1776 June 8, 2011 at 6:56 pm

yep-yep, Pom-Pom.

This has morphed into the idea (and muirdiot is a clear example of this thinking) that we should be insulated from each and every cost of health care. The more costs rise, the more that feeling is stoked. That which we call health insurance today in no way resembles insurance.

James June 6, 2011 at 6:03 pm

Food is as important if not more important to one’s health than is health care. Therefore I think we should have a ‘single-payer’ provider of groceries.

All the greedy private sector grocery providers and their profit-obsessed and obscenely compensated CEO’s could go away and we could have a “Government Grocery” in every town. And, of course because it would be non-profit, the cost for groceries would be lower and everyone would benefit. We could even give free groceries to the poor. And to keep the costs low, the government could set limits on the income of bakers, butchers, cooks, food handlers and others.

This is such a good idea, I can’t believe nobody has thought of it yet.

MarketJohnson June 6, 2011 at 6:21 pm

This post is neither productive, nor does it address the spirit of my comment, which is not that government should control everything, but that some are fine with paying somewhat higher costs for the satisfaction of living in a country where people don’t have to risk their health to make ends meet.

George Peacock June 6, 2011 at 6:26 pm

If the government should control some things and not others, how do we choose? James seems to be consistent with your post and your reply. That is, food, water, and health care are similar in importance. In fact, better nutrition might even reduce some of the health care costs. The same for some shelter, as well, I think. In many places, being without shelter can be quite hazardous to ones health.

My guess is that the “some who are fine with paying higher costs” are the people least likely to be paying anything.

Dan June 7, 2011 at 12:53 am

A govt that robs Peter to pay Paul will always have the support of Paul.

Just as the ones who are fine with higher taxes on particular tax brackets are the ones not in that tax bracket. And, if you should fall into the bracket to be taxed at higher rate, then just send in what you think is fair beyond what is asked. There s no law or legislation to prevent you from paying more. Do so at free will.

Dan June 7, 2011 at 12:49 am

Then you or ‘some’ should do so while others who disagree will not. Send in a check.

Gil June 7, 2011 at 12:57 am

Gee, the obvious answer to this is people don’t need expensive food and drink to live. Then again the government does subsidise some peoples’ everyday expenses through welfare payments. However a person may need expensive medical treatment to live.

George Peacock June 6, 2011 at 6:28 pm

I am not persuaded that most people who support the single payer system care whether it reduces quality-adjusted costs. My suspicion is that they care not about the cost whatsoever.

MarketJohnson June 6, 2011 at 6:47 pm

I wouldn’t say what proportion do. But some definitely do. The people who do are those that donate privately to hospitals and medical facilities on their own already. And when the time comes that I have to means to do so, I will too. However, my guess is that this fight will go on for a while, and eventually, perhaps within a generation or two, single payer or something close to it will be enacted.

notalawyer June 6, 2011 at 6:57 pm

The WHO report measuring overall health system performance (Found here: http://www.who.int/healthinfo/paper30.pdf) suggests 36 other countries, many single payer systems, provide overall higher quality healthcare. Because the US pays the most per person, all 36 of these are prime examples of other countries obtaining higher quality healthcare for less cost. What’s worse is we have to endure 50 million people not having insurance & medical debt contributing to approx half of all bankruptcies on top of it.

While dog food is not a minimum-standard universally provided good/service, other things like public education, police force etc are provided by a single payer (govt) regardless of ability to pay. The overwhelming majority of people support services of this sort. Public health is not yet one of these though many studies suggest the majority of people would support a system of this sort.

The key issue is universality of need & making it affordable. While I’m aware of some special foods for older/sick animals, uneducated observation seems to suggest that there is little variation in animal food. However, because not everyone has a dog, variation in the product causes no social strife, and few that have dogs have problems affording it, it seems like a poor candidate for state action.

Rob June 7, 2011 at 1:06 am

I’m willing to bet the WHO makes no allowance for the fact that most of the technology and advances used by those single-payer systems were pioneered in America. Things look a bit different when you consider this fact. The ability to profit promotes innovation.

notalawyer June 7, 2011 at 10:47 am

The WHO accounts for many variables focused upon health outcomes. Many countries invest in advances, including the US. If you have evidence its disproportionate to our size/wealth it would be interesting to see. But, even if its true, it only shows that other countries do a better job of deploying that tech and getting better health outcomes. France etc are quicker to find good tech (developed there, in the US or elsewhere) and getting to to work for people. What good is a system that innovates ultra-expensive cures only the rich can afford, when a fraction of that expense would screen for heart disease, cancer and other diseases that ruin productivity, shorten lifespans, and increase bankruptcies?

Kendall June 7, 2011 at 9:09 am

My understanding is the WHO study includes many things which have nothing to do with the quality of health care actually received. If you are sick, no country in the world does a better job of getting you well than our country. Other countries have longer life expectancies due to factors like what we eat, exercise and how often we kill each other amoung other things, none of which is the fault of our health care system. We have a higher infant mortality rate because of how we keep the statistics (a baby that dies after a couple of days counts as an infant death in our system but not in many others) and our high rate of teenage mothers amoung other things.

notalawyer June 7, 2011 at 10:51 am

The WHO study does include many things but they are focused on health outcomes. In this country, if you are RICH, no other country does a better job of getting you well. What good is a system that caters to only the rich? People argue that the free market will provide a service for poor people but they currently either don’t exist or are insufficient. French people smoke, drink, and eat fatty foods but they live longer and healthier lives for about half of what we spend per person. Its insane that people argue they want the freedom to spend twice as much in exchange for getting worse outcomes, 50 million uninsured and doubling the bankruptcy rate in this country.

yet another Dave June 8, 2011 at 12:26 pm

Kendall, you are correct. The majority of items in the composite index used in the study are not measures of health care quality at all – the study is clearly NOT focused on health outcomes. It appears notalawyer is suffering from confirmation bias (or didn’t actually read the study).

haxney June 9, 2011 at 2:45 pm

notalawyer:

“In this country, if you are RICH, no other country does a better job of getting you well. What good is a system that caters to only the rich?”

In the tech world, we call those people “early adopters,” and they are crucial in driving the technology forward.

vidyohs June 7, 2011 at 9:28 am

notalawyer, but you twist words as well as one, so why not a lawyer?

The problem with your link and the rankings shown is that quality is only shown in a oblique way, if at all. The report focuses on “efficiency” not quality, and the efficiency part is really all about delivery to the broadest numbers of people.

My looney left friends came down one day for dinner and brought this thing up, and like you they mistake delivery for quality. What made it particularly ironic is that at that time Chuck was also a legal videographer and regularly in Houston’s medcen and outlying hospitals; but, he was totally blind, or willing to ignore for the sake of ideology, the evidence all around him of the finest medical system on the planet.

This is not saying that there are places that have medical quality as good as the U.S.; but, any deviation is negligible. Furthermore, even the delivery statistics are skewed because of the huge numbers of immigrant poor non-citizens are included in the numbers of those receiving little health care.

The very biggest reason that costs of healthcare has grown since WWII is a two fold catastrophe. First is government intrusion and dictates, coupled with the second which is the explosion in numbers of plaintiffs lawyers and the frivolous lawsuits they file in numbers that will blow your mind when you look at them. The U.S., not having a loser pays legal system, is looked at by trial lawyers as just one big vast pool of gold for them to plunder knowing that 95% or better of the lawsuits they file will never get to court but will be settled our of court in arbitration. The lawyer wins no matter how shitty his case may be, the plaintiff…..generally not so much. The worse thing about this situation is that the defense lawyers love the plaintiffs lawyers, because without lawsuits being filed they have nothing to defend and would be out of jobs.

Even socialist England has a loser pays legal system and their nation isn’t run by trial lawyers like ours is.

We do not have a healthcare problem, we have a government problem.

notalawyer June 7, 2011 at 10:56 am

If government intrusion is the problem then why do so many other countries “intrude” more, get better outcomes all for a lower cost per person than the US? France has a huge north African immigrant population with a unemployment rate of nearly 25% at present, yet they don’t have a problem with covering everyone and getting far better outcomes than we do.
You argue I focus on efficiency and not “quality” so perhaps you can enlighten me on what “quality” means to you? In France, despite a huge migrant population, higher unemployment, with a culture that smokes, drinks, and eats fatty foods, people live longer, never go bankrupt and everyone is covered all for about half of what we spend per person. What measure of quality do you ascribe to us? By what metric are we creating higher quality health outcomes?

vidyohs June 7, 2011 at 6:06 pm

No, I won’t play the game by your “living rules”. Quality is subjective under any circumstances and will be saved until you answer the why of your, and others above who, deliberately and disingenuously conflating “efficiency” with quality and cite the U.N. WHO rankings.

An efficient worker does not necessarily deliver the best product. I have lived long and seen many workers who squander time and effort, but when they do finish they have done a quality job even when scrutinized carefully: Conversely I have seen men put out product with efficiency, that on the surface look acceptable, but when scrutinized carefully do not measure up as quality.

So, I won’t talk about quality until I understand how you manage to conflate efficiency with quality.

Dan June 8, 2011 at 1:03 am

The measure of longer life is based on what? What is the per capita death rate from traffic accidents? Wanna bet if we eliminated that stat from the death rate, the US beats out France? And, how about that pesky newborn death rate? How does France determine if a birth is eligible to be counted in newborn death rate? And US? Hint: they keep different measurements….. US? Any sign of life after leaving womb. Almost all of Europe measures differently from length of body, length if time in womb (premature births don’t count) , weight must be particular, and the particulars go on and on and on……

Dan June 12, 2011 at 3:24 pm

Better outcome? What nonsense? Dig deeper. You stopped once you found some stat that aligns with your misconceptions. Single payer does not produce better outcomes.

Dan June 8, 2011 at 1:05 am

WHO reports are full of misleading and false information. If this is basis of your argument…… Your done… You fail.

yet another Dave June 8, 2011 at 12:17 pm

The study you link is most definitely NOT focused on health care quality. It uses a composite index based mostly on things unrelated to health care quality (it’s based more on “social justice” parameters). As a result, the conclusions of it don’t suggest anything about quality of health care one way or the other. Rather it suggests the study was designed to reach a certain conclusion, and then it did reach that conclusion.

Don’t take my word for it – read the study. It’s almost perfectly worthless.

tdp June 12, 2011 at 3:15 pm

It’s lower quality that everyone gets. According to them, it’s more important that people spend less money rather than get better results. Which is better for a poor person? Go bankrupt but live or not have to pay but die while waiting for outdated treatment? You can prevent both of these from happening with a free market system, since cost is artificially high here because hyper-regulation gums up the works and actually makes things worse.

tdp June 12, 2011 at 3:09 pm

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″

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. ”

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).

tdp June 12, 2011 at 3:13 pm

I tried to post the links but the comment didn’t go through until I took down the hyperlinks. I will attempt to alter the URLs to circumvent this, so in reality there are no spaces in the URLs.
The sources are: -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, h t t p : / / w w w .a e i.o r g/ p u b l i c a t i o n s/
s p u b I D. 2 4 9 7 4, filter. all/ pub _d etail .asp; David Gratzer, “A Canadian
Doctor Describes How Socialized Medicine Doesn’t Work” Investor’s
Business Daily, July 26, 2007, h t t p: / / i b d editorials. com /IB D Articles.
a s p x ?i d =2 7 0 3 3 8 13 52 02 343
h t t p :/ /w w w .n c p a. o r g/p ub/ ba 596

tdp June 12, 2011 at 3:13 pm

Ergo, single payer is not better. End of story.

John Dewey June 13, 2011 at 2:07 pm

I agree that the quality of health care in the U.S. is as good or better than thgat anywhere else.

I also agree that lifestyle differences – and I’ll add genetic differences – likely explain much of the difference in life exxpectancy often cited as evidence that the U.S. lags.

IMO, U.S. spending on health care is so high relative to other nations for two reasons:

1. Medicare spending is uncontrolled due to the political clout of seniors;

2. the U.S. is so darned rich that it can afford to spend more of its GDP on health care.

JCE June 7, 2011 at 6:28 pm

yeah don, the pet food market works exactly like the health care market….

Methinks1776 June 8, 2011 at 6:28 am

Not the brightest bulb in the marquee, are ya’, JCE?

Methinks1776 June 6, 2011 at 5:33 pm

They already don’t have to sell off everything they’ve ever worked for. If your material possessions are worth more to you and your family than your life, then you will make that trade-off. Why you should be forced to accept a lower standard of living and then not even have access to medicine that will extend your life because government is tasked with making decisions for you is beyond me.

MarketJohnson June 6, 2011 at 5:44 pm

You seem to be comfortable with people having the make the choice between losing everything they have and dying. Remember, we aren’t talking about well-to-do people here. We’re talking about people who might have spent their whole lives scratching together enough savings to buy a car that’s less than 10 years old, or maybe even their own home. I guess if you feel like those people don’t deserve to have those things because they don’t have health insurance and get sick, well, you are entitled to that opinion.

Brian125 June 6, 2011 at 5:57 pm

MarketJohnson

You’re right – some people only have the choice between losing everything they own or dying. With single-payer, suddenly, people will not have to make that choice. You’ll be astonished how many people will choose to let our government pay for their healthcare concerns. The system will soon become over-whelmed by people who are choosing to live at the expense of others. Then what happens? Well, in the past, governments have become increasingly aggressive in enforcing their policies. What other logical conclusion is there?

Ken June 6, 2011 at 6:23 pm

MarketJohnson,

Who, WHO!, has to sell EVERYTHING they have or die? Just because you imagine that this might be so doesn’t make it true. Even the most expensive treatments I can think of only run $100-$200K, about the price of a mortgage.

People can downsize their lives, take second mortgages, finance part of it, but why the hell don’t these people have insurance? Insurance particularly for the rare expensive stuff can be purchased for as cheap as $100/month. And why since they were too cheap to buy insurance should OTHER people be forced to pay for the irresponsibility?

Regards,
Ken

MarketJohnson June 6, 2011 at 6:33 pm

I appreciate your argument, but $100 a month is a lot of money for some people. Hell, as a college student a student paying tuition on $8.50 an hour, $100 a month would have probably kept me from finishing school. Again, you might be comfortable with situations where people have to sacrifice significant things in order to keep your price down, but I’m really not.

Ken June 6, 2011 at 6:57 pm

MarketJ,

“but $100 a month is a lot of money for some people”

Wrong. How much do people spend on bee and cigarettes? That same college student is getting blitzed and chain smoking on the weekend.

Regards,
Ken

Ken June 6, 2011 at 6:58 pm

Typo: How much do people spend on beer and cigarettes?

Ken June 6, 2011 at 7:06 pm

MarketJ,

You’ve also failed to tell me who has these medical problems that causes them to choose between selling everything and dying. Really, who are they? Or are they just a figment of your imagination? Stop dodging the damn question. If you want to take MY money and give it to someone else because they were too irresponsible to buy an easily affordable $100/mo insurance plan, they’d better damn well exist and your theft from me to give to them (and to help you feel better at night) better fucking help them.

Something a single payer health care system DOES NOT DO!! What are the wait times in Canada for a simple scan for breast cancer? Is it worth paying more in the US today and catching a budding cancer, or having it provided for “free” in 8 weeks only to be told that in the last 8 weeks that cancer has spread throughout the body and will now kill you since it’s inoperable? This is the typical result of single payer health care: lower quality, more shortages, longer waits, and more misery and death. Thanks for delivering thousands of real, unimagined unnecessary deaths to those who otherwise might have lived, all so you can feel better about your imaginary people who have to sell everything or die.

Regards,
Ken

MarketJohnson June 6, 2011 at 7:13 pm

Ken,

I’m not sure there’s any way for us to have productive debate if you don’t agree that $100 is a lot of money for some portion of the population. I don’t (didn’t) drink, and don’t (didn’t) smoke. For at least a couple years, 95% of every check I earned went to necessities, and the remaining 5% was certainly not $100. Do some spend money on those things? Absolutely. But the argument that we shouldn’t cover people because some of those people are wasteful is not one I’m willing to support when it comes to health care. Education, housing, and many other things, yes. But not health care.

MarketJohnson June 6, 2011 at 7:17 pm

Ken,

Certainly you are not asking me to prove the existence of people who lose most or all of their financial assets paying for critical health care out of pocket, and then making the argument that those people are figments of my imagination compared to those who develop breast cancer in an “8 week” waiting period, and die because of it, while they’d have been saved without the wait.

