Ezra endorses this comment by one of his readers:
Another advantage of government funding over philanthropic funding is the theoretical ability to do better macro level allocation of resources. If you have, say, 10 billion dollars in one bucket you can have a team of experts figure out the optimal allocation of those resources across a broad range of needs, whereas if that 10 billion dollars is private charitable giving the allocation will be made in chunks of hundreds, thousands, and millions of dollars by individuals who can't see the big picture. Restricted money for sexy causes is a lot easier to raise than unrestricted money for more general and less sexy purposes, and individual organizations and donors allocate funds according to their own interests. So you get things like disproportionately large amounts of money for in vitro fertilization research and disproportionately small amounts of money for free preventive medicine for the poor. Not that there's anything wrong with IVF research, but it ought to be a lower priority compared to other things. It's not the fault of the charities or the donors that this misalocation happens, but it's a problem nonetheless.
Interestingly, this is exactly the argument that was offered for why socialism would be better than capitalism. I don't find it ridiculous; indeed, in 1935, I'm sure I'd have found it incredibly compelling. It took a genius like Friedrich Hayek (and ultimately, the collapse of the Soviet Union) to show why giant national solutions rarely outperform a competitive market.
The problem, it turns out, is that the central planners with the big picture have to design one-size-fits all programs that by their nature have more error built in because they don't have good local information. Also, when the planners make mistakes, as they inevitably will, those mistakes are bigger. They are also harder to detect because again, the planners have a much poorer grade of information about what is happening on the ground than local players do. And because there's no competition, there is no one to grade your performance against, and also, much less incentive to fix mistakes--particularly since those mistakes tend to generate constituencies devoted to protecting them. (See subsidies, farm.)
I'd say in most cases, charity is best provided as far down the government food chain as possible, or privately, where both the information and the incentives are better. The Federal government is like an aircraft carrier: a huge, ponderous weapon that needs a whole lot of special conditions to operate efficiently. People who want everything Federalized do so because they want the "best" weapon trained on the problem. But biggest is not the same as best. Sometimes, an aircraft carrier is the only thing for the job. But often a tiny little cruise boat that can go farther and faster, and bug out when needed, is much better suited to the task at hand.
Interestingly, this is exactly the argument that was offered for why socialism would be better than capitalism.
Or why intelligent design works better than natural selection.
But for some peculiar reason my natural mohair skins for my skis work better than anything synthetic.
It also seems that mellons are best preserved by leaving the rind on rather then dicing them up and putting them in containers.
When the problem solving agency is a big institution, only big problems get addressed. Little problems which could have been addressed by small programs or local action go unsolved until they become big problems. The system feeds problems, not solutions.
Do Hayek's critiques of centralization also apply to large private entities like Walmart? Because most large corporations that I'm familiar with are run with tightly centralized control.
Turbulence:
Wal-Mart is not a monopoly, if they are failing to meet a need go ahead and start to compete. And, if they are failing, they will shrink down to size.
Yes, Turbulence, they do, but the key is that if Wal-Mart does not please enough customers or suppliers of additional capital, Wal-Mart is atomized, and all human and financial capital is redistributed throughout society. In contrast, bureaucracies which can use state power to compel people to supply more capital, no matter whether people wish to do so or not, are far less likley to have their human and financial capital redistributed. Enron and Montgomery Wards no longer exist, but the Bureau of Indian Affairs goes on and on and on.
Restricted money for sexy causes is a lot easier to raise than unrestricted money for more general and less sexy purposes
Certainly. But of course this applies to national politics as well-- do not pressure groups push for federal research money on "sexy causes" rather than more general and less sexy? AIDS funding over malaria? Ahem, medical insurance over preventing drug-resistant infections in hospitals?
Do Hayek's critiques of centralization also apply to large private entities like Walmart? Because most large corporations that I'm familiar with are run with tightly centralized control.
Certainly they face some similar obstacles, whcih is why large corporations are not as overwhelmingly powerful as certain left-leaning economists thought in the '60s. Megan's point is that they do, however, face feedback in the form of the price system and the market. Giant companies can decay slowly (or all at once, like Enron or Amaranth) because of bad decisions. Bad government programs are much more difficult to end.
