Megan McArdle has some thoughts:
Robert Wright notes that “we already ration health care; we just let the market do the rationing.” This is a true point made by the proponents of health care reform. But I’m not sure why it’s supposed to be so interesting. You could make this statement about any good:
“We already ration food; we just let the market do the rationing.”
“We already ration gasoline; we just let the market do the rationing.”
“We already ration cigarettes; we just let the market do the rationing.”And indeed, this was an argument that was made in favor of socialism. (No, okay, I’m not calling you socialists!) And yet, most of us realize that there are huge differences between price rationing and government rationing, and that the latter is usually much worse for everyone. This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they’re applied to hip replacements and otitis media.
It doesn’t help that there is so much economic ignorance out there (not to mention in my comments section).
[Update a few minutes later]
Glenn Reynolds has some further thoughts:
Also, the market doesn’t deny you a hip replacement or a pacemaker because someone in government thinks your political views are “un-American.” Given the cronyism and thuggery we’ve seen with the bailouts, etc., I’m not confident this would hold true under a government health program. And I’m absolutely certain there would be a special track for insiders and favorites.
So am I.
[Late morning update]
Five leftist myths about health-care reform.
[Update a few minutes later]
Caught in the act: a blatant lie by Barack Obama about his support for single payer. Just how stupid does he think we are? And how clueless is he if he thinks that we can’t find this kind of thing on the Internet?
[Update before noon]
The people are seeing through the snake oil:
Thirty-two percent (32%) of voters nationwide favor a single-payer health care system where the federal government provides coverage for everyone. A Rasmussen Reports national telephone survey finds that 57% are opposed to a single-payer plan.
Fifty-two percent (52%) believe such a system would lead to a lower quality of care while 13% believe care would improve. Twenty-seven percent (27%) think that the quality of care would remain about the same.
Forty-five percent (45%) also say a single-payer system would lead to higher health care costs while 24% think lower costs would result. Nineteen percent (19%) think prices would remain about the same.
…Data released earlier today shows that 51% of voters fear the federal government more than private insurance companies when it comes to health care decisions. Forty-one percent (41%) have the opposite fear.
We’re not as stupid as they want us to be.
This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they’re applied to hip replacements and otitis media.
This is only puzzling because the government is in charge of rationing common sense these days.
In the old Soviet Union, the favored folks were known as the nomenklatura. There were hidden stores they were permitted to shop at, and essentially a different currency for them to use. They had first dibs on cars, houses, vacation homes (dachas), etc.
That’s how “hope and change” is supposed to end up for the SEIU executives, I’ll bet …
A thug is a thug is a thug. Now that Paine’s Common Sense is a best-seller again, Mark Levin’s book is a best-seller, and Atlas Shrugged is a best-seller again, it’s now time for … Orwell’s Animal Farm. The nomenklatura was a big target.
And I’m absolutely certain there would be a special track for insiders and favorites.
In the UK they call it the market. If you have the money you can have insurance to pay or you can pay extra to jump the queue. There’s quite a healthy private insurance and private medicine market.
If you can’t pay, the scheduling is decided by Doctors according to medical need.
Again – what about you American chappies makes you impossible to run such a system without turning into Cuba?
Daveon,
The fear is that the deck will be stacked in such a manner that private insurance firms will not be able to compete with the government option.
My own keyboard incompetence on my part cut my reply off…
and subsequently drop the coverage the currently offer leaving their former customers little to no option but the government one.
and subsequently drop the coverage the currently offer leaving their former customers little to no option but the government one.
Doesn’t work like that in UK, or Holland, or, it’s a pretty long list of countries which run systems like that.
I still don’t get why American’s can’t do something that everybody else manages to do for less money.
Glenn Reynolds writes (and Rand agrees):
the market doesn’t deny you a hip replacement or a pacemaker because someone in government thinks your political views are “un-American.”
The market denies medical care to people based on their politics or morals all the time. Some physicians won’t treat women they consider to be promiscuous. Some pharmacies won’t stock morning-after pills. Abortion is completely unavailable in many localities. And of course “the market” in general has a long history of turning away potential customers on the grounds of race, gender, sexual orientation, etc. — we have an entire edifice of civil rights laws to attempt to correct this failure of the market.