MarketJohnson June 6, 2011 at 7:22 pm

I’m not one for using anecdotal evidence to support an argument in a debate like this, but I refuse to believe I’m the only person who has ever been on such a tight budget that $100/m would have been a severe blow to my financial status.

Ken June 6, 2011 at 8:27 pm

MarketJ,

“For at least a couple years, 95% of every check I earned went to necessities, and the remaining 5% was certainly not $100.”

Either you made some terrible choices or you are exaggerating. Minimum wage is 7.25/hr, meaning a full time employee will make at least $14K/year, most of which he will be able to keep due to low income (meaning low tax rates). And if this person doesn’t have any pride they can go to the government with their hand out.

Expenses can be very low. I earned as little as just under $9000 in a year as an adult, yet managed to save $1000. I didn’t have insurance, but I could have ponied up an extra few dollars per month and bought a cheap insurance plan.

“Certainly you are not asking me to prove the existence of people who lose most or all of their financial assets paying for critical health care out of pocket”

That’s precisely what I expect because, like you, I’m suspect of anecdotal evidence, particularly ridiculous statements like, someone has to sell everything or die.

However, the anecdotal evidence you provide me for $100/mo being a lot is directly refuted by my own personal experience. The year I left the navy I was a waiter, the year I made that $9000 in a year. I rented the cheapest place I could find (~$300/mo utils included, so $3600/year); I ate cheaply, around $5/day (hello mac and cheese), another $1825 a year. Gas for my motorcycle was around $20/mo, which is $240/year; no insurance needed for said motorcycle. I still managed to go drinking at least twice a month (around $30/outing, pretty cheap due to working in the restaurant biz), so another $720/year. Plus that $1000, I saved. That’s an accounted for $6485. The rest was probably eaten up by food and drink, both of which I like. Since I made so little that year, and I lived in a no income tax state, I paid almost nothing in taxes that year.

I had plenty of free time, since I typically worked only 20-32 hours/week. Had I worked full time, I’m sure I would have made north of $10K that year. I could have easily gotten a second job; I thought about waiting at another restaurant, in addition to the gig I all ready had.

So, really don’t tell me $100/mo is a lot. It isn’t. Making just minimum wage (almost all of whom are less than 25 years ole), that’s a grand total of 13 hours in a month, i.e., 4.25 hours per week.

Regards,
Ken

MarketJohnson June 7, 2011 at 12:07 am

We could go back and forth discussing expenses, what a person should or shouldn’t spend on this or that, but that would be completely unproductive. The only thing I’ll say is that for many parts of the country (especially urban environments, where a lot of the people that are involved in this conversation come from), $300 is extremely cheap for rent. There are some places where that price is absolutely unheard of, and not everyone has the option of moving.

Nevertheless, if $100 were easily affordable for everyone, everyone would pay it. And that $100 would only get them a high deductible, catastrophic style plan, which still may put people out of their homes depending on their finances.

If you want to discuss the cultural conditions that cause people to spend ridiculous amounts of money on expensive clothes, jewelry, shiny new rims for their car, or other seemingly luxury items instead of things like health insurance, I totally agree. It’s disgusting. But while there are many like that, it’s not everyone.

And if you want to discuss the educational conditions that leave a large portion of our young people unable to make good decisions with their money, once again, I agree. The decisions some people make (an appropriate argument given the sub-prime mortgage boom) are absolutely astounding sometimes, going into debt that they have no hope of ever getting out of. But that isn’t everyone either.

Not everyone falls into those categories. Some are just genuinely struggling, and if covering them means covering some deadbeats and some idiots too, then I accept that.

Ken June 7, 2011 at 12:56 am

MarketJ,

“$300 is extremely cheap for rent. There are some places where that price is absolutely unheard of”

You mean like downtown Seattle, where I got that rent. You’re right, Seattle is known for it’s low low real estate prices. Four men splitting the rent on a four bedroom condo can get low rent. It wasn’t the nicest place or the safest, but it was cheap and safe enough and nice enough for the price. In other words I made the trade off between nicness and safery with price. This is the way of the world – trade offs. Grow up.

“not everyone has the option of moving.”

Wrong. Everyone can move whenever they feel like. this is a BS excuse to take my money to make your life easier. Sack up and be an adult. People just don’t want to move, but it’s easy enough. I’ve moved over 20 times in my adult life.

“Nevertheless, if $100 were easily affordable for everyone, everyone would pay it.”

Why? With so many people like you so will to take from others to give to your preferred citizens? With the incentive that you are providing by offering to pay for it with other people’s money, why would anyone pay it? Then there’s the whole, it won’t happen to me syndrome. Many don’t think ahead and people like you incentivize short term thinking. But again, your answer is don’t worry about it, other people will pay.

“And that $100 would only get them a high deductible, catastrophic style plan, which still may put people out of their homes depending on their finances.”

This statement doesn’t make sense. If a person is covered with catastrophic insurance, how would they be put out of their homes went these catastrophes occur? Yes, high deductibles come with cheap insurance plan, but certainly you can see that it’s much easier to pay a $5K-10K deductible, rather than a $50K-100K catastrophe, can’t you?

“It’s disgusting.”

I don’t think people’s spending is disgusting; it’s their money and their choice. Maybe you should start thinking about the sactity of the individual and the choices these individuals make for themselves rather than trying to make these decisions for them. I think people like you justifying taking other people’s money to spend how you see fit is disgusting. You degrade the dignity of the individual because you think you know what’s best.

“And if you want to discuss the educational conditions that leave a large portion of our young people unable to make good decisions with their money, once again, I agree.”

Then why incentivize further bad money decisions by teaching people not to be responsible, not to take care of themselves, not to save their money, and not to buy insurance? You’ve got it covered: single payer health care. It’s like you don’t even understand basic human nature.

You aren’t calling for a better society, by arguing in favor of a society of perpetual adolescence, where no one takes responsibility for their own lives. Congratulations, you and people like you lie at the root of the rot of Western society.

Regards,
Ken

lamp3 June 7, 2011 at 3:30 am

I have to agree with Ken on the subject of moving around and making little money.

I work 10-20 hours a week at a hospital making $11/hr, having just gotten a BS degree. I’m young and have a low risk for some kind of monster chronic/acute problem, so have a $50/mo cash insurance plan in case I get hit by a car.

Between food, school, living, a $40/mo cell phone bill and saving to apply for graduate school, you certainly can scrape by. On beans and rice, but that can be jazzed up with some bulk spices/herbs.

I don’t want to move, but if I’m priced out of the area I’m going to have to. We all face economic decisions, I think most of them are non-pecuniary.

Ron H. June 7, 2011 at 5:07 am

MarketJ

Look, you keep trotting out that $100/mo that you or someone else can’t afford, and it misses the point entirely. If you choose to go to school , work a low paying job, and go without medical insurance, those were your decisions. It doesn’t matter whether that insurance costs $1000/mo or $1/mo, it’s your responsibility. You have incredibly big balls to suggest that I should be forced to pay it for you. Your sense of entitlement is astounding. I’ve likely already been forced to pay for part of your education, and now you want more!

MarketJohnson June 7, 2011 at 4:56 pm

Ken,

If you are going to with one breath say that people need to cut back on expenses to be responsible and pay for their own health insurance, then completely reverse that statement and say “I don’t think people’s spending is disgusting; it’s their money and their choice” after I agree, there’s really no point in addressing you anymore.

The Rest,

I’ve had my fill of this. I knew coming here and commenting wouldn’t be anything than what it was, which is a bunch of pack-minded ideologues who like to try to destroy any viewpoint that doesn’t align with their own. I haven’t changed your mind, and you probably won’t change mine. The good thing is, it’s only a matter of time before we go to single payer, which will be an improvement over what we have now. It’s not perfect by any stretch, but knowing that the rest of the civilized world gets by just fine using it is enough for me to know that all the claims about slavery and freedom-hating are as off the wall as I believe them to be.

Ken June 7, 2011 at 5:56 pm

MarketJ,

“I don’t think people’s spending is disgusting; it’s their money and their choice”

This isn’t a reversal at all. It fits in quite logically with the individual liberty and individual responsibility exactly. It is their money and it is their choice. They, AND ONLY THEY, are responsible for the outcomes of their decisions. Please learn to think clearly and logically.

“The good thing is, it’s only a matter of time before we go to single payer”

I see you’re stupid too. All countries that have chosen single payer are going bankrupt fast and the US is all ready starting to see a backlash. Perhaps you weren’t around last fall, but all those in favor of a gov take over of anything got their asses handed to them.

“which will be an improvement over what we have now.”

Government involvement in anything has never been an “improvement”. This is merely ignorance or lying on your part.

“I haven’t changed your mind, ”

Primarily because you don’t know logic and weirdly think that gov can make things better despite this never being the case.

Regards,
Ken

Methinks1776 June 6, 2011 at 6:32 pm

You seem to be comfortable with people having the make the choice between losing everything they have and dying.

I’m comfortable with the realities of life. Yes, I am.

We’re talking about people who might have spent their whole lives scratching together enough savings to buy a car that’s less than 10 years old, or maybe even their own home.

No, we’re not. We’re talking about a single payer system for everyone. You do not have to enslave 100% of the population to a suboptimal system to solve the problems affecting 5% of the population. That’s what single payer does.

I guess if you feel like those people don’t deserve to have those things because they don’t have health insurance and get sick, well, you are entitled to that opinion.

Did you enjoy building that straw man? I imagine you actually sniffed as you punctuated that sentence.

MarketJohnson June 6, 2011 at 6:38 pm

Enslave. Definitely the proper word here. If that’s the case, most of the civilized world is enslaved, by your definition. I guess you want freedom, you’re just going to have to move somewhere with no health care system at all.

Methinks1776 June 6, 2011 at 6:43 pm

Nice dodge. I see you’re out of arguments and you’re happy to build your card castle on sand.

MarketJohnson June 6, 2011 at 7:20 pm

It’s not a dodge at all. Your argument is that single payer is slavery, and you would rather let people die than be a slave. Well, I agree. If 100% of us have to be slaves to save the lives of 5%, it’s probably not the way to go. But it isn’t slavery. I illustrated that point by making the observation that a lot of the civilized world uses single payer, which they surely wouldn’t stand for if it truly was slavery.

Methinks1776 June 6, 2011 at 7:53 pm

No, that is not my argument. Try reading my comment again.

Gil June 7, 2011 at 1:01 am

Gee, if you think a single health solution provided by government subsidises unhealthy dullards then you must despise the government’s singular solution to crime and punishment which means you’re subsidising dulllards who live in crime-prone areas.

Ken June 7, 2011 at 1:12 am

Gil,

You actually said something intelligent, although I’m sure it’s completely unintentional since I think you were trying to be sarcastic, but failing miserably. The government absolutely should stop subsidizing the criminal elements in cities in such places as Cabrini Green, Pruit-Igoe, etc.

Regards,
Ken

lamp3 June 7, 2011 at 3:34 am

@Gil – I think the singular solution of drug illegalization has helped exacerbate the problem, an example that might suit your question.

Gil June 7, 2011 at 4:13 am

Lamp3 – I’m not just talking of drug crimes but all crimes. So someone has been robbed and you’re now forced to chip in to see if the culprit can be caught and sent to trial then jail? Let the individuals pay for private anti-crime insurance or defend themselves on a user pays basis. Surely the free market can handle crime problems just like health problems.

lamp3 June 7, 2011 at 11:36 am

@Gil – I listened to a speaker discuss how if provisions for crime fighting were indeed private, those with the most to lose would definitely pay. In other words, everyone with money and property would voluntarily pay or risk not having it.

You can act, but you’ll have to face the consequences. Especially if it’s known you haven’t paid for protection but everyone else around you has — a dislike of freeloading might come with interpersonal costs between you and your neighbors for instance.

I think insurance exists if your car, house and other property is robbed. Another sure thing is that government failure on the part of crimes exists; petty crimes that target individuals with high resale value items like iPhones on university campuses being an example. The police have a tough job, often say they cannot respond to everything and often are the only game in town — could competition work better than government here?

This article describes one city’s disbanding of its government departments in exchange for purchasing services from other municipalities. It looks like they’re shopping for services from those around them who can provide it best. Given their baseline as an unprofessional police department, things are looking better afterwards.

http://www.nytimes.com/2010/07/20/business/20maywood.html

Craig S June 7, 2011 at 12:07 am

MarketJohnson, you keep repeating this sob story like its a common occurance. We can go tit for tat with anecdoteal stories all day. Clearly there are ways to help the rare cases you are describ ing with out forcing a single payer system on all of us.
Also it should be noted, that while bankruptcy is not good, it does not mean you have to sell all your belongings and live under a bridge wearing only a barrell.

MarketJohnson June 7, 2011 at 12:13 am

If there is such a clear and simple way to avoid the situations I am referring to, what is it, and why hasn’t it been implemented already?

Lemme guess, it’s the governments fault.

Gil June 7, 2011 at 1:03 am

If dire health stories are rare then government involvement for such scenarios won’t break taxpayers.

Ken June 7, 2011 at 4:13 pm

Gil,

“If dire health stories are rare then government involvement for such scenarios won’t break taxpayers.”

Even you are smart enough to know what a stupid statement this is. Name a government program that didn’t grow out of control or beyond what it’s original charter. Even now medicaid and medicare are providing much more than just for “dire health” scenarios.

You mark yourself as a fool saying what you’ve said.

Regards,
Ken

SheetWise June 7, 2011 at 12:46 am

So … what you’re saying is that YOU don’t believe people should be required to exhaust their personal resources before they begin demanding the resources of other people. They should be able to keep what they have, and pay for what they need by passing the cost on to others. Have I got that right?

You do realize that some of those “others” have needs as well, don’t you? This sounds like another one of those Social Security tricks — which sound real nice — but end up with McDonalds workers paying the green fees for wealthy retirees. That’s the nature of entitlements — you’re entitled to them.

cmprostreet June 7, 2011 at 2:22 am

MarketJohnson:

You wrote “…I refuse to believe I’m the only person who has ever been on such a tight budget that $100/m would have been a severe blow to my financial status.”

You aren’t. I’ve been there multiple times, mostly due to college and grad school. However, when I was in those situations, I had the maturity to understand that I was making a trade-off and choosing to bear the risk of not having health insurance so that I could get my degrees and have a better future. (I put a lot of thought into it, and the value of my education was sufficiently high enough that bankruptcy would have been worth the risk).

I did NOT whine and cry about how unfair it was that I couldn’t afford health insurance and then demand that someone steal resources on my behalf in order to give me that coverage. Now that I’m through that situation and I have health insurance through my employer, I have no fucking patience for someone else in that situation who can’t accept the trade-offs in their life and so demands that I be forced to pay for their lifestyle.

Make no mistake, it is a trade-off. How many of those people for whom $100/month is a severe blow have smart phones?

MarketJohnson June 7, 2011 at 5:18 pm

cmprostreet,

Probably a lot of them have smart phones. I totally agree that prioritizing economically is a major problem in our society (see my comments above about it to Ken). I have my own beliefs about what ought to be important to a person, and what shouldn’t, and I follow those. That includes making sure I have money for health insurance before I sign up for an expensive phone contract (which I actually don’t have, since I am paying for health insurance, repaying student loans, and contributing to a retirement account which I have had since virtually the day I graduated).

So I guess you and I can have a grand old pow-ow about how stupid people are in spending money on things they don’t really need, who then get upset when they can’t afford health insurance. But that’s not really going to accomplish anything.

One drawback of our consumption based society is that people want things like iPhones and fancy cars because even if they are broke, they can feel like a rich person when they are driving or texting. No one feels rich paying their health insurance bill. It’s a natural side effect of a society that places more value on material wealth than any other kind. Hell, American exceptionalists still use the argument that we are the greatest country ever because we are the richest, and not because of many of the selfless things we have done for the world over the years, and the success we’ve had as a diverse and integrated society.

I’d buy the argument that people need to change their priorities a lot faster if the people who make that argument aren’t also the people argue a society is at it’s happiest when it is richest.