I say this not because I think the planned economy aspect of socialism is extremely attractive or workable, but because continuing ignorance of socialism helps to perpetuate the myth that there is no reasonable alternative to "free markets"...
Any remotely reasonable version of socialism -- and there are a number out there! -- have central planning agencies that take care of the whole nation, but they also have a lot of power delegated to local councils. The broad details would be handled in a central location, by my understanding, but it wouldn't be required to build the whole system by itself. Rather, they would set certain parameters and allow local groups to work out the particulars.
This is again not to say that this is attractive, but straw-socialisms are obnoxious.
Mike, your advanced socilaism may work in theory, but what you call straw-socialism failed in practice.
re. straw-socialism -
And yet these local councils still have monopoly power within their communities, still report, ultimately, to the national authority, have little or no price feedback on their actions and do not take risks on experimental approaches due to a lack of incentives.
They are a great way, however, to splinter graft into a 'thousand points of darkness'.
The 'reasonableness' of this approach eludes me while the unattractiveness of central planning (both in terms of outcomes and personal liberty) remains.
Are there successful socialist models that still engage in central planning of industry? (anticipating a response, would you call Japan's MITI a central planner?)
I'm not sure that your analogy works. Capitalism works better than socialism because information is communicated through prices. The problem is, in charity, there's no real market-- there aren't prices to communicate how much good each marginal dollar could do for any given cause, let alone to reflect the values of individual donors. Due to the lack of (and perhaps the impossibility of) a market, it's not at all surprising that private donations would be inefficiently allocated.
The problems with government giving aren't that you're losing out on market mechanisms as you are when comparing socialism to capitalism. Instead, the problems are the simple lack of any reason to believe that government will provide a more efficient allocation of resources than private giving, and the complete disconnect between the allocation of government resources and individuals' valuations of various charitable expenditures (compounding the difficulty of any analysis of the efficiency of government resource allocation).
That said, if a single government contribution to philanthropy, research and development, etc, could be shown to be highly cost-effective (taking into account the deadweight loss from the taxation required to fund it), given the current level of private giving-- would you oppose it?
Which is not to say that donations do not often go to the slickest marketers or those able to confer the most status on the donor.
Most non-anarchists would. Obviously I don't spend a lot of time wishing international waterways were patrolled by private police as opposed to the U.S. Navy. This is something we do that is immensely valuable to us and the world.So, why isn't this occurring now?
Where's the team of experts in our Federal government figuring out the optimal allocation of our resources???
The problem, it turns out, is that the central planners with the big picture have to design one-size-fits all programs that by their nature have more error built in because they don't have good local information.
Saying, "Tsk, tsk; you clearly haven't read Hayek" is a stock response that is sometimes true and sometimes not.
If I argued that defense against foreign enemies should be the responsibility of city governments because Boston, Providence and Hartford each face threats unique to those localities that a one-size-fits-all national defense program simplay can't address, people would think that I was a lunatic. There is no meaningful difference between those localities for purposes of national defense. Even if there were any differences that you could point to, they would be dwarfed by the manifest efficiencies of providing defense against foreign enemies on a national scale.
Arguing that Hayek proves (e.g.) that Ezra Klein is wrong to think that a national single-payer health care scheme is workable amounts to the same thing. The French have a national single-payer program. We have a national single-payer program covering seniors (Medicate). It's clearly workable to do it. If you want to claim that he's wrong because we'd lose some valuable advantages based on tailoring to local needs, you'd have to start by being at least a little more specific about what you think those advantages are.
To be fair, Hayek's criticism applies much better to the broader economy than it does to charity. The problem is that most people don't really donate to charity rationally. They do it to feel good about themselves, and they seem to derive that good feeling from the act of giving, not from the amount of good their donation actually does. So the incentives for charities to heal the world's ills aren't nearly as strong as the incentives for businesses to serve the desires of the customers.