Given the cronyism and thuggery we’ve seen with the bailouts, etc., I’m not confident this would hold true under a government health program. And I’m absolutely certain there would be a special track for insiders and favorites.
Most hip replacements are for senior citizens. We’ve had socialized medicine for seniors for 44 years. Where’s the special track for insiders and favorites? Most rich countries have socialized medicine — are “special tracks” a big problem for them? Or are U.S. civil servants particularly corrupt?
Ezra Klein has a great post today on the distrust that fuels attitudes like Glenn and Rand’s:
Click my name for the rest.
McArdle writes:
This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they’re applied to hip replacements and otitis media.
McArdle is only puzzled because she seems to think that health care is like “any other good.” It isn’t. That’s health care economics 101.
The market denies medical care to people based on their politics or morals all the time.
It never does so.
Some physicians won’t treat women they consider to be promiscuous.
And some, even most physicians will.
Some pharmacies won’t stock morning-after pills.
And others will.
Apparently, your ignorance of economics is so profound that you don’t even understand what the word “market” means. “The market” doesn’t refuse to provide services — just some providers within it do that. The market overall does just fine.
What happens when there is no market, but instead only one provider, and it refuses service?
And if Ezra Klein has a “great post,” it will be a first.
Again – what about you American chappies makes you impossible to run such a system without turning into Cuba?
Have you taken a look at Obama, Pelosi and Reid? Otherwise you would know you are asking a rhetorical question.
“The market” doesn’t refuse to provide services — just some providers within it do that. The market overall does just fine.
If all the providers within a market refuse to provide services, what’s the difference? 87% of U.S. counties, home to 1/3 of U.S. women, have no abortion providers. And of course the hotels, restaurants, lunch counters, etc. of much of our country denied service to blacks for nearly a century.
And if Ezra Klein has a “great post,” it will be a first.
I didn’t realize you’d read all of Ezra’s posts — good for you.
Have you taken a look at Obama, Pelosi and Reid?
You can tell that they’re Communist revolutionaries just by looking? That’s quite a skill.
Have you taken a look at Obama, Pelosi and Reid? Otherwise you would know you are asking a rhetorical question.
Of course I have, and compared to, hmmm, let’s say, Tony Blair, they’d be center right politicians in British poltical axis.
They’re frankly to the right of most of the European “right” leaning parties too on most critical issues.
McArdle is only puzzled because she seems to think that health care is like “any other good.” It isn’t. That’s health care economics 101.
Jim, please explain your ideas further. At it’s most fundamental level health care is indeed like any other good.
There are consumers (those seeking health care) and providers (those who provide health care). The only thing that really screws things up is layer upon layer of government bureaucracy that forces the providers and insurers to offer services with features that the consumer may not need or want, but is forced to bundle anyway. This introduces inefficiency into the system resulting in rising prices which the government then attempts to solve by adding more regulation and mandates on the provider and insurers.
Health care is fundamental negative right in that no one, including the government, should be allowed to interfere with my right to seek and purchase any form of health care I deem best from anyone I choose. On the other hand, health care is not a positive right. I don’t have the right to go out and demand that someone else pay for or provide me health care that they wouldn’t otherwise provide to me without the threat of incarceration for failing to pay (tax payers) or offering the care below market rates (doctors).
The fundamental problem in this country is that we attempt to treat health care as being fundamentally exempt from market forces and cry foul those market forces react in very predictable ways to such ignorance.
You can tell that they’re Communist revolutionaries just by looking?
We can tell they’re incompetent boobs by just looking, and listening.
They’re frankly to the right of most of the European “right” leaning parties too on most critical issues.
If the Europeans are happy to have surrendered to the left then “hurray” for the Europeans. The majority of Americans don’t want to be like Europe and as long as they have a voice in the matter (which seems to be quickly eroding) they will voice their opposition no matter how inconvenient for those who want to move us in that direction.
Mike highlights the essential differences and why there’s no room left to compromise. Just run for cover when the lead starts flying…
Slavery was wrong in the 1800’s and its still wrong today.
If someone has the right to put a gun to my head and make me work for them without compensation then that’s slavery.
Anytime someone wants to claim a “right” that requires others to pay for it that’s slavery. Everyone has a duty to support the operation of government, courts, defense, police, schools etc… they are shared responsibilities.