Ken June 7, 2011 at 6:05 pm

MarketJ,

“prioritizing economically is a major problem in our society ”

It absolutely isn’t. The major problem is that YOU think you know how I should prioritize economically. Your arrogance is stunning. Please tell me how much I should save, how much I should pay for medical care, how much I should be for housing, how much I should pay for clothing, etc. Can you answer any of those questions? Of course not because you have no idea what MY goals are, what MY salary is, what MY health is. Yet here you are boldly saying that you can make things better for the average person, when you don’t even have basic knowledge of 99.999% of the population.

“stupid people are in spending money on things they don’t really need,”

It’s nice to know that you know what others need. I mean after all, with all your ignorance about anyone, how could you not? Amaright?

“One drawback of our consumption based society is that people want things like iPhones and fancy cars because even if they are broke”

Yeah, that whole “knowing stuff” and “getting around” thing really is over rated isn’t it? I mean if you really think about it, why do people need to know anything or go anywhere, since you will tell us all what we need and where to go without that whole driving business. Amaright?

“American exceptionalists still use the argument that we are the greatest country ever because we are the richest”

No American exceptionalist will tell you this. You have it ass backwards. We are the richest BECAUSe we are exceptional.

“I’d buy the argument that people need to change their priorities ”

Then why incentivize bad behaviour? Your policy suggestions, like a single payer system, removes any responsibility from the individual. Do you not understand this basic principle?

Regards,
Ken

crossofcrimson June 7, 2011 at 9:47 am

“You seem to be comfortable with people having the make the choice between losing everything they have and dying. ”

And you are too as long as you’re living above subsistence level and someone on this planet is dying. Should we be able to force you to do otherwise?

tdp June 12, 2011 at 3:45 pm

Read Sally Pipes on why health insurance costs so much. With a free market system and common sense, costs would fall and everyone would be able to get insurance. The reason those people are that poor in the first place is also because of government mismanagement that harms the economy.

Plus, lots of currently uninsured COULD technically afford insurance but don’t because they feel it isn’t worth the money. 18 million people without health insurance earn $50,000 a year or more, and 10 million of that 18 million earn $75,000 a year or more. They are predominantly young, healthy people who don’t want mandated coverage for acupuncture and homeopathy that doubles the cost of insurance. 14 million people qualify for Medicare, Medicaid, or CHIP but aren’t registered (though given the quality of those programs I wouldn’t blame them), and another 10 million people aren’t US citizens/aren’t technically supposed to be here. Of the 46 million people Obama claimed had no health insurance in 2008, I count 42 million on that list, minus a few million for overlap and a few million for people who really are screwed (too rich for medicaid but too poor for regular coverage, pre-existing conditions, sick kids, etc.). Let’s say 10 million are well and truly unable to get any kind of insurance.

Using these parameters, I shall reveal to you how to fix healthcare.

Allow competition across state lines, remove mandates from policies (people can pick and choose the coverages they want rather than requiring that all policies have x,y, and z), enroll those 14 million people who qualify for government aid, and end tax preferences for employer-provided insurance, instead giving tax breaks to those who purchase insurance themselves. Add in Paul Ryan’s plan of a $2,300 tax credit for individuals and $5,700 for families to purchase insurance, received at the beginning of every year.

Results:
1) People can buy insurance anywhere in the country and insurers have no more artificial monopolies. Since the same policy costs $960 a year in KY and $5,560 a year in NJ, prices will plummet to the cheapest rates. Millions more people can afford insurance or choose to buy it no since its cheaper.

2) People no longer lose their insurance when they lose their job since insurance policies are predominantly bought and sold individually. By ending the preference for employer-provided insurance, people see the real costs of insurance and shop around for the best deal. Prices fall further.

3) Millions of people are enrolled in Medicare, Medicaid, and SCHIP.

4) Because of the extra cash in people’s pockets from Paul Ryan’s plan, people can afford more than bare-bones care. What they save of that $5,700, they keep.

5) Of that 46 million, now only people with pre-existing conditions or sick kids don’t have the ability to get healthcare.

On to step 2:
-Forbid insurers from denying coverage to those with pre-existing conditions and create a NATIONAL, not state, exchange, complete with larger tax refunds for these families, to help pay for their coverage, which would still be at higher rates for actuarial reasons.

This solves all our problems except one: people with catastrophic illness that even the most kind-hearted insurer can’t afford to pay for, like a rare, aggressive cancer that costs $200,000 a year to treat. In Europe, someone sick like this would die, either because the technology isn’t available there, it costs too much, or the waiting list is too long. However, the family isn’t bankrupted. I grant that someone like this is screwed pretty much anywhere, but at least with the resources in the US, they can TRY to be cured, even if they go bankrupt. However, these people can be helped, too.

1) There are numerous hospitals, like St. Jude and the Mayo Clinic, that provide state-of-the-art, life-saving treatment for free. Have a government program that pays the transportation costs and other related expenses so families can travel to these places.

2) The government can take the money saved by repealing ObamaCare and use it to pay part of the cost of these cases, which should be small enough in number not to break the bank. From there, there is only so much that can be done, and after all this aid, there are still myriad charitable organizations to provide further assistance.

To prevent people getting screwed, require transparency of company policies and make all policies state in plain English the terms of the policy. People can further supplement their care with HSAs, which would not be taxed like they currently are, but instead given tax breaks. These act as layaways for any future emergencies.

Economiser June 6, 2011 at 6:10 pm

Try thinking about this in a different way. In the past, the sick person in your hypothetical had one option: dying. Today, thanks to medical advances, they have two options: dying, or paying for very expensive medical treatment. The second alternative is invariably better than the first.

This is a circumstance where classical insurance is very useful — a low-probability, high-cost circumstance. The problem is that the government has manipulated the medical insurance market into something more akin to pre-paid medical care, and assumed full control over that market for the most expensive segment of the population (seniors). The government has turned a great case for insurance into a mish-mash of third-party payors, artificially inflated demand, underpriced premiums for seniors, guarantees despite spiraling costs, and a distorting preference for employer-sponsored health insurance. Health insurance today barely resembles a market.

George Peacock June 6, 2011 at 6:21 pm

Yes, that’s one of the problem, health “insurance” is not really insurance for the most part.

Methinks1776 June 6, 2011 at 6:32 pm

Arnold Kling calls it “insulation”.

James June 6, 2011 at 10:46 pm

I’m not sure what is more impressive. The fifteen round smack down that was delivered to MarketJohnson or the fact that his corner handlers were able to get him up off the canvas to answer the bell.

Based on his comments, it appears he is the poster child for, “If you aren’t a liberal in your twenty’s…”

MarketJohnson June 7, 2011 at 12:16 am

I am neither a liberal, nor in my twenties. Maybe the fact that I don’t necessarily believe markets to be the savior of humanity and the cure to every ill makes you believe that, but there really are shades of gray in economic discussion. Things are so much more interesting (and productive) when you see them.

vikingvista June 7, 2011 at 2:04 am

“I don’t necessarily believe markets to be the savior of humanity”

Which is to say, you believe the salvation of humanity may require the bullying of innocent people.

Methinks1776 June 7, 2011 at 10:22 am

Yes, because governments have traditionally been the saviours. I don’t understand why people look for religious experiences in economics.

Chris O'Leary June 6, 2011 at 5:25 pm

If single-payer is so awesome, then why is the Obama administration moving NASA away from a single-payer astronaut delivery system (for reasons of cost)?

Bret June 6, 2011 at 5:55 pm

Relative to what? And for whom?

Could a single payer system reduce the quality-adjusted cost of health-care relative to a completely free-market system for everybody who could afford it?

Certainly not.

We don’t have a completely free-market system.

Could a single payer system possibly reduce the quality-adjusted cost of health-care relative to some other NON-free-market system for certain politically well-connected groups? Absolutely.

This is a political debate, not an economic one. In political debates, sometimes folks use pseudo-economic arguments like claiming that costs will be lower.

Martin Brock June 6, 2011 at 5:58 pm

The problem with this analogy is that we don’t already have a pet food industry mired in an incredibly complex system of regulation with vast opportunities for rent seeking, many of them already exploited by rent seeking “entrepreneurs”, growing with every session of Congress, every page of bureaucratic rule-making and every line of “contractual agreement” among organs of the corporative state.

Would a Canadian-style, or even a British-style, system be worse than what we already have? I don’t pretend to know. Ask me about some theoretical, more market-based system, and I’m more inclined to accept your logic, but the U.S. health care system is so far from this theory that the agreement can only be academic.

Seth June 6, 2011 at 6:11 pm

Martin – I agree with your assessment of the present state of health care. I believe most people do not see this. They see “for profit” companies in the mix, equate that with “free market” and claim that all the problems in health care are failures of the free market that must be fixed by government.

But, I’m not sure that relates to the question. We have a relatively free market in pet food and we have a single payer health care models to look at, as you point out. Which bests delivers?

I don’t see many people crossing borders to get the pet food they want.

Ryan Vann June 6, 2011 at 7:21 pm

Hell look at pet health insurance. Take away: fuck doctors, just see a vet when you get sick.

Ryan Vann June 6, 2011 at 7:15 pm

I’ll throw in with Martin here. I’ve no clue whether a single payer system would be quality-adjusted cost (whatever that is) superior to the Frankensystem the US utilizes. If I had to wager a guess, I’d say yes ( at least for me).

Methinks1776 June 6, 2011 at 9:19 pm

I don’t have to wager a guess. I have a lot of experience as a patient in such a system and I have many family members who were doctors in such a system and I have seen enough statistics about health care outcomes in such systems.

You would lose your wager.

Vance Armor June 6, 2011 at 6:10 pm

Don is setting up a false alternative for the Progressives/Socialists. He is entering the lion’s den for the collectivists with his example. The problem is that collectivists always “win” their arguments by juxtaposing “ideal collectivism” versus some motley of market-based, highly regulated/subsidized/taxed system of economic organization, which they will call “capitalism.” Pet food has not been regulated by the 1973 HMO Act, which basically made it impossible for doctors to act as single agents who went on house calls as they did before 1973. Also, pet food doesn’t have occupational licensure, which is the biggest problem with medical care — along with the “entitlement” programs. Pet food distributors do not have guaranteed payments for their services (racked up by the hour) by the government for clients who happen to be over the age of 65.

Publius June 6, 2011 at 6:29 pm

The problem with this question is that we currently don’t have a free market for health care, as we do for pet food. The consumers of health care services, and resources, are not the who pays for it. Everyone has a third party payer. For Medicare/Medicaid patients, that is the government already. For those with private insurance, it is there private insurance company. But, health insurance companies are heavily regulated state to state in terms of what services may or must be covered and in many states there is only one or a few health insurance company, legally protected from out of state competition. So even private health insurance is not purchased in a free and competitive market.

Therefore, to ask whether a single payer can reduce costs compared to a free market is an irrelevant question since the status quo is not a free market. The truth is you have no incentive to be thrifty when you are spending someone elses money so any third party payer system, whether public or private, is going to produce escalating costs. Health care costs can only be reduced by a true free market, fee-for-service, system (which will leave some unable to afford care) or rationing. Pick your poison. There’s no such thing as a free lunch and Utopia doesn’t exist….

Methinks1776 June 6, 2011 at 6:37 pm

The problem with this question is that we currently don’t have a free market for health care, as we do for pet food.

That’s not a problem with the question. That’s a problem with the system.

Everyone has a third party payer.

Not I.

Charlie June 6, 2011 at 6:56 pm

There is nothing illogical about believing

free market (or some ideal solution) > single payer > current system

If the solutions one believes are better than single payer systems are not feasible for some reason, then it is not illogical to advocate a single payer system.

Methinks1776 June 6, 2011 at 8:12 pm

There is nothing logical in your comment.

SheetWise June 7, 2011 at 12:52 am

Not unless you believe in the transitive property of ordinal solutions. Then, it makes perfect sense.

muirgeo June 6, 2011 at 6:30 pm

Hummm… I would recommend that you read some Hayek. He clearly explains the difference between unpredicatable insurable cost and pricing of things that are more applicable to market forces and price mechanism.

Health care is unpredicatable and is amenable to …wait ….. do I REALLY need to explain this to a professor of economics.

Why don’t you explain… in contrast to all the developed worlds successful single payer systems, why you think the one you propose which exist NO WHERE in the world would work the best.

We certainly have the MOST free market of health care systems and it certainly is the most quality adjusted expensive.

Sometimes the more I think about it the more we’d be better of to have the government provide for ALL of our insurable risks. The government is a far more effecient cost adjusted insurser than the private markets.

Sandre June 6, 2011 at 6:35 pm

Now that you answered some favorite question of yours that you like answering again and again, try this one for a change:

I have a question for anyone who believes that a single-payer health-care system (where the single payer is government) will reduce the quality-adjusted cost of health-care: will a single-payer pet-food system (where the single-payer for pet food is government) reduce the quality-adjusted cost of pet food? That is, under a single-payer pet-food system (with government as the single payer) will consumers be better supplied, at a lower cost, with pet food than consumers are supplied today with a free market, myriad-payer system for the provision of pet food?

If not, why would a single-payer system for health-care reduce the quality-adjusted cost of health-care? But if so, why not socialize the entire American economy given that a single-payer system (with government as the single payer) would clearly deserve the presumption of being a superior method of economic organization than myriad-payer free markets?

Methinks1776 June 6, 2011 at 6:42 pm

I’m certain Don Boudreaux really values your recommendation, Muirdiot.

why you think the one you propose which exist NO WHERE in the world would work the best.

Utter bullshit.

We certainly have the MOST free market of health care systems and it certainly is the most quality adjusted expensive.

We do not. Singapore has a much more free market health care system. Singapore spends just over 4% of GDP on health care and has the same or better outcomes than the U.S. – and the U.S. outcomes are superior to outcomes in European countries with single-payer systems.

muirgeo June 6, 2011 at 9:28 pm

Hey methinks we had the debate on theoretical libertarian free market medicine. I showed that even you, a cold hearted libertarian, would open your arms to a mother in need even if it meant the creepier doctor person down the street would run you out of business.

Your response to that scenario blew your own position to shreads…..

In a free market system uninsured pregnant women with premature twins go to the street and die or they are the burden of the good hearted people who default their incomes to the money grubbers freed of all real responsibility.

That’s why we don’t have free market medicine or free markets. Because we don’t want to set up a society were they wickeest of people profit the most with no debt to society.

Methinks1776 June 6, 2011 at 9:38 pm

Morongeo,

I never for one second expected you to understand the difference between reaching into my own pocket when I want to help someone and holding a gun to another person’s head to rob them in order to help a needy person. That ordinary Americans reach into their own pockets to help out others all the time and that they do so happily, freely and without caring if their neighbours are also reaching into their pockets is completely lost on you.

Blunt force violence is all you understand and all you will ever understand. There is nothing more wicked than that.

SheetWise June 7, 2011 at 12:54 am

** silent applause **

sandre June 7, 2011 at 1:26 am

Muirdouche is speaking for himself. He would let his mother and twins would die, if it really happened to him in real life – if he couldn’t find someone with money to steal from that is. He just thinks that everyone shares his values. What a douche bag.

muirgeo June 7, 2011 at 9:23 am

Again… if markets were efficient you wouldn’t need charity. Again if you reach into your pocket …in the libertarian world charity is NOT deductible and the Libertopian Hospital down the street will run you out of business in no time at all. They will undercut your rates and pay better salaries. The libertarian society that relies on charity to fill the huge gaps it creates is set up to punish the giving, the caring , the charitable and allow the creepers to take all the profit with no obligation. You want to set up a society for an Epic Fail. Now picture a bubble with your pipe dream inside… it just popped.

Methinks1776 June 7, 2011 at 10:34 am

If the markets were efficient you wouldn’t need charity? Are you insane?

There will always be people who fall on hard times. There will always be people who suffer brain injuries in freak accidents and can’t take care of themselves, for example. That has nothing to do with market efficiency.

Like millions of Americans, I give money to charity. I love it. I don’t feel punished. In fact, part of the reason I still work even though I don’t have to anymore is to give more money to charity and the bulk of my estate is wiled to charities and to fund research. It’s a joy for me – as it is for many many people. We are not punished. We find it incredibly gratifying. I don’t give a toss about whether my neighbour gives to charity or not and neither does anyone else I know. There is no fail, epic or otherwise, when you unshackle human beings.

crossofcrimson June 7, 2011 at 11:14 am

“Again… if markets were efficient you wouldn’t need charity. ”

Where did that blind assertion come from? I don’t think “efficient” is what you think it means.

rmv June 6, 2011 at 10:56 pm

“In a free market system uninsured pregnant women with premature twins go to the street and die…”

Wow

muirgeo June 7, 2011 at 9:24 am

Tell me from a market and priced based economic perspective how I am wrong. Remember charity is not a write of in your great society of liberty.

muirgeo June 7, 2011 at 2:57 pm

Yep…WOW. It’s ALL about the individual liberty BABY!!!