The same is true of government, of course--people vote at least as irrationally as they donate, and largely for the same reasons--so Klein's claim that government works better than private charity is not obviously correct. I just don't think that Hayek's argument necessarily works very well here.
alkalki wrote: If I argued that defense against foreign enemies should be the responsibility of city governments because Boston, Providence and Hartford each face threats unique to those localities that a one-size-fits-all national defense program simplay can't address, people would think that I was a lunatic. There is no meaningful difference between those localities for purposes of national defense. Even if there were any differences that you could point to, they would be dwarfed by the manifest efficiencies of providing defense against foreign enemies on a national scale.
So is this to say that Boston, Providence, and Hartford don't face threats sufficiently unique to require municipal police forces, and that MA, RI, and CT don't need regional or state police forces or statewide national guard units, because any threats these areas face can be handled by divisions of the US military?
That's closer to what MM is arguing against IMO. Central planners would be the ones trying to apply US military units to all matters of security and law enforcement, while in fact in the real world, these needs are served much better by several agencies comprised of varying structures, jurisdiction, and accountability to the citizens they serve.
By 'rational" do you mean it as in rational choice theory? I do not believe strict rationality of consumers is necessary for us to benefit from voluntary exchange. I'm not the world's Hayek authority, but I don't think he would describe perfect rationality as necessary either.
anony-mouse: My point is that sometimes the "local entities have more information about local situations" is a valid objection to central planning, and sometimes it's not. It depends on the particular facts. That the Department of Defense coexists with other military and law enforcement agencies proves the point.
Not to throw OT bombs, but do you suppose handling natural disasters such as hurricanes and wildfires should fit into Alkali and anony-mouse's discussion?
Sorry, just stirring the pot.
alkalki: so basically, you are in agreement with MM's position (and mine, actually)? Sometimes things do need to be solved at the macro level, and sometimes small solutions are better?
Mindless Dreck, from where I stand watching NGOs work in Vietnam, Matthew is exactly right that there is no mechanism akin to prices for communicating the effectiveness of spending to donors; and your claim
There is a strong feedback system and charities that are deemed corrupt and ineffective suffer in reduced donations.
is wrong. Far and away the most important criterion for an NGO's ability to garner more donations is the strength of its advertising campaigns and political connections. NGOs are (sometimes) punished by donors when they are found corrupt. They are rarely punished for being ineffective. The donor priorities are set far away, in Washington or New York or Paris, and the money sloshes in and pours towards those who know how to fill in the forms and schmooze the key people. Huge amounts are spent showing off Potemkin Villages to visiting donors; donors somehow rarely complain about how much is being spent to bring them to see the projects. Statistics are compiled in meaningless fashions which allow the programs to claim huge achievements (number of beneficiaries "reached", for example, or number of cases of illness "prevented"). And with hundreds of different organizations sloshing around trying to make their own donors happy, it's almost impossible to coordinate with the priorities set by public health authorities. "We have a program to help HIV-positive drug users in Mudville!" "What? No, WE have a program to help HIV-positive drug users in Mudville! Who're your members? Wait -- they're the same as ours! You stole our members!" "Well, our donors wanted to see we'd reached a lot of beneficiaries, and..."
You could say the answer is to donate to projects that are local, so you can see the benefits. That's great, and it's a good idea. But for obvious reasons, the poorest areas have fewer donors.
The difference between philanthropy and consumerism is fundamental: buying stuff for yourself works differently than giving it to others. Anyone who's ever tried to figure out whether their daughter REALLY likes the gift they gave her can see this. The rules that apply in the capitalist economy do not always apply in building social safety nets or in philanthropy. NGOs and charities have a role to play, but government is also indispensable. You can't get around complexity here.
alkali,
Your comparison of health care to national defense is specious. National defense is clearly a public good. That is, "consumption of the good by one individual does not reduce the amount of the good available for consumption by others; and no one can be effectively excluded from using that good." As such, and for certain reasons, it makes sense to fund national defense through involuntary taxation.
But this is obviously not true of a nation's health care system. The only parts of the health care system that qualify as public goods are those that fall in the realm of public health. This includes things like clean drinking water, a safe food supply, air pollution standards, consumer product safety standards, and so on. But the vast majority of goods and services provided by a nation's "health care system" are not like this. The primary beneficiary of a health care intervention is the individual patient and his immediate family, and it is obviously possible to exclude individuals from those benefits.