When government decides it wants to branch out into wealth redistribution its branching out into slavery.
If all the providers within a market refuse to provide services, what’s the difference? 87% of U.S. counties, home to 1/3 of U.S. women, have no abortion providers.
According to Planned Parenthood, 79% of women don’t have abortions.
What’s your point?
And then there is this whitepaper regarding Why Fewer Hospitals Are in the Delivery Business”:
Difficulty in staffing was another main reason that hospitals closed their obstetric facility. Medical malpractice burdens for OB/GYNs and family practitioners, changes in physicians’ attitude toward work and quality of life, and the difficulty and costs involved in recruiting supporting specialists such as anesthesiologists and surgeons all contributed to hospitals’ decision to cease providing obstetric services. Forty-four percent of respondents noted that, to their knowledge, high liability insurance costs and the threat of being sued forced doctors to quit delivering babies in their hospitals. Medical malpractice burdens seem to affect the availability of obstetric services in rural areas disproportionately.
I’ll also note that the Texas Medical Board, shows about 200 more OB/GYNs in Texas now than in 2004. Besides the fact that many counties don’t even have a hospital, if you want to increase availability of services, perhaps you ought to increase the incentives for doctors to provide those services. Or in the case of tort reform, decrease the disincentives.
Ezra Klein is right. What possible reason would anyone have to distrust Der Staat? If history–particularly the history of the past hundred years–teaches us anything, it’s that The State is our best friend. If you can’t trust an institution that can take your money and kill you, what can you trust?
Going back to Megan’s point, no we don’t consider it rationing to “ration” food or housing by price.
But neither do we let people starve or freeze. We have food stamps, aid to women, infants and children, public housing and housing subsidies, etc. In short, we provide everybody a baseline of services, and they then can buy more.
That’s exactly what Medicare has been doing since 1964. It hasn’t driven out choice of doctors or care, nor has it driven away private insurance for seniors, including Medicare supplement policies.
Given that fact, why in the world would adding a public option to an existing choice list suddenly cause the world to end?
It hasn’t driven out choice of doctors or care, nor has it driven away private insurance for seniors, including Medicare supplement policies.
And it’s going broke, fast.
“The protesters believe the government capable of madness. There is no evidence for that claim, which means that there is no answer for it…”
.
Jim, are you kidding? There’s no claim for governments going crazy or standing on the backs of the citizens? There are times throughout history where that has happened. It’s exactly how WE came to be a country NOT colony.
And if it’s NOT the case, then WHY do the leftys in the country keep saying Bushitler, was Bushitler? That he was the leader of a money hungry, tax stealing conservative cabal?
That he lead jack booted thugs.
It can’t be a fact before Jan 21st, 2009 and a myth afterward.
Your memory is short of even your own comments here concerning governments.
The ultimate question here is where does the U.S. Government get the power to do MOST of what it does? There certainly isn’t anything legal that would allow them to take over health care. Providing it to the needy and aged is questionable, taking it over is constitutionally out of bounds.
There certainly isn’t anything legal that would allow them to take over health care. Providing it to the needy and aged is questionable, taking it over is constitutionally out of bounds.
Legally, Congress can regulate interstate commerce under Article 1, section 8 of the Constitution. The insurance portion of health care, controlled by nationwide companies, is clearly interstate commerce.
Regarding “governments gone wild,” yes, governments can go bad. Are you thinking ours will suddenly go bad too? Because I don’t see that happening in the foreseeable future.
Because I don’t see that happening in the foreseeable future.
Some people only see what they want to see.
Jim, please explain your ideas further.
Click my name for Arrow’s 1963 paper on the question. To summarize:
* No individual knows ahead of time what her future health care expenses will be; they could be from nothing to 10x median lifetime earnings.
* Since there’s a chance (but no certainty) of expenses being far greater than an individual’s resources, health needs have to be covered by insurance, in order to spread the risk.
* Since an insurance company, not the consumer, is paying, you have three parties making decisions on what to buy: the patient (who wants to be healthy), the insurance company (which wants to save money), and the doctor (the only one with medical expertise and detailed knowledge of the patient’s condition).