Ken June 7, 2011 at 4:20 pm

muirgeo,

It is indeed about individual liberty. With a health care benefit denial rate of twice that private sector please explain to me how the government will prevent pregnant women with premature twins from dying. All government run facilities have on thing in common: shortages of necessary resources. Those women you mention will be admitted to the government run hospital, only to be put in a room so squalid you wouldn’t put your dog there and the children will certainly die because this hospital doesn’t have the resources necessary to take care of premies.

With all health care decisions made by individuals, instead of by faceless bureaucratic fiat, resources will flow to where they are most needed and wanted, rather than to the politically connected.

Regards,
Ken

muirgeo June 7, 2011 at 12:46 am

Singapore offers a public option.

Methinks1776 June 7, 2011 at 10:48 am

No doubt. And a much much much more free market. I’m okay with the way Singapore does it. I’ve said that a million times on this blog.

Methinks1776 June 7, 2011 at 10:51 am

BTW…it’s not a “public opition” in Singapore. The country has limited universal health care for all citizens in the form of a limited amount of money – paid out of tax revenue – devoted to paying for extremely basic care. Any additional costs for private rooms, better food, etc. must be paid for out of pocket. Health care providers compete for that spending.

Rob June 7, 2011 at 12:28 am

Muirgeo,

Here’s a question for you. I assume that you, like many “progressives” treat as Gospel the idea that Walmart exploits its workers in order to make a profit. If this be the case, how do you respond to this scenario? Say you’re shopping at a Walmart and at the check-out, you see a jar set aside for you to contribute to the betterment of Walmart associates. Any money you put in goes directly to them…like a tip. Do you tip? If not, why do you consistently find it okay for the government to force people to support others? What makes one situation different from the other?

muirgeo June 7, 2011 at 12:53 am

That’s easy. I don’t shop at Walmart. If everyone did that Walmart Associates would have better jobs at other places. Tipping a worker is just like saying you support the Walmart boards practices.

SheetWise June 7, 2011 at 12:58 am

“That’s easy. I don’t shop at Walmart.”

So — you prefer to see the premium you want to pay included in the price of the items you buy.

Interesting. Makes no sense to me, but interesting.

Rob June 7, 2011 at 1:15 am

I anticipated such an answer from you. So here’s my question amended question to you….I assume that you, like many “progressives” treat as Gospel the idea that [insert name of evil corporation] exploits its workers in order to make a profit. If this be the case, how do you respond to this scenario? Say you’re shopping at a [insert name of evil corporation]and at the check-out, you see a jar set aside for you to contribute to the betterment of [insert name of evil corporation]associates. Any money you put in goes directly to them…like a tip. Do you tip? If not, why do you consistently find it okay for the government to force people to support others? What makes one situation different from the other?

Now…if you are will to say with a straight face that you live a pious life and avoid each and every “evil corporation” that exists….mind me asking you to list the typical contents of your kitchen and where you got them from?

rmv June 7, 2011 at 1:25 am

He built his house and everything in it.

Muirgeo has conquered comparative advantage.

muirgeo June 7, 2011 at 9:29 am

The reason you “force” people is because if you rely on the charitable to make up for all the failings of your libertarian society the wickedest among us will profit the most in such a society with NO obligation to put back into the system. I refuse to put the burden of the poor completely on the backs of the charitable. Again… your society will reward the worst among us and make he charitable among the poor and unable to contribute at some point.

crossofcrimson June 7, 2011 at 11:27 am

“The reason you “force” people is because if you rely on the charitable to make up for all the failings of your libertarian society the wickedest among us will profit the most in such a society with NO obligation to put back into the system.”

Firstly, I think people who perpetrate violence or the threat thereof on innocent people are the wickedest among is in this comparison – congratulations for sending “greed” to a distant second morally speaking.

Secondly, what do you mean “put back into the system”??? Do you mean on top of what they’ve already given? Is that like, if I go to a drive-thru and get some food I can pull back around to the window again after the transaction was completed and demand they “put back into the system” by giving me some additional money or food? Or maybe they should be allowed to come to my door when I get home and demand I “put back into the system”?

“I refuse to put the burden of the poor completely on the backs of the charitable.”

So your answer to the perceived immorality of greed or lack of self-sacrifice is violence and theft. Bravo. You’ve made the world a better place, I’m sure.

“your society will reward the worst among us”

How would a libertarian society “reward” (which by the way would indicate something voluntary and also no trade taking place….congrats on butchering that assumption) the “worst” among us? Who are the “worst” and how would a libertarian society reward the “worst” unless people had a preference to actually do so?

sandre June 7, 2011 at 1:28 am

Walmart Associates would have better jobs at other places.

What a hilarious douche bag. Hahaha

Rob June 7, 2011 at 10:38 am

Everyone take note that muirgeo refused to answer the updated question!

LowcountryJoe June 7, 2011 at 11:45 am

How much did you pay, Dr. Balella, to get you mug scrubbed from this footage?

vidyohs June 7, 2011 at 6:10 pm

Fuuuuny. Loved it.

Polly June 7, 2011 at 4:35 pm

I’m curious, muirgeo. Do you know how many people the government pays to administer the Medicare and Medicaid systems, how much they pay those people, what retirement and other benefits those people are/will be provided by the taxpayers?

Both programs are rife with fraud, abuse and waste. Each politician guarantees he can save those programs by eliminating the fraud, abuse and waste. No politician has ever succeeded in doing so. Do you have the figures on how much fraud, abuse and waste the private insurance industry endures as compared to Government’s insurance? And what ARE Government’s true, all-inclusive costs?

Government saves money by refusing full payment to doctors for their services, causing doctors to increase fees for private-pay patients (at least for as long as they agree to accept those Medicare and Medicaid patients); it’s the only way those government programs can exist. Is it then fair for Government to complain that private-pay health care/health insurance is tooo expensive? And what happens to those doctors when the government is in charge of the whole system? (One of mine says he’ll merely retire.)

You obviously believe in “eliminating the middle man”–by inserting thousands of nameless, faceless, unaccountable bureaucrats. Sounds like a plan.

Charlie June 6, 2011 at 6:50 pm

Why is insurance different? Is that the heart of the question? Here is Hayek’s answer:

““Nor is there any reason why the state should not assist the individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance – where, in short, we deal with genuinely insurable risks – the case for the state’s helping to organize a comprehensive system of social insurance is very strong… Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken,” – The Road To Serfdom (Chapter 9).”

muirgeo June 6, 2011 at 9:30 pm

“Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken,”

BINGO!!!!! If you libertarians don’t want to live in a civilized society then go live in the jungle for crap sake!

Methinks1776 June 6, 2011 at 9:40 pm

Any society that includes a violent little chap like you cannot possibly be all that civilized.

muirgeo June 7, 2011 at 12:56 am

Hey stop actin all bad ass… you’re no libertarian… you saved the pregnant destitute women with premie twins. That excludes you from being a libertarian… you’re a humanist and a supporter of public health and civil society and of the idea that everyone needs to chip in. A real libertarian would have sent her to the street to die because if he didn’t he would quickly be out of business.

rmv June 7, 2011 at 1:13 am

Why do you continue with the assertion that libertarians do not believe in charity?

sandre June 7, 2011 at 1:28 am

rmv, because muirdouche is a selfish douche bag.

lamp3 June 7, 2011 at 3:54 am

I don’t understand Muirgeo — libertarians are all about letting individuals make decisions, free of coercion, and bearing the consequences of those decisions. I don’t see anyone is solely focused on chasing money.

Charities, non profit organizations, donations and the like are all things the I think libertarians appreciate. From a libertarian perspective, I would expect to feel wonderful about the world because I would know the good that we do, we do so freely and voluntarily. If someone made a poor choice, hopefully they will have considered the risk beforehand. Perhaps this sort of life would demand people create long-lasting, positive relationships with each other to form a network and safety net. Your neighbor’s on tough times so you invite them for dinner, that kind of thing.

The Hayek quote sums it up perfectly. If it’s a good idea to work collectively, you can voluntarily organize and do so because the benefits outweigh the cost. Your focus on Methink’s pregnant lady answer ignores something else Hayek said — that people do not always charge market prices in their interactions with others. Like for family, neighbors, strangers in need and so on.

If we chase benefits > costs, the benefits from not charging the market price for something, like satisfaction, image or reputation, are important non-pecuniary factors as well. They’re hard to quantify into dollars, but they have a real effect. This is manifest in how jobs that allow flexibility for family and scheduling often pay less than jobs that demand long hours — part of the nonpecuniary benefit could be time at home, for instance.

muirgeo June 7, 2011 at 9:31 am

Again guys …charity is not a write off in a libertarian society. That you think it will fill all the holes in your society is silly. Any charity will ONLY serve as economic advantage to the unscrupulous and the evil. They will be the winners in your society. The charitable will join the ranks of the poor.

muirgeo June 7, 2011 at 9:33 am

Imagine how well charity would work for Joplin Mo. There’s no way.

crossofcrimson June 7, 2011 at 11:32 am

“Again guys …charity is not a write off in a libertarian society. That you think it will fill all the holes in your society is silly. Any charity will ONLY serve as economic advantage to the unscrupulous and the evil. They will be the winners in your society. The charitable will join the ranks of the poor.”

Translation: Violence is the only answer to problems in a civilized society. You can’t be civil without bombs and cages.

lamp3 June 7, 2011 at 11:51 am

You are right Muirgeo, I don’t think a libertarian society will forever and always solve all problems in the most optimal way possible. To do so would require significant analysis in hindsight, so it’s not going to happen. However, we can try to create the best incentives for excellent outcomes as possible.

From this blog, it seems like the profit and loss mechanism would play a much greater role in what you call Libertopia. While the rewards for making good decisions increase, the disincentives for bad decisions also grow.

As for Joplin, MO, since incentives and disincentives magnify, if it’s a poor calculation to be living there, fewer will. If it’s a good idea to bring more goods and services, including healthcare, it will come. These all will factor into the calculation for that town’s existence by each person living there.

In this regard, it is possible that someone will go without healthcare. But the current system and proposed single payer systems do not address scarcity as well, in my opinion. If the benefits of healthcare for the poor outweigh the costs, in a more libertarian, market oriented environment, I’d expect to see some entrepreneurship aimed at addressing this type of situation. If we believe that the benefits of healthcare do not outweigh the costs, this implies that saving an additional life and delivering two premature babies will cost more than those three lives elsewhere in the economy.

Like battlefield medicine, sometimes it’s not worth saving a life at the cost of others.

Ken June 7, 2011 at 4:22 pm

muirgeo,

“Imagine how well charity would work for Joplin Mo. There’s no way.”

I’m sure it worked better than FEMA. Why don’t you ask New Orleans residents who helped them more after Katrina: Wal-Mart or FEMA. The overwhelming response will be Wal-Mart.

Regards,
Ken

James June 6, 2011 at 11:12 pm

“Wherever communal action can mitigate disasters against which the individual can neither attempt to guard himself nor make the provision for the consequences, such communal action should undoubtedly be taken,”

Except for the fact that the individual can “attempt to guard himself” &
“make the provision for the consequences”. It’s known as insurance. Also, communal action may mean nothing more than charity. Note Hayek doesn’t suggest that the solution involve government coercion. I think we can safely assume, based on Hayek’s writings and beliefs, he would not have been in favor of Single Payor.

Finally, you’re invoking a fallacious argument known as “Appeal to Authority”. Simply because Hayek was a supporter of Libertarian ideas, that doesn’t mean his words are the end all on the subject. Also, even if he supported the idea of Single Payor, that isn’t proof it’s a valid idea.

muirgeo June 7, 2011 at 12:59 am

“Except for the fact that the individual can “attempt to guard himself” &
“make the provision for the consequences”. It’s known as insurance.”

And when you find out the fine print on your policy allows them to rescind your policy at any time and now you are uninsurable will you be pretty comfortable first performing your own hemodialysis and then your own kidney transplant? I think there are videos on those things on YouTube so you should be OK… good point.

James N June 7, 2011 at 7:24 am

Do you have anything other than straw man arguments?

muirgeo June 7, 2011 at 3:05 pm

Yeah because this DOESN’T happen right now with existing private health insurance plans.

Gil June 7, 2011 at 1:10 am

Well even Hayek gets it wrong now and then.

crossofcrimson June 7, 2011 at 11:30 am

A la Locke – the jungle (where uncivilized people are) is where your rights are ignored. That sounds a lot more like what you’re trying to bring to the table than us. We ask you to be civilized – then you produce a club to beat innocent people over the head with. Compassion and civility indeed.

SheetWise June 7, 2011 at 1:05 am

“… common hazards of life against which, because of their uncertainty, few individuals can make adequate provision.”

This one is starting to look like a wager. How about we pick an emergency room in some major city, pick the hours we want to use for the wager, monitor all patients during that period, and then ask the doctor if these were “uncertain hazards” … we can then examine the financial circumstances of the uninsured patients to determine if they had the ability to make adequate provisions. It would be a good wager I think. Properly structured, one I would jump on in a heartbeat.

Matt N June 7, 2011 at 9:45 am

But regarding health care, “the individual” (in the abstract) _can_ “attempt to guard himself” _and_ “provision for the consequences.”

No doubt _some_ individuals cannot, but the same could be said about any good or service.

Randy June 6, 2011 at 6:52 pm

Re; “But if so, why not socialize the entire American economy…”

Since when is that not the objective? They are simply picking the low hanging fruit first. And as more of the economy is socialized, as the population becomes more dependent, as opportunities outside of the political organization become fewer and less attractive, the easier it will be for them to make the case that all aspects of the economy must be socialized… that is, that all aspects of life must be socialized.

MarketJohnson June 6, 2011 at 7:31 pm

I’m sorry, but I really fail to see how literally half the country can be seen as a group of people this bent on controlling the lives of others, no matter how much you might disagree with them. Casual observation of people with different views than yours ought to demonstrate that it is certainly not the case.

Randy June 7, 2011 at 8:38 am

Good response, but it isn’t necessary for half the country to understand the objective as an objective. Most of these are simply trapped by the objective. As it is now necessary for them to play a role in the political organization, it is natural for them to rationalize their support for the political organization. Only those with a natural inclination to heresy have the ability to step away from it, and to see it for what it is.

MarketJohnson June 7, 2011 at 5:28 pm

I sort of agree. I do think there are many people out there who can’t see incentives and motives, although our political system is so disgusting that most of the people I talk to regularly have no remaining trust for the goodness of politicians. One of the things we can be truly thankful for in this country is the ability to see when things truly are going to far. The second is, as much as I hate it, the extremity of opinion, which is infuriating in the individual, but in the large group helps balance us from getting too far left or right.

Chris Lemens June 6, 2011 at 7:30 pm

Dear professor:

I think you are underestimating the consistency of the progressive position from their own point of view. It seems pretty simple to make such a case, so long as you believe in interpersonal utility comparisons.

It is a pretty commonplace assumption that adding resources to the production of any resource reduces the marginal and average utility of the product. Likewise, reducing the output raises the marginal and adverage utility.

Now, let’s subsitute the idea of cost for resources used in production and quality for marginal utility. If we reduce the cost of healthcare (i.e., the resources people spend on it), then the total quality will certainly drop. but less than proportionally, so average utility per dollar spent will rise.

(Note: you didn’t define what “quality-adjusted” means. Since it necessarily asks for interpersonal, quantitative comparisons, it is necessarily arbitrary, so I chose average utility per dollar spent. You can’t gainsay me because you started the argument on their territory, in which some mythical measurer can calculate utils.)

Thus, advocates of this position would agree that you could do the same thing for pet food. They would point to a difference in their defense of why it is important for government to act on medical care, where it is not important on pet food.

These advocates would claim that the government is better able than patients to determine what medical treatments have lower utility. (Hence, my point above about interpersonal utility comnparisons.) They woud probably point out that evaluating medical effectiveness is difficult and the huge amounts of money to be made leads to incentives for inventors (e.g., drug companies) to mislead about results. they would point out that individuals can better assess the value of different varieties and brands of pet food (e.g. does the dog like it, does it smell OK, what’s in it, etc.).