And yes, single-payer systems can be "workable." That doesn't mean "better."
Do Hayek's critiques of centralization also apply to large private entities like Walmart? Because most large corporations that I'm familiar with are run with tightly centralized control.
Posted by Turbulence | October 24, 2007 10:29 AM
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Actually, the most successful large corporations have strong reporting and communications systems, but allow local managers some autonomy to deal with local conditions and innovate. They use that system to communicate successful innovations - "best practices" - throughout the organization. It was certainly like that at GE when I worked there and from what I understand Walmart does much the same
Mixner, the definition of public good you're using excludes a very large number of things that have always been thought of as public goods. For example, I don't understand how consumption of clean drinking water by one individual does not reduce the amount of clean drinking water available for consumption by others.
In any case, universal health insurance is a public good under your criteria, in the sense that one person's use of the protection against having no access to health care does not reduce anyone else's protection against having no access to health care. What is being promised here is not a whole lot of eye surgery. Instead, what is being promised is a universal guarantee that should anyone ever need eye surgery, they will get it, without having to go into financial ruin. That guarantee does not need to be a scarce commodity; there are enough eye surgeons to go around. Countries with universal insurance do not, in fact, have longer waiting lists, mythology to the contrary.
As to whether it would be possible to exclude some from the public good of universal insurance, in this question that is a meaningless distinction which depends on the design of the program. If you make it universal, no one can be excluded.
anony-mouse writes:
alkali: so basically, you are in agreement with MM's position (and mine, actually)? Sometimes things do need to be solved at the macro level, and sometimes small solutions are better?
I suppose that's one way of putting it, although my intention in responding to MMcA was to point out that asserting that central planning is not responsive to local conditions is just the start of the analysis. In particular, if you are asserting that responsiveness to local conditions is really important with respect to a particular issue, that presumes that there really is important local variation in conditions with respect to that issue.
Mixner: the point I was making had to do with the relative merits of centralized vs. decentralized control, not whether something should be funded through taxes or paid for by individuals, which is a separate issue.
brooksfoe,
Mixner, the definition of public good you're using excludes a very large number of things that have always been thought of as public goods. For example, I don't understand how consumption of clean drinking water by one individual does not reduce the amount of clean drinking water available for consumption by others.
You don't understand the definition. It's not the "consumption" of drinking water that's a public good, but the things the government provides to ensure a safe water supply (aqueducts, sewers, water treatment plants, etc.). The national defense is also like that. The health care system is not.
In any case, universal health insurance is a public good under your criteria, in the sense that one person's use of the protection against having no access to health care does not reduce anyone else's protection against having no access to health care.
You're still confused. The issue is: Is health care a public good? By "health care," we mean the goods and services typically provided by a nation's "health care system." These include consultations with physicians, diagnostic tests, pharmaceutical drugs, surgeries, that sort of thing. These goods and services obviously do not meet the definition of public good. They are rival and excludable, not non-rival and non-excludable.
What is being promised here is not a whole lot of eye surgery. Instead, what is being promised is a universal guarantee that should anyone ever need eye surgery, they will get it, without having to go into financial ruin.
First of all, there is no clear line between "needed" and "unneeded" eye surgery. Eye surgery may be clearly beneficial, but whether it qualifies as "needed" depends on the definition of "need." I am sure there are various kinds of eye surgery that would benefit many citizens of nations with "universal health care," but that those health systems do not provide because they are deemed to be too expensive or not worth the cost. And second, "universal health care" is clearly no guarantee against "financial ruin" due to illness. Most of the costs arising from an extended period of serious illness are not direct medical costs (the kind of costs that would be covered, in part at least, by "universal health care"), but indirect costs arising from lost income and other effects of the illness. If you seriously believe that Canadians and Britons never face "financial ruin" from an illness, you are seriously mistaken.
brooksfoe,
Countries with universal insurance do not, in fact, have longer waiting lists, mythology to the contrary.
You mean just for eye surgery, or for health care services in general? There is abundant evidence that countries with "universal insurance" have longer waiting lists for health care services than the U.S. does. And this includes waits for both non-critical "elective" services, and critical, potentially life-saving ones.