Given all that, the normal rules of economics fly out the window. I may want a nicer car but I won’t buy it because I’d rather have the money to spend on other things. But if I want an MRI in case it will explain my back pain, why shouldn’t I insist on getting it? It won’t cost me anything. I’ll buy a car from dealer A instead of dealer B because dealer A offers a better price. I have no idea where I might get a cheaper MRI, and don’t care all that much because I’m not the one paying. My insurance company is motivated to reduce costs, but doesn’t particularly care about me. So it will try to cancel my policy if I get too expensive, or keep me from getting expensive treatment even when it’s medically called for. Standard economics does not provide a way to balance the different interests at play.
The fundamental problem in this country is that we attempt to treat health care as being fundamentally exempt from market forces and cry foul those market forces react in very predictable ways to such ignorance.
No, the fact that health care works at all in the U.S. is due to government regulation. There is no example of a successful free market health care system — none. There are numerous examples of heavily regulated or socialized health care systems that deliver good results, including some in the U.S. (e.g. the VA and DOD systems).
That’s exactly what Medicare has been doing since 1964. It hasn’t driven out choice of doctors or care, nor has it driven away private insurance for seniors, including Medicare supplement policies.
Actually, Medicare has driven out choice of doctors for many people. Every year or so, Congress “saves Medicare” by cutting reembursement to doctors. Every year, more doctors refuse to accept Medicare patients. If your doctor will no longer subsidize Medicare patients by accepting the low payments, then you’ve lost your choice in doctors.
If someone has the right to put a gun to my head and make me work for them without compensation then that’s slavery.
Anytime someone wants to claim a “right” that requires others to pay for it that’s slavery. Everyone has a duty to support the operation of government, courts, defense, police, schools etc… they are shared responsibilities.
When government decides it wants to branch out into wealth redistribution its branching out into slavery.
This sentiment echos Lincoln’s words from the Lincoln-Douglas debates:
“It is the eternal struggle between two principles, right and wrong, throughout the world. It is the same spirit that says ‘you toil and work and earn bread, and I’ll eat it.’ No matter in what shape it comes, whether from the mouth of a king who seeks to bestride the people of his own nation, and live by the fruit of their labor, or from one race of men as an apology for enslaving another race, it is the same tyrannical principle.” [Lincoln-Douglas debates, 15 October 1858]
The history of the 20th century is that with a road paved with good intentions the socialist gathered the reins of power within an over reaching centralized government. It was only a matter of time that a fascist would rise up and utilize that centralized power in ways the socialist could barely conceive of.
Jim, are you kidding? There’s no claim for governments going crazy or standing on the backs of the citizens?
There’s no evidence for the claim that the U.S. government would set up panels that rule on whether your Downs baby or 80 year old grandmother is deserving of medical care. If you think the U.S. government is capable of that, and that none of the checks and balances of our system would prevent it, then there isn’t anything I can say to change your mind.
I just marvel at the fact that you let this same government build nuclear weapons.
According to Planned Parenthood, 79% of women don’t have abortions.
What’s your point?
To recap: Glenn Reynolds and Rand are worried about government health care resulting in special treatment of political favorites, and discrimination against political opponents. They are worried about this despite the fact that they can’t come up with any examples of it happening in Medicare, or in the other socialized medical systems around the globe. They are smug in their certainty that “the market” does not discriminate against consumers based on their politics.
I was just pointing out that in fact “the market” discriminates all the time, and the unavailability of legal abortion services in the counties that contain 1/3 of American women is one example. The fact that most women don’t get abortions is a total non-sequitur.
because someone in government thinks your political views are “un-American.”
Just a note: Pelosi and Hoyer did not describe anyone’s views as “un-American.” What they wrote is:
Do Glenn and Rand disagree?
I think statism is un-American.
Do Glenn and Rand disagree?
Yes. It is rude, it is boorish, but it is not un-American. If it is, then a lot of leftists on college campuses are un-American, when they drown out conservative speakers. And SEIU is un-American, when it sends out memos telling its members to “drown out voices.” What does Nancy (and Jim) think about them?
There’s no evidence for the claim that the U.S. government would set up panels that rule on whether your Downs baby or 80 year old grandmother is deserving of medical care.