The rebuttal to that point is fairly obvious to anyone who has done any reading in the public choice school, so I assume that I don’t need to lay it out. I’ll just note that the argument applies equally to decisions about which medical treatments to ban as having low utility and to decisions about which markets to socialize because the decisions are just too tough for consumers.

Chris

Herman June 7, 2011 at 1:33 am

The root of this is RATIONING. If the government is the single payer, then health service costs can be controlled by rationing them.

In theory there is a need for this. Health treatments will expand to consume whatever money is available for them. And the pool of money is huge, and the consumer and provider are insensitive to their cost. Only a powerful overseer can force the pool of money to be smaller, given this condition.

At first the rationing would be meant to reduce services that are deemed wasteful and ineffective. That’s noble. The next steps will be to reduce services that are less effective and expensive; then services generally and those less essential to life.

Then the politics would kick in, and the services backed by lobbyists would thrive, and services provided to the politically connected would be superior.

Finally, certain unhealthy lifestyle choices would be forbidden, in the name of preserving the public resources.

Chris Lemens June 7, 2011 at 3:21 pm

Herman:

I think rationing isn’t really the right word. Rationing implies you can have something, but only up to a certain amount per period of time. There would probably be some of that, as there is under current Medicaid (up to 3 prescriptions per month, at least in Texas).

I think what would really be happening is that certain medical treatments would be prohibited, or at least prohibited to some people. For example, my wife’s family is from Nothern Ireland (which is part of the UK, so is subjected to the National Health Service). Her brother-in-law’s mom went to the doctor to ask why she wasn;t on the same cholesterol medicines as all of her sons, since she has the same condition. The doctor looked at her and told her, “You’re no longer a contributing member of society, so we can’t give you those medicines.” She was 64 at the time.

Apart from that quibble, I agree with your description of how things would proceed.

Chris

Dan June 8, 2011 at 12:44 am

With Medicaid in Az, you are limited on doctor visits, aside from emergency. Rationing with a side of incentive to use ER as doctor for illness. Way to go Govt medical care…… Can I Have some of that? NOT!

Herman June 8, 2011 at 1:41 am

I think there are other ways to define rationing, ex: how long you have to wait. There is also limiting how much the insurer is willing to pay for a treatment, which will cause fewer treatment options and fewer quality levels to exist.

I still maintain that the root goal of single payer is to achieve rationing, along with a bias over who exactly gets to ration it and to whom. The macro argument is that health care as a share of the economy is too high. The micro argument is that some individuals can’t or won’t afford it, to the detriment of the public good. (transmission of disease, moral obligations to provide catastrophic care for free when needed, and unwillingness of the healthy to buy insurance to underwrite the cost of the sick). The answer is to pool, ration, and distribute.

The private market has not done a good job of rationing and the cost has gone up accordingly, pushing the price of insurance up to a market equilibrium that is vexing to many and unaffordable to some.

Chris Lemens June 9, 2011 at 1:40 pm

Herman:

Again, I quibble. I think economists generally call it “queuing” when you have to wait for a good or service. Rationing and queuing have different features that can be interesting for academics to study. They also have different effects on wealth distribution. For example, queuing generally favors the unemployed, who can wait in line.

I would generalize more and say that the goal of single payer is to give politicians control over heath care (as well as resources not currently devoted to health case that would be re-directed in order to allow the policitians even more control). Just calling it rationing doesn’t say that explicitly enough for me. It implies that the politicans are dividing out limited resorces according to a single, fairly transparent set of criteria, like “no more than X of procedure Y per time Z.” In fact, it would be more obscure than that. There would be all kinds of mechamisms, giving politicians and their cronies lots of ways to put the fix in. Like how Medicaid and Medicare work now.

And private insurers only use rationing on a few things, most of which they tend to think of as optional — preventative care (e.g., 1 physical per year) and metal health care (e.g., up to 30 days per year). Otherwise, they tend to use cost-sharing (either co-pays or co-insurance). Cost-sharing has very different features from rationing, so calling everything by the same name hides more than it reveals.

Chris

Herman June 9, 2011 at 11:42 pm

We’re close enough that I’ll say we agree.

Although, I do not think you addressed my assertion that the private system did not do a good enough job of rationing/queueing/etc to maintain an affordable system for a broad enough swath of the population.

Doug Ransom June 6, 2011 at 7:48 pm

It is quite simple. It costs less because, although the same services are offered, they are not delivered in the same quantity. Some really smart people decide how many of each treatment or service should be delivered and who gets the service. Demand in excess of that determined by the smart folk is denied or placed in a queue.

It is great because consumers who might pay the market clearing price are saved from spending their savings on health care.

That does not prevent them from spending for their pets health care. In BC (canada) the wait list for an MRI is several months for a person, yet people are free to spend $1000 to get an MRI for a dog within a day.

Single payer needs to be expanded to vet care as well, so that some really smart people decides which dog or cat gets an MRI and families don’t waste their precious resources on their beloved pet.

James Hanley June 6, 2011 at 8:29 pm

The assumption underlying this question is that pet food and health care are similar enough types of goods to analogize between them. While I’m sympathetic with Boudreaux’s criticism of the argument that single-payer health care will cut costs without cutting quality, I think that assumption needs to be examined carefully. Is health care really that similar to pet food? I.e., pet food is very clearly a private good with minimal–if any–externalities. Is health care so wholly a private good without externalities? It seems to me that it has enough positive externalities to at least make this assumption worth more careful examination than it’s been given here.

Methinks1776 June 6, 2011 at 8:50 pm

Yes, healthcare is totally exactly like pet food. Why, they’re perfect substitutes.

Look at the question. He’s asking if the quality-adjusted price cost of a government provided good will be higher or lower. That question can be asked about all goods – education, health care, laundry detergent, pet food, groceries etc. The goods needn’t be similar in any way except that it’s government provided.

James Hanley June 6, 2011 at 9:19 pm

“The goods needn’t be similar in any way except that it’s government provided.”

No, that’s wrong. Unless you want to say that government-provided national defense is analytically no different than government-provided pencils.

The government provision is, of course, an important part of the question, but so is the type of good we’re talking about, whether private, public, commons, or toll (club) goods, as shown here.

SheetWise June 7, 2011 at 1:17 am

“No, that’s wrong. Unless you want to say that government-provided national defense is analytically no different than government-provided pencils.”

It’s not that analytical. Sometimes people FREELY choose one provider — like Microsoft. Those that don’t, are free to go their own way. If I had a choice for my defense, I would choose the US armed forces, but why shouldn’t I be free to choose Israel?

SheetWise June 7, 2011 at 1:19 am

After all — they’re a lot closer to what the US Government has determined is my defense.

;)

James Hanley June 7, 2011 at 10:05 am

Actually, it is, or should be, that analytical. Even your example doesn’t work to counter that because you’re only asking about choosing between two governments (and I personally believe you should be free to choose your country), rather than between government and market.

Most–nearly all–goods are better provided by the market than by government. There are a few where markets don’t do well because of the nature of the good (usually inability to exclude non-payers or presence of externalities). The market’s inability to provide those well doesn’t mean government actually will do better, but it creates the possibility that in those particular cases government might do better (or a public/private partnership might be the best way to go).

Pet food clearly is not one of those types of goods–the market does an excellent job of providing it, as it does most goods. My question is whether there are elements of health care that are of that type that the market does not in fact provide well. The responses here are not addressing that question. If no one has an answer, that’s fine (I don’t, either). But to claim it’s not a relevant question is dead wrong.

I don’t know of Boudreaux has read my comment, but if he has I’d be interested in his response because it’s a question I haven’ seen seriously addressed by very many people–on either side–in this debate. Because if health care is wholly a private good without significant externalities, like pet food, then I’m wholly on Boudreaux’s side. But if it’s not–or portions of it are not–then comparing it to a wholly private good is a misleading approach that moves us away from understanding what the best policy is.

SheetWise June 7, 2011 at 10:51 pm

“Actually, it is, or should be, that analytical. Even your example doesn’t work to counter that because you’re only asking about choosing between two governments (and I personally believe you should be free to choose your country), rather than between government and market.”

I’m guessing this markup wont work for some unexplainable reason that someone has found an explanation for. So — you may not be seeing what I’m seeing, as we have no preview or validators or edits. Nonetheless, I will attempt to make my point.

I am not asking to choose between two governments. All parties should be able to ask for my support. If they are not local support, then what services they provide me they need to negotiate with their peers prior to selling me their service.

I don’t understand “between country and market” because country is a market. It is win/lose — winner takes all — and very political — but, nonetheless a market.

Phil June 6, 2011 at 8:36 pm

Boo! This analogy might work if 50% of the nation’s pet food costs were already paid by government and the remaining 50% was mostly covered by insurance companies whose premiums were paid for by both employers and consumers and the consumer only paid a small fraction.

rmv June 6, 2011 at 11:05 pm

The second 50% has to pay for 100% of the nation’s healthcare costs. Taxes and decreased monetary compensation.

PrometheeFeu June 6, 2011 at 8:50 pm

I’m agnostic on that topic but here are some directions in which I would point:
1) Because of drug patents, monopolies/oligopolies are quite frequent in the production of drugs. A quasi-monopsonist may be able to reduce price when facing a monopolist. Pet food suffers from no such inefficiencies.
2) Currently, we pay for people without insurance when they show up at the emergency room consuming expensive healthcare while their problem could have been taken care of with cheaper healthcare. Under single-payer, those people would be directed to cheaper general practicioners.
3) Taxes are OPM aka Free Money. OK, this is tongue in cheek, but I definitely think people don’t think of tax money as being as scarce as private money. After all, the government can just keep raising taxes right?

All that said, I do actually favor a single-payer system to a certain extent simply in order to ensure that the poor and the rich both have access to some basic level of care. To those who point to the Canadian system with rationing etc, I would reply with the UK system. You get a voucher to buy preventative care, life threatening/very grave conditions are taken care of free of charge (though not necessarily with the most alacrity and by the absolute latest that medical science has to offer) and you are free to go on the private market to buy any extra care you want. I think that if you find private charity an insufficient way to provide care for the poor, a UK-style system is probably the best approach.

nailheadtom June 6, 2011 at 10:53 pm

Statistics show that the uninsured/emergency room treatment scenario is a fairy tale. By far the majority of emergency room admissions are people with insurance.

vikingvista June 8, 2011 at 1:59 am

True. What is more, the uninsured overwhelmingly pay their bills.

Methinks1776 June 7, 2011 at 2:22 pm

but I definitely think people don’t think of tax money as being as scarce as private money. After all, the government can just keep raising taxes right?

Well, of course. I mean I would be willing to work just as hard and take just as many risks if the tax rate were 100%, wouldn’t you? Worked really well everywhere that has been tried. The Soviet Union was an awesome example of that brave new world where resources were not scarce.

BTW, do you practice on the West Coast? If you do, you maybe should know that the vast majority of those in emergency rooms have HMO insurance and can’t get an appointment with their physician for three months. Certainly, a government HMO would work infinitely better, right?

Publius June 6, 2011 at 8:51 pm

@Methinks 1776 – Technically you are correct, it is a problem with the system, not the question. It is only a problem with the question in the sense that single-payer is being proposed as an alternative to the current system, not as an alternative to a free market system, which we don’t have.

While I appreciate that a few people, such as yourself, don’t have a third party payer; you still are subject to the increase in prices incurred as a result of everyone else’s third party payer (although as a practitioner I can tell you that typically someone paying cash is charged less by their physician than someone with insurance…). It’s third party payers that are cause of rising costs. That’s true whether they are private or government.

Methinks1776 June 6, 2011 at 9:16 pm

Publius, I understand how third party payer increases the price of care. As a practitioner, you must already know that government is the largest third party payer.

What I don’t understand is if you understand that third party payer increases costs, then why is the fix for that making the entire health care system third party payer? That’s what a single-payer system is. How is an alternative that will raise costs above where they are in our current nasty hybrid system better?

There is another alternative: move toward more free market and away from third party payers – especially government. Certainly third party payers will continue to bear on costs, but not as much as if the entire system were third party payer.

In any event, this is not, as I read it, Don’s point.

Dallas Weaver June 6, 2011 at 9:04 pm

Yes, I could set up a government run pet food system that would provide the citizens with cheaper dog and cat food. The following cost savings come to mind, which would offset even government inefficiency in this highly automated production business:

1– All the diets would be least cost formulated. Some producers now use fixed formulation diets for the higher end products (less risk of an ingredient switch causing problems — if it works don’t fix it, even when ingredient prices change). If a specific ingredient like fish meal increases in price, they can switch to feather meal or blood meal or soy bean meal or single cell protein from food processing waste waters, etc. in the diet. Since all are switched, the statistics on vet. incomes could be used to determine whether there was a problem with the new low cost formulation. Unless someone really screws up in their least cost linear programming models, the customers with never know the difference.

2– With least cost formulations, no more using human grade fish in cat foods. Soy protein with taurine and specific amino acid additions can produce a balance diets for carnivores. We do it with farmed fish, we can do it with cats. The use of such high quality ingredients is to make the cat owner happy, not provide the cat with required nutrition. Some super high end cat foods in Japan use sashimi grade tuna for the center piece in the can.

3- We could use single cell protein in the form of water treatment sludges in the diets. The juk factor doesn’t apply to animal feeds.

4- We could eliminate all the advertising and marketing cost (a very significant item in the case of pet foods). Some companies probably have more staff in marketing and accounting than in production.

5– We could eliminate all the redundant R&D that is conducted by the different manufactures, with their nutrition studies. Yes, they have labs with hundreds of cats and dogs and keep all the information proprietary.

6- We may get some minor economies of scale by shutting down the smaller niche facilities.

7- We could eliminate profits, but the government workers would eat that up in excessive benefits and unnecessary overhead.

In other words, pet food is an example of a system that operates a long way from minimum cost, with it’s appeal to human ego and emotions. The vast majority of customers don’t know what they are buying or the nutritional requirements of their pets and their decisions are pure irrational emotions.

Health care has the same problem. The primary customer usually has very little idea of what is the optimal treatment, let along how much it will cost. He/she has the most at stake — his/her life — combined with less relevant knowledge than even some bureaucrat at an insurance company. You then have the MD’s and Parms, which are the providers of information to the consumer, resulting a a major principal / agent conflict.

If you want some funny reactions from MD’s, just read all their scientific publication before you go to them and read everything (journal stuff, not media junk) the subject at hand. It is surprising the reactions you get, especially when you tell them that the test they just recommended wouldn’t provide enough information, considering what we know so far, to be worth my time or medicares expense? Just “covering all the bases isn’t an adequate reason for test” (there is a lot of theory on this relating to false positives).

Most MD’s don’t understand that if you have a test that is 99% accurate for a disease with a frequency of 1 per 100,000 people that the probability of someone at random (no symptoms or family history) who tests positive having the disease is only 1 in a 1000. Most MD’s answered that if a person tested positive he had a 99% chance of having the disease.

I don’t have a solution about how to you get honest and real information to customers who are increasingly scientifically illiterate at a time when the information is becoming even more complex. A Renaissance man is no longer possible.

Economiser June 7, 2011 at 12:09 am

There are major information asymmetries in nearly every major or complicated purchase. Medicine isn’t unique.

> Most MD’s don’t understand that if you have a test that is 99% accurate for a disease with a frequency of 1 per 100,000 people that the probability of someone at random (no symptoms or family history) who tests positive having the disease is only 1 in a 1000. Most MD’s answered that if a person tested positive he had a 99% chance of having the disease.

If most MDs answered that way, they were either confused by the question or are compatriots of our good Dr. Muirgeo. Actual medical labs running actual blood tests routinely re-test positive results to minimize false positives (they often don’t re-test false negatives, however).

Dallas Weaver June 6, 2011 at 9:13 pm

The discussion of medical care has to approach this information asymmetry issue. Actual knowledge goes roughly as follows: researcher in an area > MD > Insurance company bureaucrats > government bureaucrats >> consumer of medical services. How the hell to you get a customer to make a rational decision.

Even picking an insurance plan like prescription drugs medicare part D where there is good software (free) available to rank plans by cost. However, I have lost on every annual choice I made when something else came up and I changed my medication mix. I have a better understanding of risk analysis that most and I can’t seem to pick an insurance plan any better than a number on lottery ticket.

muirgeo June 6, 2011 at 9:44 pm

“I have a question for anyone who believes that a single-payer health-care system …”

I have a question for any one who believes in free market health care.