Actually, isn't the guarantee actually that the payment for eye surgery will be covered?
That's all insurance does after all.
And how come I keep hearing about a shortage of RN's, and how we're having to recruit overseas to fill positions here?
Brooksfoe- I have unfortunately seen much of what you describe here. In fact, between the two organizations I referenced above.
But I would hardly describe this as exclusively a private sector phenomenon. The provision of food Aid to Mobutu's Zaire is a good place to start as a failed government aid program, and one that crowded-out private aid programs (as much Mobutu's doing as ours).
As for complexity, I'm more used to seeing that as an argument in favor of distributed voluntary exchange, since it makes the planning fallacy all the more likely to govern.
sorry, went to do some actual work and now my comment is out of sequence.
Brooksfoe, what is the alternative to NGO's in Vietnam? The government of Vietnam? The NGO's you're talking about are distributing aid from other countries inside Vietnam. I thought this was a discussion of how to fund/manage social programs in the US, through charities and voluntary contributions or through taxes and the government.
International aid and intervention is another whole topic with completely different issues.
EI
You're still confused. The issue is: Is health care a public good?
And I say, no, the issue is: is health insurance a public good? The US is not proposing a National Health Service, a la Britain. It is proposing various ways of reforming the health insurance system, a la France, Germany, Scandinavia, Japan, etc.
So what do you say? When I have more health insurance, does that mean there's less health insurance to go around for everyone else?
On the waiting lists issue, well, the studies I've seen show there aren't longer waiting lists in France than in the US. So, we disagree.
EI, they're different, but not COMPLETELY different issues. NGOs in Vietnam, like those inside the US, are faced with the choice of pleasing their donors or of working in the context of public health systems and priorities set by the government. One of the bugbears of public health is the issue of "parallel systems", where NGOs set up their own clinics that do substantially the same things as government clinics do; but the services provided by the NGO clinics are fickle and donor-dependent, so they may be much better at first, and then abruptly disappear, stranding their beneficiaries. In the meantime they suck community attention away from the government services. They may also enlist beneficiaries in programs and systems that actually conflict with the government systems. One or the other may be better, but usually everyone is better off if there's more coordination. But getting more coordination can conflict with NGOs' desire to present what they're doing as special and unique, to gain donor support, since donor appeal is a lot like advertising -- what makes your product different?
I think we're all arguing about the details here. Everyone agrees that government and NGOs both have a role to play. But from where I stand, what's going on at the moment is more and more outsourcing of government responsibilities to donor-dependent NGOs in the belief that they're closer to people on the ground, without any recognition that they're often much more responsive to donor concerns than to beneficiary concerns. Governments are partly insulated from the bad kind of donor pressure because they have reasonably assured budgets. The down side of that is that they feel less pressure to work hard. But everything has its ups and downs. A lot of people in government are very dedicated, caring and hardworking, and they have the power to make long-term investments without worrying that a rich donor will pull the plug.
brooksfoe,
The thing you keep missing is that there are never an unlimited supply of physical goods or services supplied by others.
You wrote:
The answer to your question is, everything else being equal, yes. Insurance itself is not an unlimited item, and if one person consumes more of it, then there must be less for everyone else.
Health Insurance is very much a public good. Under the current system if people don't have Health Insurance they go to the Emergency Room, an expensive, inefficent way to get treatment for the most part, they can't pay and the costs get passed on to all of us. Also, not having Health Insurance causes people to wait until things are really desperate before going to the Emergency Room which also makes the costs higher.
brooksfoe,
And I say, no, the issue is: is health insurance a public good?
What is the purpose of health insurance if not a mechanism for providing health care?
And health insurance obviously isn't a public good, either, anyway. It is rival (money spent on health insurance for person A cannot be spent on health insurance for person B) and it is excludable (it can be withheld from any individual).
The US is not proposing a National Health Service, a la Britain. It is proposing various ways of reforming the health insurance system, a la France, Germany, Scandinavia, Japan, etc.
Various people are proposing various different reforms. Some people are proposing drastic reform to create a single-payer system similar to that of Canada. Others are proposing more modest reforms to reduce the number of uninsured in various ways. What reform are you proposing, exactly? What is your health care plan?