So, you honestly believe that panels won’t be set up to determine what treatments are covered by Obamacare and which are not? Furthermore, there are close advisors to Obama who advocate that not just the cost of the treatment be examined, but the value of the person to society be calculated as part of the equation. Look up Ezekiel Emanuel and Communitarianism and tell me this won’t be the case.
The problem is not that such “cost/benefit decisions” aren’t made everyday within the health industry, but that a faceless, unaccountable government bureaucracy would be in charge of the decisions is what’s scary. The citizen will have no recourse and the opportunity for evil will be overwhelming. Of course the politically connected will have no problem getting treatment, but the rest of us un-Americans would be screwed.
But I’m willing to bet you’re going to keep trying. Your main argument to date appears to be “Hey, we already have single-payer in the form of medicare. We’re just extending it, that’s all!”. And some crap comparisons with regulation of supermarket meat counters. Entertaining if nothing else Jim, keep it up.
There’s no evidence for the claim that the U.S. government would set up panels that rule on whether your Downs baby or 80 year old grandmother is deserving of medical care.
No evidence, right? How about Obama’s own proposal:
Speaking from the White House Friday, Mr. Obama said he has given Congress a proposal that should “bend the cost curve so we’re not seeing huge health care inflation.”
“I’m actually confident they may adopt these proposals,” Mr. Obama said.
The White House has proposed establishing an independent, non-partisan commission of doctors and other health experts to oversee the costs of Medicare. White House Budget Director Peter Orszag described the proposal in a letter (PDF) Friday to Pelosi and other Democratic leaders.
An existing group called the Medicare Payment Advisory Commission already produces yearly reports with ways to bring down costs, but the group’s report is only advisory and “ends up sitting on a shelf,” the president said.
“We want to force Congress to make sure they are acting on these recommendations to bend the cost curve each and every year,” Mr. Obama said. “We need an independent group that is empowered to make these changes, and that’s something we’ve proposed.”
“I’m confident if we work with the foremost experts in the field we can find a way to eliminate waste (and) slow the growth of costs,” he added.
The whole purpose of the panel is to determine the allowable treatments for different ailments, as Obama stated here:
“In terms of these expert health panels — this goes to the point of ‘death panels,’ that’s what folks are calling it — the idea is pretty straightforward,” Mr. Obama said. “We’ve got a panel of experts — health experts, doctors– who can provide guildelines for what procedures work best… These aren’t going to be forced on people, but they will help guide how the delivery system works so that you are getting a higher quality of care. And it turns out higher quality care often costs less.”
And denying care can cost even less.
Any more lies, Jim?
Any more lies, Jim?
Judging from history, I think we can safely expect them to continue.
Lets replace the words “Health Care” with “The Church”.
Studies show that Prayer and meditation can improve the quality of life for a person. However, the Federal Gov’t Church will only prescribe to a Tantric meditation ritual that has been show most effective at healing the soul from the least amount of dollars. So, therefore tax payer money will be used to create a network of Federal Prayer centers to which everyone must choose to be a part of. If you already like your church, you can keep it. If you don’t have a church, we will provide one for you. In order to sustain the cost of these meditation centers all tax exempt purchases by existing churches will unfortunately need to be revoked. Don’t worry though, your attendance to the Federal Meditation Centers will be free and mandatory. Knowing that there are a multitude of denominations that have a variety of views as to how to attain immortality and spiritual prosperity we must create an all inclusive non-denominational spiritual advisement council. This council will see to examining all the methodologies to enlightenment and will serve to coalesce these multiple viewpoints into a single coherent path to everlasting salvation.
May a nonexclusive deity of your choosing endow a mutually agreeable favor on these United States.
I was just pointing out that in fact “the market” discriminates all the time, and the unavailability of legal abortion services in the counties that contain 1/3 of American women is one example.
That’s a rather pointless argument when 4/5th of American women are not interested in that service from the market.
The fact that most women don’t get abortions is a total non-sequitur.
You write that because you don’t understand markets. If no one is interested in a service, then there is no market for that service. So the fact that 1/5th of women are in the market explains why a service is limited to availability to about 2/3rd of women. That means there is an abundance of supply. Or is your point that we have too much supply, and Obamacare will cut back on that supply to help lower healthcare costs?
The non-sequitur is the part about counties. Are you suggesting women can’t cross county lines to get an abortion?