Scenario;

You are the owner of a hospital and a drug addicted lady pregnant with 25 week twins shows up to your emergency department. She is homeless with no money or insurance. Do you take care of her or send her out in the street to die along with her twins?

This is the unanswerable question for a libertarian who believes in free market medicine. This is the check mate scenario that explains why we might want single payer health care and why the question of siingle payer pet food is irrelevent.

Civilized people DO NOT ACT LIKE LIBERTARIANS!!!!!

Ken June 6, 2011 at 10:06 pm

muirgeo,

“This is the unanswerable question for a libertarian who believes in free market medicine”

Why is this unanswerable by libertarians? Have you never heard of charity or pro-bono? The difference between you and I is that I am unwilling to force someone to work for free, whereas someone like you has no problem forcing others to do what you want.

Your question is also a red herring since the government would almost certainly turn this woman away under a single payer government controlled health care system. This woman almost certainly doesn’t vote, doesn’t contribute a significant sum to a campaign, and her death will not be reported as a big deal. Or were you unaware the the government rejects health care claims at a rate twice that of the private sector?

The problem with you is the you think that just wanting to help someone is equivalent to, you know, actually help them. Get a clue, clown.

Regards,
Ken

muirgeo June 7, 2011 at 1:25 am

No sorry Ken… you don’t get to assume charity solves the problems. The markets are perfect and their should be no need for charity. if their is a need for charity then you admitting your markets ARE NOT perfect. Assuming charity will solve the problem IS the reason government needs to have ALL to add back equally. Relying on charity is the same as forcing a gun to people to offer their money and time while allowing the scum bags not willing to provide charity to get off with out any obligation and to hoard all the profits and benefits of society.

That”s why libertarianism promotes a society of thuggery. What a shitty nasty society you guys would force on those good natured enough to contribute charity.

Ken June 7, 2011 at 2:09 am

” you don’t get to assume charity solves the problems.”

I’m not assuming anything. In fact I know that the “problem” will not be solved. Ever. All resources are scarce, including medical. You’re the one making the assumption that greater government involvement will “solve” whatever problem you see, contradicting mountains of evidence that this is not so.

“Assuming charity will solve the problem IS the reason government needs to have ALL to add back equally.”

Government has NEVER “add[ed] back equally” as current events has shown very clearly. What government does and has ALWAYS done is take away from the politically unfavored/unconnected and given to the politically favored/connected. Never has “equality” played a roll.

“Relying on charity is the same as forcing a gun to people to offer their money and time”

So not using force is exactly the same as using force. Got it.

” hoard all the profits and benefits of society.”

How does one “hoard” profits? You are aware that to make a profit, in free markets anyway, you have to provide someone with a service they are willing to pay for, aren’t you? So all ready simply by earning a profit you have made the world a better place. And with this profit you can essentially do four things:

1. Spend it, which is the very opposite of “hoarding”
2. Invest it, which is the very opposite of “hoarding”
3. Save it in a bank. Banks make money by using their deposits to make loans, which fuels investments. In other words, that money is used to make investments, hence not hoarding.
4. Convert the profits to cash/precious metals/etc and store it in a vault somewhere. This comes closest to what you call hoarding. But what are the effects of this? Doing this effectively takes this money out of the economy. As is well known, when you remove money from an economy, you cause deflation, meaning that everyone else’s dollar can now purchase more, including that precious health care, than they could have before with that same dollar. Is this so bad?

” libertarianism promotes a society of thuggery”

Right. Because as you explained so clearly above, not applying force is the same as applying force. You’re a model of logical inconsistency. Next you’ll be telling me that gravity actually pushes two objects with mass away from each other, since it’s the same thing as those two objects attracting each other.

“What a shitty nasty society you guys would force on those good natured enough to contribute charity.”

Single payer health care in ALL OTHER COUNTRIES WHO’VE ADOPTED IT have seen a decline in medical care, particularly in wait times, which is a huge cost. The decline is particularly acute in access to health care. Since there is no incentive for people to provide it, since it removes the profit incentive, fewer people provide health care. Additionally, it’s typically first come first serve irrespective of need, which is usually taken care of by people’s willingness to pay more for speedy service for problems that require speedy service.

Yet here you are, opining for a system that has been PROVEN shitty over and over and you fling you nasty little insults at everyone else. You consider yourself good natured, but you call for a decline in health services. How is that good natured?

Regards,
Ken

James Hanley June 7, 2011 at 2:07 pm

The markets are perfect and their should be no need for charity

Charities are part of the marketplace, muirgeo. The market is just a system or process of voluntary exchanges. A charitable act is just a case of someone exchanging their labor for a price below what the market could bear–i.e., anything from a discounted rate to a price of zero. A doctor who voluntarily treats a patient for no cost or a drastically reduced cost is not engaging in a non-market act–it is an exchange he is willing to make without coercion, so it is a market act.

The market, both the for-profit and the non-profit sectors of it working together, will not solve all our health care provision needs. But your analysis will be more accurate if you understand what a market really is, rather than persisting with your inaccurate conception of it.

muirgeo June 7, 2011 at 3:06 pm

“Charities are part of the marketplace, muirgeo.”

Guess what….so is government.

Ken June 7, 2011 at 4:26 pm

“Guess what….so is government.”

Wrong. Government simply takes what it wants without having to compete for anything, as do people in a marketplace.

Whole language fail? No problem. Keep in going for almost a decade.

FEMA fail? No problem. Take from tax payers and give to FEMA.

Banking over site fail? No problem. Take trillions from tax payers and give it to the banks.

The list is endless.

Regards,
Ken

James Hanley June 7, 2011 at 2:15 pm

That”s why libertarianism promotes a society of thuggery. What a shitty nasty society you guys would force on those good natured enough to contribute charity.

I always have to laugh at these types of comments. These folks seem to think that libertarianism is primarily about “getting what’s mine” rather than about “not taking from others what’s theirs.” Apparently libertarians would never engage in any charitable acts or community service. They’d never help push your car out of a snowbank or give you a jump start in the mall parking lot–not unless you paid them anyway!

I must be a lousy libertarian, because while I’m certainly not the champ in doing these things, I do them all often enough that it’s a pretty standard part of my life. Heck, I’ve even been known to help friends move furniture in my pickup truck without negotiating a fee upfront, and one time I went out with a rake and unplugged a clogged storm drain that was flooding my street–and I didn’t demand a penny from any of the neighbors!

I guess I’ve been doing this libertarian thing all wrong. Thanks for setting me straight, muirgeo.

muirgeo June 7, 2011 at 3:08 pm

“I guess I’ve been doing this libertarian thing all wrong. Thanks for setting me straight, muirgeo.”

I can point you in the direction of lots of people who are now homeless… can you help? Got a few extra rooms there do you?

Polly June 7, 2011 at 5:25 pm

Yep, muirgeo, it appears that James may not be as charitable as the rich liberal politicians, all of whom allow the homeless to stay in their extra rooms, as well as in their extra homes. James, you should be ashamed.

brotio June 7, 2011 at 7:54 pm

Got a few extra rooms there do you?

John Kerry has lots of extra rooms, at homes he rarely visits.

All of that money you gouge from your patients for carbon-spewing vacations across the globe, all the while complaining about the carbon-spewing habits of non-believers in The Church of Anthropogenic Climate Change (formerly known as The Church of Anthropogenic Global Warming) could be spent on the homeless, and the uninsured, you selfish bastard.

Dick Fitzwell June 7, 2011 at 2:32 pm

No sorry Ken… you don’t get to assume charity solves the problems.

Why not? You assume that she and the twins will die on the street.

brotio June 6, 2011 at 10:20 pm

Methinks already replied up-thread. What you don’t give us is your answer; which would be to abort the twins, because the planet is dying from too many people. Besides, what kind of life would they have with a drug-addicted mother, and a planet rapidly approaching inferno stage thanks to eeeevil corporations providing things like electricity, gasoline, automobiles and air conditioning.

By the way: How do you plan to vote on the Jews! FOAD Anti-Circumcision Act proposed by the tolerant and open-minded shitizens (http://news.blogs.cnn.com/2011/03/01/low-flow-toilets-cause-stink-in-san-francisco/) of San Francisco?

muirgeo June 7, 2011 at 1:27 am

I take care of these moms and their babies all the time because fortunately for now we live in a civil society that understands we all have an obligation to contribute back into the system to make it work.

Ken June 7, 2011 at 2:10 am

“take care of”

Ha! That’s hilarious coming from you, muirgeo!

brotio June 7, 2011 at 7:57 pm

You didn’t answer this:

If you’re able to vote on this initiative, how would you vote on the Jews! FOAD Anti-Circumcision Act proposed by the tolerant and open-minded shitizens (http://news.blogs.cnn.com/2011/03/01/low-flow-toilets-cause-stink-in-san-francisco/) of San Francisco?

Caleb Standafer June 6, 2011 at 10:48 pm

Muirgeo,

In your hypothetical, I would have already established a foundation to provide medical care for those who could not pay. I and the foundation would have held annual charity balls as well as other fund raising activities. Here is one that has been around since 1954 https://www.jewelcharity.org/. 50 years ago my father owned a dance band in Eugene, Oregon that played for the annual hospital ball. These organizations have existed for more years than you or I have been alive. If you google “hospital charity ball” you can find similar groups holding balls all over the U.S. That is at least partially why I do not see in the newspapers that homeless drug addicted women pregnant with twins are found dead in the streets.
Caleb

James N June 6, 2011 at 11:39 pm

I wouldn’t waste my time answering the question. It’s clearly a straw man argument and also a False Dichotomy or Faulty Dilemma. In other words, muirgeo is assuming there are only two alternatives when in fact there are more. Someone has already mentioned charity, which could involve the hospital or some other benefactor.

Don’t fall into the trap of debating with someone that clearly is not above stacking the deck.

muirgeo June 7, 2011 at 1:34 am

Again… your markets are supposed to be perfect. Why would their be a need for charity? I think your best answer would be to claim there would be no poor or destitute to begin with in your society. But I would bet they would grow exponentially.

Ken June 7, 2011 at 2:11 am

murigeo,

No one’s claiming markets to be perfect, simply better than the government, which really isn’t hard. Particularly since the government is staffed with boneheads like yourself.

Regards,
Ken

James N June 7, 2011 at 7:29 am

Great job of avoiding the obvious fact that your question is a fallacious argument and therefore, doesn’t warrant a response.

“(false dichotomy, fallacy of bifurcation, black-or-white fallacy): two alternative statements are held to be the only possible options, when in reality there are more.

crossofcrimson June 7, 2011 at 11:37 am

Define a “perfect” market. If it means anything close to what you seem to imply when you use the word “efficient”, then you’re simply wrong.

muirgeo June 7, 2011 at 1:31 am

In your libertarian society charity would have no tax benefit. You sure you could cover all the needs of the poor better thenMedicaid now does. Again the idea of relying on charity is to me like applying selective taxation on those with a conscious while we let the demons of society profit free of obligation. That is one sick ass way to order society.

I think the Libertarian Hospital down the street with the really low rates that excludes these costly cases would run you and your charities quickly out of business.

Ken June 7, 2011 at 2:19 am

muirgeo,

“In your libertarian society charity would have no tax benefit.”

So? Why should there be? Taxes should be applied equally to everyone as we are all equal before the law.

” You sure you could cover all the needs of the poor better thenMedicaid now does.”

Without question.

“Again the idea of relying on charity is to me like applying selective taxation on those with a conscious while we let the demons of society profit free of obligation.”

Charity will not be the exclusive or even primary way people get health care. As with every other product in a free market people will purchase health care. In a free market, people naturally don’t like to pay too much for any product, including health care, and will search for the best trade off between quality and price, driving down costs fostered by competition. In a free market health care providers will have to compete openly with each other the same way Shoppers and Giant do, looking for ever greater efficiencies, getting the same quality for less work, which will produce some automation, lowing costs as it has in all other industries.

Charity will be used on the margins, for those who truly need help, instead of by crooks like you looking to game the system and pad your wallets as much as possible. Additionally, no one needs to “rely” on charity. At any time in a person’s life, this person can start working, saving, and buying insurance, becoming self reliant.

Regards,
Ken

James Hanley June 7, 2011 at 2:18 pm

I think the Libertarian Hospital down the street with the really low rates that excludes these costly cases would run you and your charities quickly out of business.

This statement makes no sense at all. First, if the libertarian hospital is charging low fees, Muirgeo should be praising it because it would enable more people to afford care there. Second, the charity isn’t in competition with the libertarian hospital because the libertarian hospital is charging fees, while the charity is relying on outside sources of financing. Muirgeo is putting in overtime in his efforts to make illogical arguments here.

Methinks1776 June 7, 2011 at 2:29 pm

Muirdiot,

Are you under the impression that the reason people give to charity is because of a tax benefit? It’s not. The tax benefit simply allows people to give more to charity.

Charity is not selective taxation. People choose to give to charity. People can’t choose not to pay a tax. And what is fundamentally wrong with allowing those who wish to help out do so?

Charities will not be run out of business. Charities aren’t in the business of making a profit, so they can’t be “run out of business”.

Any hospital that does pro-bono work does not rely on a charitable tax deduction. The cost of providing the care is booked as an expense that reduces the profit. The reduced profit is then taxed and the tax burden is reduced that way. You can’t prevent a hospital from booking expenses.

Doofor June 7, 2011 at 2:52 pm

There was an article in Japan Today about a guy having a heart attack being being driven around by his wife being rejected by 19 hospitals in a row because he couldn’t pay for his care and was uninsured. That’s what the awful truth is. A scenario without a boom and a bust.
You prefer the fruity rainbow fantasy where any junkie overdosing should be able to knock on the nearest designated rich guy’s door and get what ever they need no questions asked. This is the boom.
Your fruity ideals of carbon free unicorn rides condemn us all to us a much worse fate: Take a look at DeGoya’s eyewitness paintings like Satan Devours. That’s what it looks like when both you and the rich guys get crushed by tanks and military convoys after the socialist calculation spectacularly fails. This is the bust.
You want to steer markets, I want them set free.

LowcountryJoe June 7, 2011 at 3:28 pm

As Methinks1776 writes below (paraphrasing): why do you assume that libertarians are only going to be motivated by some tax advantage to give?

It’s a silly assumption really. Most people are charitable [admittedly, discriminately -- definition 1b] and the benefit that they get for the cost is non-pecuniary utility. At a certain level I know that you understand this George because you, yourself, is willing to be charitable…with other people’s money.

Randy June 7, 2011 at 8:49 am

It depends on how many drug addicted ladies we’re talking about. Just 1? If so, I might take her on a as a charity case. But what if its thousands every month? And what if the government passes a law that forces me to care for them all without compensation? Then I quietly close my hospitals doors and move my resources to a more productive use.

muirgeo June 7, 2011 at 9:41 am

No Randy… I said a libertarian society. The government would compel you to care for anyone…that’s what is so neat about it…you can just kick them out of your hospital to the street.

Ken June 7, 2011 at 4:29 pm

muirgeo,

“The government would compel you to care for anyone…you can just kick them out of your hospital to the street.”

Writing fail. How can you kick anyone out of your hospital if the gov compels you to care for anyone?

That you think people do nice things only under the threat of violence only shows how shallow you are. You seem to think that everyone is as cheap and ugly as you unwilling to do anything nice for anyone unless forced to by the government. Of course, this is laughable.

Regards,
Ken

LowcountryJoe June 7, 2011 at 11:54 am

If she lives anywhere near Faifield, CA, I’ll personally drive her over to where you’re working. And if you’re off work, I’ll take her over to your house.

In fact, why is there not a Internet registry of samaritans who will help people out in a pinch with instructions on how to reach them and the office hours that they keep especially for charity cases?

muirgeo June 8, 2011 at 1:33 am

No, no please call 911 and have them take her to our neonatolgy unit. The cost will be covered by the taxes we ALL… me, you and the others. Of course if you want to pay for her out of charity rather than have the tax payers equally share the burden I am sure we can’t get that arranged.

LowcountryJoe June 8, 2011 at 7:37 am

I don’t wish to burden anyone else, Dr. Balella. Unless, of course, they’re vocal about helping the disadvantaged and feel so strongly about it that they’ll resort to Internet trolling on websites.

And this is not the fairest thing to ask of you since you’re not an Obstetrician. How about providing the check-ups on the twins, then. At least until the mom rehabs and/or “gets on her feet”.

Nicolas Martin June 6, 2011 at 9:51 pm

So long as we have occupational licensing and prescription drug laws, we can’t begin to talk about free market medicine. Too many free marketeers neglect these factors, and therefore don’t confront the full extent of the distortion of medical economics.

michael June 6, 2011 at 9:53 pm

I completely agree with your logic and I personally think the US shod return to a more free market system.

However, my single-payer favoring friends would say, “well, people don’t treat health care like pet food. If your kid needs care you’re not going to shop for a better price.”

I hate this response, and I have my own ways of responding. But how would you respond to this question?

lamp3 June 8, 2011 at 1:07 pm

Are they willing to give their children care if in the pursuit of satisfying the cost of care’s price, we make other kids starve and die?

Are they willing to pay you to get a medical education and residency, then pay your salary, so you can be their personal doctor?

nailheadtom June 6, 2011 at 11:03 pm

Off on a little tangent, theoretically the government is supposed to treat us all equally, unless we’re farmers or some other favored group but it seems unlikely that every citizen will require the same amount of health care during their lives. Sure, it’s just anecdotal, but my experience seems to indicate that females have more health issues than men do. Are there any statistics on the average lifetime health costs of women versus men?

nailheadtom June 7, 2011 at 1:23 am

Oh, here it is:

Principal Findings
Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women’s longer life expectancy. Nearly one-third of lifetime expenditures is incurred during middle age, and nearly half during the senior years. For survivors to age 85, more than one-third of their lifetime expenditures will accrue in their remaining years.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361028/

Quinn Clark June 6, 2011 at 11:56 pm

While it might seem useful to talk about whether a single-payer system is more efficient at providing health care (better quality-adjusted costs), it misses the central point. If you believe in the non-aggression principle (that the initiation of force is immoral), as I do, and as I think most Americans would say they do (if the question were asked before any implications are pointed out), then the only consideration that matters is whether force is being applied. If government must use force to create a single payer system, then it doesn’t matter whether it’s more effective.

Ends cannot justify means.

James Hanley June 7, 2011 at 2:23 pm

The non-aggression principle, like all other principles, is not an absolute. To take any single principle and treat it as an absolute that must never be compromised for any other principle or value or combination of principles or values is simplistic. It is arguments like this that enable otherwise intelligent people to simply dismiss libertarianism as shallow. Give the non-aggression principle great weight, by all means, but don’t treat it as pure, sacred, and inviolable.

Pharmer Joe June 7, 2011 at 12:27 am

The US hasn’t anything remotely resembling a free market health care system since the 1940s. The US government currently foots the bill for over 50% of all health care expenses in the country, in addition to running an overly complex and awful price control system through Medicare. People like Medicare because it is heavily discounted medical care. There is also an incredibly amount of rent seeking within the health care professions. States contribute to this through licensing schemes. For example, why are there such heavy regulations against those beside physicians prescribing medications? The AMA is an incredibly powerful lobby, swaying Medicare through the Relative Value Update Committee and maintaining a monopoly through the billing system.

People that want greater government intrusion in the US health care system are typically too ill-informed to diagnose the actual problem, which is why our health care costs so much and why so many people are priced out of the market. Start reading about Medicare and all of the regulations within it. Come back to me when you are finished in about a year or more, and then you will be able to finally understand why people love receiving Medicare and why it is bankrupting this country. As always, through unintended consequences, the poor and lower middle class get screwed the most.

SheetWise June 7, 2011 at 1:34 am

Start with a constitutional amendment —

“The right of the people to be free in their choice of medical and health decisions shall not be violated. There shall be no interference in individual choices, methods of provision, types of treatment, or any freely contracted indemnity.”

What would you add?

vikingvista June 7, 2011 at 2:14 am

It’s what I would remove:

“The right of the people to be free in their decisions shall not be violated. There shall be no interference in individual choices.”

SheetWise June 7, 2011 at 10:58 pm

“The right of the people to be free in their decisions …”

Far too broad. Change “their decisions” to “right to act or contract without aggression on any party not party to the act or agreement” and you’re getting close.

But then again — it’s that type of language that got us into this mess.

vikingvista June 8, 2011 at 12:14 am

Since it an article of restraint against the government, it can’t be broad enough for me.

Seth June 7, 2011 at 10:37 am

It seems like a constitutional amendment is where Obamacare should have started.

SheetWise June 7, 2011 at 11:00 pm

Amen.

nailheadtom June 7, 2011 at 1:18 am

“The PM seems too weary to think out a policy for the restoration of the country after the havoc of the war. This morning he sent me that part of the Conservative Election Manifesto which deals with new Health Service. He asked for my comments, though it is printed and ready for circulation. I found the manifesto full of platitudes: ‘Liberty is an essential condition of scientific progress,’ and other resounding phrases of that kind. It is all politics. No attempt is made to face the facts. Poor people have come to dread the expense of illness. They want their doctoring for nothing, and the party which gives them this will be on a winner.”

Lord Moran, President of the Royal College of Physicians and personal physician to Winston Churchill, “Churchill, Taken From the Diaries of Lord Moran”, Houghton Mifflin Co., Boston, 1966, pg. 270

Antonio Mendes June 7, 2011 at 5:35 am

Nobody asked the question because it does not make sense to compare the demand for health care with the demand for food or clothing or anything else. In the case of life-threatening diseases the demand is infinitely elastic but the supply is not so in the short span of time left before the patient passes away.
That is why the common sense solution is a universal single-payer system for hospital care with a free market for top-on services and non-life threatening services.

James N June 7, 2011 at 9:15 am

Demand for the product, whatever it may be, isn’t the issue. The issue is whether a single payor system, run by government, will reduce the quality-adjusted cost of health-care. The author’s argument, which you ignored, is if proponents of single payor allege that to be true, then why won’t it work for every other product? Answer that question.

James Reade June 7, 2011 at 8:48 am

Astonishing to find, in all the comments here, 7 references to the word “information”, and 2 to “mistake”.

There are many reasons why the comparison set up here (and in other cases on this blog alas) is false and probably dangerous. Most are taught in basic microeconomics courses.

One is information: Libertarians act as if the market solves everything because as Hayek once said, it conveys the most information to the most people. But it does so via the price mechanism, and if that mechanism isn’t going to work due to the nature of the market, then the market isn’t best any more. Information on healthcare – can we ever really hope to understand it if we haven’t gone through 7+ years of medical training? Answer: no. No glossy magazines in the stores can help us as consumers.

And what’s the cost of mistaken choice? Well, with pet food, it’s the cost of the bag of crappy food – dog doesn’t like it, there we go. With a medical procedure, either needed or otherwise? Well, death, chronic illness, severely impaired health, etc.

Now of course, saying this doesn’t mean we have to jump to that single provider of the government. But it says that that market sure as anything is not going to provide the best quality of healthcare – we haven’t even talked about externalities and the problems of adverse selection and moral hazard in insurance markets either!

One interesting point is provided by this recent survey: http://liberalconspiracy.org/2011/06/06/new-survey-ranks-nhs-1-for-efficiency-and-effectiveness/. In the US without its single provider, you pay over $7k on health per capita. Here in the poor old UK, with our decrepit, socialized system, we pay under $3k. Last time I checked, our health outcomes are not less than half as good as yours. Would seem to suggest that somehow, the NHS has achieved some degree of quality despite being a single provider. How about that?

James N June 7, 2011 at 9:38 am

We can now say that the word “mistake” has been used three times, i.e., your post. You, like many others on this thread, have changed the discussion to the issue of “health care”, not “health insurance”. Single Payor refers to who’s paying the cost, not who’s delivering the care. The author’s argument has nothing specifically too do with dog food, automobiles, televisions or any other product he may have chose to use. His argument, which you didn’t address, is why would health care be a unique product, that defies the laws of economics and be better served by government “paying” for everyone’s treatment? If you accept the superiority of government involvement in the health care sector, why wouldn’t the same result occur with any other product?

Captain Profit June 7, 2011 at 10:00 am

@James N
I think James Reade already attempted to address your question by saying that medical services are different from other commodities because they’re complicated. IOW, I can’t properly comparison shop for dialysis or chemotherapy because I don’t know how they work. It’s not like they’re a refrigerator or a cell phone or something…

nailheadtom June 7, 2011 at 11:03 am

There is a wide variation in MRI and other testing prices in any given market. But doctors are under no compulsion to find you the best deal, they just get you an appointment (perhaps with a service of which they are part owners). I don’t go for that. There’s no evidence that a cheaper MRI provides less information than a more expensive one. I’ll go with the cheaper, no matter who is paying.

James N June 7, 2011 at 6:49 pm

“I can’t properly comparison shop for dialysis or chemotherapy because I don’t know how they work.” I agree but, the problem doesn’t go away regardless of who’s footing the bill, a private insurer or the government. Does anyone, currently covered under a health insurance policy, ever comparison shop their medical services? My point is that no matter what the product, I fail to see how making government, an over-bearing, poorly managed, coercive entity, in charge of it, will make the outcomes better. And so far, no one on this thread, that defends Single Payor, has proven otherwise.

James Hanley June 7, 2011 at 2:27 pm

it does so via the price mechanism, and if that mechanism isn’t going to work due to the nature of the market, then the market isn’t best any more.

There’s the fundamental error that too many advocates of government action make. The assumption that if the market isn’t working well, something else–i.e., government–is working better. But the effectiveness of the something else is unaffected by how well the market is working. If the something else doesn’t work fairly well on its own merits, then an imperfect market won’t make it work any better. So when the market isn’t working well, it’s a logical error to say, “therefore government will do a better job.” All that can logically be said is, “therefore we should take a close look to see if in this case government might do a better job.”

The assumption that government necessarily works when the market doesn’t is the cause of many a lousy public policy.

Tom McCarten June 7, 2011 at 8:57 am

To answer your question regarding the value of a single payer system,with empirical evidence accumulated over 50 years, look at the Canadian health care system. This bloated, bureaucratic, bungling mess pays tribute to the “pay more get less” quality of most government serves.

To think for a moment that a single government payer system has any redeeming attributes is a breathless symbolic tribute to stat-ism.

Floccina June 7, 2011 at 10:32 am

I think that single payer advocates think that the consumers are being ripped off in medical care but not pet food and that government has the ability to stop them from being ripped off.

I think that they also believe that most medical care providers have high status jobs and so using monopsony power to push down prices would not lead to a significant decrease in care quality. Monopsony also provides a way to get around excessive state medical licensing.

LowcountryJoe June 7, 2011 at 12:20 pm

Dan: “Why is it so hard for single payer advocates to just voluntarily submit themselves and leave ALL who dissent from participating?”

MarketJohnson reply to Dan: “You are assuming that I wouldn’t volunteer for such a thing. Of course I would.”

May I suggest then, and with all sincerity, that you, MarketJohnson, form a co-op with like-minded people on this issue and go the cooperative insurance/medical services route [either health insurance or outright medical treatments at cost]. This way you (and people like) you could volunteer for it and Dan (and people like Dan) could choose some other arrangement if he does not wish to participate. This compromise will give you what you both want, correct?

And as a thought experiment: what do you do if someone who thought as Dan did, and opted out, comes to you when he is in need of medical treatments? Will you not be a tad bit discriminating in who joins this co-op and under what condition that they do so? If not then how long does your co-op stay afloat? If so then what would make you any different than the current health insurers and their practices — practices that you claim are socially unjust?

Dale June 7, 2011 at 1:01 pm

I believe a reasonable argument can be made that the two cases are not at all analogous for at least two reasons.

In healthcare, you have serious problems of asymmetric information where suppliers of healthcare can use their information advantage to sell non-optimal treatments at excessive prices.

The above reason is exacerbated by this one–the health insurance business model is quite dysfunctionally built. Insurance covers routine medical treatments. Its demand is artificially bulked up by the fact that companies offer huge insurance packages as part of employees’ compensation. Thus, it encourages huge amounts of spending–the incentives are all geared towards more usage and demand.

If government handles health care, it might counter the information advantage and not act in an inefficient, profit-seeking manner.

I find that unlikely, but it’s a consideration. Anyway, those two facts do make an analogy between pet food and healthcare slightly foolish.

CRC June 7, 2011 at 1:24 pm

Forget pet food (arguably a “luxury good”). Why not regular human food (more critical than health care and health insurance)? Clothing? Housing?

These things are all easily as critical (and arguably more critical) than health insurance and health care.

Why not a single-payer system for any of these?

How is it that despite relatively little government intervention* in these markets, the market is quite adequately providing a huge array of goods and services and wide range of prices and quality levels and options.

*I’d note there is almost none in clothing and a moderate amount in food and slightly more in housing. What’s interesting is that the result of these interventions appears to be negatively distortive in the form of higher prices and fewer options, etc.

Polly June 7, 2011 at 5:44 pm

I like the idea of a grocery store where I and everyone else can just walk in, fill our baskets with whatever we want, and walk out. I’m certain that I and all the others would make the same choices as we do now, when we’re paying for it ourselves.

Especially helpful, time-wise: no need to clip coupons to save money on the products I use.

Doofor June 7, 2011 at 2:30 pm

Of all the destructive “Saving Lies” the single payer type are category 5. Highways & Roads are expensive, deadly, and do not really meet the needs of anyone. As soon as you leave your property in the morning, you experience the crime, inconvenience, and all around failure of economic calculation streets and highways represent.
By eradicating the last 20% of private market health care and drugs in the U.S. , you’ll see losses of 10s or 100s of trillions in wealth immediately.

Quinn Clark June 7, 2011 at 2:54 pm

The statements:

“We should force everyone to contribute to a single, government-run health care pool because it will increase the aggregate efficiency of the system”, and…

“We should kidnap people and force them to work on our plantations, since doing so will create a net increase of cheap labor, causing a reduction in the price of cotton.”

…are not fundamentally different from each other. The most important part of each statement is its beginning, the means used to accomplish each end. And yet everyone wants to argue whether the conclusions are true or false.

It doesn’t matter. The initiation of force is immoral. People are their own ends, not a means to some “greater good.” I completely reject the notion that “single payer” should be promoted or rejected based on its results. It must instead be rejected because it uses immoral means to accomplish its ends.

Mr. Econotarian June 7, 2011 at 5:54 pm

I have beagles, who eat anything, so I’m not worried.

But you better not socialize my dogs healthcare! My vet is the only doctor I have who is not ashamed to discus costs of procedures.

Slappy McFee June 8, 2011 at 11:11 am

My beagles won’t eat vegetables. And one of them doesn’t trust people enough to eat from your hand so it has to go into his dish first so it can be inspected properly.

muirgeo June 8, 2011 at 1:38 am

So when the charity runs out and one more mother shows up pregnant with pre-term twins…. then what do you do?

Does she go to the street or do take care of her with your last dollars and declare bankruptcy?

I mean if you libertarians are telling us… guaranteeing us… that your charity will take care of ALL these cases then sure lets go for it. But when the people start dying in the streets with more regularity then they already do in Texas … then the deals off and we will revert back to a civil society with shared burdens and you can all STFU at that point because the results of your useless scheme should have been clear by a cursory examination of the human psyche.

Methinks1776 June 8, 2011 at 6:21 am

You still haven’t grasped the concept of limited resources, have you?

muirgeo June 9, 2011 at 2:04 am

There are 400 people with $1.6 trillion dollars of resources alone…Another 800 billion spent on the military each year. We do not have limited resources. We have a very poor allocation of resources thanks to your type of economic and political mindset infiltrating public policy and rational markets.

LowcountryJoe June 9, 2011 at 7:29 am

Where in this world do you like the combination of the amount of resources available and the way that those resources are distributed?

Follow-up question: if not in the United States, why aren’t you living within this place?

Slappy McFee June 8, 2011 at 11:07 am

I will continue to send them to you so you can provide your services for free. You should start a national campaign that you will provide medical services at no cost to whoever can get to you.

LowcountryJoe June 8, 2011 at 12:08 pm

mean if you libertarians are telling us… guaranteeing us… that your charity will take care of ALL these cases then sure lets go for it. But when the people start dying in the streets with more regularity then they already do in Texas … then the deals off and we will revert back to a civil society with shared burdens and you can all STFU at that point because the results of your useless scheme should have been clear by a cursory examination of the human psyche.