McArdle is only puzzled because she seems to think that health care is like “any other good.” It isn’t. That’s health care economics 101.
With a grade of “F.”
Special interest groups often claim they are “special” and the laws of economics don’t apply to them.
Mark Whittington thinks the laws of economics don’t apply beyond Low Earth Orbit.
Jim thinks they don’t apply to health care.
We can’t repeal the laws of economics any more than we can repeal the law of gravity. They apply to everyone, those who choose to believe in them and those who don’t.
Rand – no, the point of the advisory panel is to determine what treatments are effective, not who gets them. Right now, the company proposing the treatment pays for studies to show its effectiveness. You should be able to see the problem with that.
Josh Reiter – let’s not replace health care with the Church, unless you can scientifically prove people have souls. (I think they do, but can’t prove it.)
Leland and Jim – in a country in which people shoot abortion providers and blow up their clinics, do you really want to argue that “market forces” drive clinic locations?
I think that drowning out people you disagree with is un-American, whether it’s done by tea partiers, birthers, SEIU, Code Pink, campus leftists, or whomever.
I just marvel at the fact that you let this same government build nuclear weapons.
Jim, do you not understanding the difference between nuclear weapons, which are not supposed to be affordable and available to the average citizen, and health care, which is? Or are you just being inane?
Edward Wright – of course economic laws drive health care. Right now, those laws drive private insurers to:
1) Not insure sick people
2) Overcharge currently healthy people
3) Underpay for treatment
Unless you own an insurance company, these are not favorable to you. Adding a public option forces the private sector to make their services more attractive to you.
While Rand and Glenn worry about the well-connected getting special favors from government health insurance, it’s already happening in the private sector (click my name for the whole article):
Jim, do you not understanding the difference between nuclear weapons, which are not supposed to be affordable and available to the average citizen, and health care, which is?
Yes. I do not understand the world view of someone who is certain that our government has the moral judgement to possess nuclear weapons, but will nonetheless euthanize its own citizens at the drop of a hat.
You write that because you don’t understand markets. If no one is interested in a service, then there is no market for that service. So the fact that 1/5th of women are in the market explains why a service is limited to availability to about 2/3rd of women.
And you really think that the women who want abortions all happen to live in the counties where they are available? How naive are you?
To take one example, Wyoming only has two abortion providers (as of 2005), so 96% of Wyoming women live in counties without one, and many Wyoming women who visit those two clinics travel over 100 miles to do so. Supply isn’t low because demand is low; supply is low (and falling) because of politics.
Any more lies, Jim?
You haven’t shown any yet. As Chris points out, IMAC is a non-political effort to improve the cost/benefit ratio of Medicare spending. Might that make it harder for doctors to get reimbursed for treatments that have been scientifically shown to be ineffective? Yes. Will it mean that a group of people will get together and pass judgement on whether a particular patient deserves to live or die? No.
Anyone complaining as much as Rand does about Medicare’s fiscal crisis should welcome IMAC with open arms. But I suspect Rand would rather do away with Medicare than fix its problems.
The problem is not that such “cost/benefit decisions” aren’t made everyday within the health industry, but that a faceless, unaccountable government bureaucracy would be in charge of the decisions is what’s scary. The citizen will have no recourse and the opportunity for evil will be overwhelming. Of course the politically connected will have no problem getting treatment, but the rest of us un-Americans would be screwed.
You think the health insurance industry is accountable? You think that 40+ million aren’t getting screwed right now? Open your eyes.
Jim, you are appearing stupider by the post. If we can believe this page, a grand total of seventy women got abortions in Wyoming in 2005. That’s an average of less than one woman per week per clinic. How many more clinics do you think that Wyoming needs, again?
Yes, it’s unfortunately a fact of life that when there is little demand for something, there will be correspondingly little supply. How much of the taxpayers’ dollars to set up a clinic, whose staff will spend most of the time sitting around waiting for a customer, should we provide to ensure that women who choose to kill their babies don’t have to take a trip to do so?
I find it fascinating that you would choose this particular medical procedure, of all the possible ones, to display your monumental economic ignorance. It doesn’t engender much sympathy for your cause. But then, you think it’s no problem to call your political opponents un-American.