Privately donated funding through charity will make a significant difference but because the discerning givers to charity will only entrust their hard-earned contributions to organizations who will use the money wisely, not everyone is going to be provided for. You cannot expect people to give to charity when the discover that their contributions went to individuals with unsavory habits and are of unsavory character.

But you, Muirgeo, want to think that government will not be discerning. You are incorrect! The government will make discriminations based on entirely different criteria such as who will be a net drain on resources going forward [e.g. the so-called Death Panels that even Paul Krugman says are needed].

So, Ducktor, how is that for your civil society with shared burdens? How’s that for your defense of state-ism versus the libertarian bogeyman that leaves people wanting? Perhaps it is time for you to STFU or defend that your version of caring for the needy is somehow better. I think that even you would admit that the libertarian ideal of advancing charity as the solution does two things that your state-ist solution does not: 1) preserves freedoms and choices; 2) provides needed signaling for others to clean up their act if the expect to get a hand out [isn't this a desired positive 'externality'?].

Methinks1776 June 8, 2011 at 12:18 pm

Well said, sir.

Not to mention that we can choose charities with low operating costs so that over $0.90 of every dollar donated actually ends up being spent on the needy – as opposed to $0.10 of every dollar taxed away for that purpose.

muirgeo June 9, 2011 at 2:06 am

You said Death Panels in a serious way… that makes you stupid. Why don’t you go educate yourself exactly what the so-called death panels were all about. Hint Fox News, Right Wingnut Radio and Conservative Think tanks are not places to be educated.

brotio June 9, 2011 at 2:32 am

If you’re able to vote on this initiative, how would you vote on the Jews! FOAD Anti-Circumcision Act proposed by the tolerant and open-minded shitizens of San Francisco?

LowcountryJoe June 9, 2011 at 7:24 am

I actually wrote “Death Panels” and I prefaced this with the compound word “so-called”. But I did look into this and discovered that I had a misunderstanding about what the legislation did — which was to compensate physicians for providing counseling about treatments and planning at/toward the end-of-life. So, yeah, I bought into the scary language and knee-jerked on this one*.

But that does not excuse Krugman for dousing the topic with flammables through his suggestion that what would really need to happen going forward is a discussion about the rationing of care for folks who wouldn’t make the grade in some cost-benefit analysis which bureaucrats would calculate. You cannot deny [well, you could] that he said and meant those words and that he speaks for many Progressives.

[*admitting that you've been full of sh_t on a topic is much more credible than continuing to spew it or, worse, duck out of a discussion: you should try it...often]

LowcountryJoe June 9, 2011 at 7:37 am

You said Death Panels in a serious way… that makes you stupid.

You addressed a small portion of my reply to you and avoided the rest of it. While this doesn’t mean that you’re stupid [there's other evidence readily available for that], does it make you chickensh_t to have a real discussion about the role of government, the concept of liberty, and outcomes in planned versus market economies within countries or a country’s various industries?

Dave Pinsen June 8, 2011 at 3:06 am

“In those other nations, 7% to 8% unemployment is the norm.”

What do you think is the norm here? In hindsight, it appears that our unemployment rates from the late ’90s to 2006 or so were based on the credit and housing bubble, which of course has since popped.

Germany, where six weeks paid vacation is standard, just posted its lowest unemployment rate since unification, and its 23rd consecutive decline in its unemployment rate: “Germany continues to outpace the U.S. in job creation”

“6 weeks of paid vacation? Who’s paying? Why is Europe always lagging In development? Why are they consistent in high unemployment? Why are our ‘poor’ wealthier than their working lowest wage earners?”

Do you think Germany’s “lagging in development”?

Dan June 8, 2011 at 3:18 am

Can I have that nice Blue tint for my name? I like blue.

Richard Stands June 8, 2011 at 12:16 pm

Put in a website address when you enter your comment. :)

Richard June 8, 2011 at 4:13 am

The US has managed to get the worst of all worlds.

Single payer largely works and on key metrics the US system largely delivers similar or worse outcomes than other systems for far higher costs. Infact the US government still manages to spend more on health than many single payer systems in addition to the huge insurance costs.

“Everyone knows — or should know — that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts, the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results with figures from 12 other countries that are members of the Organization for Economic Cooperation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.

Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.

And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.

This is where a “serious conversation” on health-care costs would start — with what has worked, and what we can learn from it. Instead, it’s where our conversation about health-care costs never quite goes.”

Methinks1776 June 8, 2011 at 6:19 am

Where do people missing work, suffering and dying on wait lists factor into your medical costs of the UK and Canadian system? How are those costs expressed as a percentage of GDP?

And I have news for you….the growth rates of health care costs in countries with socialized medicine are as high or higher than in the United States.

This is where a “serious conversation” on health-care costs would start — with what has worked, and what we can learn from it.

It can only start when you compare apples to apples and are honest about what’s really going on.

Slappy McFee June 8, 2011 at 11:16 am

Mrs Methinks –

I think Richard does pose a very valid question. Why is it that those that push for a single payor system never realize that our own government spends more on healthcare than anyone else? This does not even include the private sector spending. This data point should refute any single payor advocate that thinks that government is more efficient.

Methinks1776 June 8, 2011 at 11:58 am

I’m not sure that’s the question he’s posing, Slappy. But he does make a good point about starting with what works. None of the countries he mentions work. Of all the countries with universal health care (I’m assuming here that most people find some basic treatment for all a thing they’re willing to pay for – as per the polls), Singapore has the best system. Yet, it is NEVER looked at by those who claim to be in favour of universal coverage.

I can only conclude that universal coverage is a pretext for more government control.

Gil June 9, 2011 at 4:07 am

Singapore kicks ass, eh?

nailheadtom June 8, 2011 at 8:13 am

The NHS, the health care delivery system for a nation of less than 62 million souls, is the THIRD LARGEST EMPLOYER IN THE WORLD, right behind the military of the peoples republic of China and the Indian National Railways. Aside from that, what does anyone, except the Italians, for instance, care about the efficiencies of the Italian health care paradigm? And, since we’re ostensibly free, why can’t we be allowed to develop our own voluntary contractual relationships with health care providers?

Vance Armor June 8, 2011 at 10:55 am

I grew up in a small town in NW Oklahoma. I am 45 years old. When I was six years old and quite ill, the local physician would make house calls for ill patients. That cannot happen today under our extremely regulated health care system.

John Dewey June 8, 2011 at 11:55 am

I have read about Nurse Practitioners who provide in-house care to patients in rural areas and small towns. As I remember it, the services they can provide vary from state to state.

Methinks1776 June 8, 2011 at 12:00 pm

I have received several solicitations from doctors who make house calls and concierge services. I believe they are coming back into vogue for those willing to pay out of pocket – and the costs are not that bad.

Methinks1776 June 8, 2011 at 12:01 pm

The prices, that is.

STATISTICULOUS June 8, 2011 at 12:17 pm

Just throwing this out for response, I am not in favor of a single-payer system and I do not confuse health care with insurance. Speaking of insurance strictly, isn’t it a different type of market than food or shelter (which we libertarians like to use as examples)? When I buy groceries the grocer doesn’t care about who I am or what I do; they value the transaction at their end the same whether their customer is dying of cancer, smokes, has diabetes or runs marathons. The same is not true of insurance. Of course insurance companies want your money too, like the grocer, but more importantly they have to want your risk. If your risk is too high you will be denied the service. Doesn’t this make insurance, once again not health-care, fundamentally different than these other markets.

Two side notes:
1. I am an actuarial trainee, so I deal with risk and insurance and think about it a lot.
2. My wife is a type-one diabetic and I know that she cannot, with current prescription costs, be profitable to any insurance company. If her employer didn’t help facilitate a plan, she would not be able to afford her medications- she is but one example of a risk that insurance companies will attempt to avoid.

Vance Armor June 8, 2011 at 12:54 pm

Perhaps we could all declare ourselves to be animals and receive low cost health care from veterinarians.

Gil June 9, 2011 at 4:09 am

Or better yet get access to euthanasia.

brotio June 9, 2011 at 2:13 pm

That would fit Yasafi’s view. He’s all in favor of terminating inconvenient life.

Vance Armor June 8, 2011 at 12:58 pm

I am a subspecies of the family Pan. Therefore, I do not have to sign up for Obamacare and the veterinarian can treat me.

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LowcountryJoe June 9, 2011 at 12:25 am

Will Brandon, Donna, Kelly, Steve, David, and Andrea be contributing as well, Brenda?

Slappy McFee June 9, 2011 at 5:08 pm

Its wierd but I thought Andrea was hot….

Slappy McFee June 9, 2011 at 5:09 pm

The question I would like an answer to is, single payer healthcare results in more efficient use of scarce resources by…….

Molon Lobe June 9, 2011 at 6:45 pm

I am amazed that America has become a society of vampires. Those who are willing to give up their liberties for the supposed security of government provided alms.

Those vampires use the poor, elderly and young as human shields to justify an equitable distribution of wealth to “all.” An examination of our education system reveals what a single payer scheme delivers. In inner cities do the children get the same results as in religious schools in the same district? No.

Comapre the results in schools in other areas for results. California, Washington DC, NYC spend over 10,000 per student and get results worse than Mississippi schools. Would health care be any better?

For all who desire government provided healthcare one can only conclude the the “utopia” of the possible is to be preferred over reality.

The US government runs two health care systems all ready. The Indian Reservations and Veterans. Who in his right mind would hold these up as models? These two have delibertedly infected their patients, neglected the basic safety procedures resulting in the worsening of thousands, provided healthcare at levels that would have private medical systems being prosecuted.

Ignore the results of healthcare in the UK or Canada where waiting periods for critical proceedures can exceed 6 months.

Some of the nation can’t wait to suck the life energy out of the productive. To them I say get a life or go to a society like Cuba where your desires will be met.

Jim June 12, 2011 at 12:44 am

“Ignore the results of healthcare in the UK or Canada where waiting periods for critical proceedures can exceed 6 months.”

As opposed to this country, where everyone who needs a “critical procedure” gets it immediately? I rather think that many people never get the critical procedures done due to excessive cost and no means to pay. At least in those countries, all citizens have a means to get such procedures done without having to consider whether or not their “free market” systems will provide coverage.

David June 10, 2011 at 12:34 pm

Easiest answer EVER. The issue is in the nature of the product. Health care is a product that often HAS to be offered to non-paying customers. If you are in a car wreck, unconscious and the ambulance can’t find your wallet, can they just leave you to die on the side of the road? Like it or not, health care institutions are often legally and/or morally required to provide service to customers that other businesses would turn away. Call a plumber to your house, tell him you won’t pay him but he needs to fix your sink. He will tell you no and you will praise his business acumen. Go to Petsmart and tell them to give you a free bag of food because your dog is starving and I bet you get the same result. However, pass a law or create a new societal expectation that pet food HAS to be provided to anyone who needs regardless of the ability to pay, and you introduce all sorts of market failures – failures that would eventually lead to a single payer systems being a better option.

It is simple really. If health care is just another product and just another “private enterprise”, then people without the means to pay have to be turned away. That IS what business DOES, right? But if you operate health care like that, it will get messy, and it will challenge everyone’s belief in the value of “life. The plumber never fixes that sink. And consider, if you did die on the side of the road because the ambulance couldn’t find your “means to pay”, it is not a tragedy, it is just good business. Rather than sue, your dependents need to give that driver a medal. So to answer your question – as well as make a case for single payer systems – pet food is just another consumer product and health care is not – it comes with all sorts of laws and moral expectations that business is unable to accomodate.

Molon Lobe June 10, 2011 at 8:54 pm

David:

Really? So someone who is straving goes into a resturant and the owner must serve him?

A hospital has to serve someone with a toothache or the flu?

Better yet explain to me how emergency services in California allowed a man in the surf to stay there for two hours till he died?

No one has a right to any service without consequence. Your argument is without logic because it presupposes that medical care must be provided regardless without regrad to cost.

So then why not education, housing, food, water, entertainment, in short al the guarantees contain in the USSR’s constitution all at the bargain cost of no freedom, liberties or rights.

Sorry the argument of using the poor, elderly, or children as human shields for advocates arguing for mythical, free services is not acceptable. It just doesn’t pass the laugh test.

Methinks1776 June 10, 2011 at 8:58 pm

So then why not education, housing, food, water, entertainment, in short al the guarantees contain in the USSR’s constitution all at the bargain cost of no freedom, liberties or rights.

…or the promised goods!!!

I love and plan to steal your human shields bit. Hope you don’t mind.

Jim June 12, 2011 at 12:39 am

You continually compare discretionary items, such as pet food, to healthcare spending. I don’t see the validity in your comparison.
I work in healthcare. It is expensive. Most “consumers” want the best and latest technological advances, medications, providers, etc, available to them. This is expensive. To make the free market comparison, I would say, everyone gets to drive a Cadillac (or a Lexus, Mercedes, etc), until it comes time to examine the real cost of owning and driving such a vehicle. Most consumers feel the “need” to drive (again it is a choice, but that’s another topic for another day), so they may have to scale thier expectations back accordingly.
Back to the topic: I don’t think that healthcare works on so-called free market principles. To many consumers, it is an afterthought until it is needed (read: medical emergency, life threatening diagnosis) and then, the expectations regarding what “should” be available to them, should be available to everyone. The medical and healthcare professions do not practice from an economic set of values, but rather a set of ethics based on their responsibilities to the patients themselves. We provide the care that is needed and (often) is available, regardless of the ultimate cost. If you were coming into the Emergency Department of your local hospital with chest pain, would you want the hospital registrar or attending physician reminding you about the cost of your treatment and giving you choices about taking various tests or getting various treatments due to expense? A provider would need to make decisions based on what was best for the patient, balancing that out with what the facility has to offer and whether a patient’s needs can be best served elsewhere. Regardless of whether unnecessary and superfluous tests have been performed in getting to this point, you must see that the decision tree used by providers just doesn’t necessarily lend itself to patient choice and providing patients with difficult choices to make when they are desperate to feel better and/or find out what is wrong with them.
Regarding single payer healthcare, I say go for it. I harbor no fantasies about costs coming down as a result. It is a philisophical decision that we as a nation need to make. It reflects the kind of society we want to live in and the message we send to our citizens. It is money well spent and a good investment overall.
We are competing globally with businesses in other countries that already provide this to their citizens and, regardless of what you think about any given country’s belief system, on this basis, we, as a nation, will continue to struggle economically, until we stop apportioning such a large percentage of our income to healthcare. This is what has happened with the so-called “free market” principles in place. Could things get any worse than they are now? I tend to think not. Remember, our healthcare outcomes suffer by a large margin compared with other industrialized nations.

David June 12, 2011 at 12:52 pm

Molon Lobe – wow, you missed my point entirely. I was addressing the original post – this idea that healthcare is just another economic product in the market place – which is ridiculous.

Pet food was one sample cited – if a single payer system is acceptable for health care, why not a single payer pet food system. My answer is that pet food food producers can operate quire well in a free market because they have a product that can be denied to non-paying customers without social consequences or legal action. The product has little or no special meaning or attachments.

Hospitals and doctors can only deny their services to non-paying customers with great risk. Why is that? Because, right or wrong, they will face public outrage and law suits if they deny service to a flu patient who dies a few minutes later in the parking lot. Right or wrong, there are social expectations (even moral obligations?) and certainly legal requirements that frequently require healthcare providers to make SEVERE un-business-like decisions (for example, provide service to a customer that can’t prove their means to pay).

I am not supporting a position here, merely pointing out what should be obvious to all. I understand the faults of single payer systems quite well. However, if your solution to health care is “free markets,” then we have to first free health care providers of all requirements to make decisions not in their economic interest. That is not just tort reform. It also means if you need care and can’t demonstrate the ability to pay – not only CAN they refuse you service – they SHOULD refuse you service…and we as a society and the courts will need to be OK with that. For free markets to work, health care has to be like the pet food market or plumbing business where there is no social stigma for refusing service to non-paying customers.

The problem is – as Jim describes so well – people do NOT see health care as just another economic product. As individuals and as a society that claims to value life, we have attached certain expectations and obligations on a product/service that makes it entirely different than pet food or automobiles. Like it or not, believing free markets can fix health care means you have to believe life and health are ordinary commodities – in other words, you have to devalue life and health relative to how we presently value it. Of course that last bit only matters if you want to be logical consistent.

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