On the waiting lists issue, well, the studies I've seen show there aren't longer waiting lists in France than in the US. So, we disagree.
France seems to compare fairly well with respect to waiting lists (unlike, say, Canada and Britain). But France's health care system has other serious problems, most importantly the fact that its public insurance fund chronically runs huge deficits.
The line between national insurance and national healthcare is perilously thin. Consider the amount of coercion Medicare commits to keep doctors in system and following their guidelines. Medicare even attempts to control (and has in the past dictated) the investments held in hospital captive insurers through the HCFA guidelines. Medicare guidelines determine an enormous amount of what's available to all patients, particularly in hospitals. That's one of the reasons we all have to acknowledge we are a long way from a market-based system today.
And if proponents of universal healthcare and politicans can conflate insurance with healthcare (the famous 48 million) why can't opponents conflate it as well? (just joking)
Government coercion is efficacious, not efficient.
Hey Brooksfoe, how come you trapped yourself?
Isn't this an accurate description (including dollar amount) of what the Bill and Melissa Gates Foundation does?
When Conservatives ruled Britain, they did privatize a lot of things, but not healthcare. British system delivers decent health care for the least amount of money among highly developed nations. As Conservatives gave a priority to cutting taxes, they had to stick with NHS, tweaking it a bit.
During recent elections in Central Europe a rightwing party was accusing the centrist party of planning to privatize healthcare, leading to horrors that well-travelled people know from USA. Right wingers lost, but mostly because of very clumsy attempts to introduce a police state, but centrists have to be in coalition with left-of-center guys who are also against privatization.
Multi-party systems has its advantages, not the least of them is the difficulty in introducing a police state. By the way of comparison, GOP had easy time stacking courts with statist judges and politicing prosecutors. If moderate Republicans were a separate party, and the ultra-Evengelicals another separate party, it would be much harder.
Back to healthcare. So Medicare imposes certain limits on the entire system. But on whom? Consumers have no idea what is good for them, and big health care organizations are bargaining with big service providers and they design very intricate rules, and consumers who ostensibly may choose among health care organizations and plans basically have no means how to compare the price and quality of various options.
So it may happen that you are not sick enough to stay in a hospital, to sick to be accepted by a hospice, and unable to afford home care. You are also oscillating between acute pain and morphine and all the complicated choices are incomprehensible, but required.
Before you end up in this sorry state, you may want to review your insurance options, but good luck if you can understand the consequences of your choices. A lot of it how the health care organization interprets rather vague rules.
I'm going to come back to this "public goods" issue one more time.
As I said earlier, many things which are universally considered "public goods" do not meet the criteria Mixner provides. Let's take public parks. Consumption of the public park by one person does reduce the amount of the public park available to others to use, as anyone who's been in Central Park on Puerto Rican Pride Day can tell you. And it is possible to exclude people from using the park; in fact, when Central Park opened in the 1870s, it was reserved for people in horse carriages. Only public pressure forced them to allow the hoi polloi to walk in. At other times, parks have excluded blacks and Asians. Public playgrounds often exclude adults without children. Public schools flagrantly do not meet the first criterion; at different times, they've failed to meet the second, too. As for national defense, in countries which face security threats from two enemies, it is certainly possible for one person's enjoyment of national defense (against the Redcoats, say) to come at the expense of another person's national defense (against Indians). And when Israel decided to evacuate Gaza, the settlers who left unwillingly certainly would have argued that they had been excluded from the national defense.
One might say, "well, if a public park excludes some people, then it isn't really public." Okay. This implies that when you do make it available to everyone, it becomes a public good. Does this remind you of something? Universal health insurance, perhaps?
There are only a very few "public goods" that actually meet Mixner's criteria. Clean air and absence of infectious disease come to mind. But everything else which we consider a "commons", including the commonly held grass meadow in an old English town which gives its name to the term "commons", is a commons not because of some ineffable property of the thing itself but because of the social and legal rules which make it a commons. A commons is a commons because everyone is allowed to use it. The problem this creates is one of investment: no one but government will invest in improving the commons, because no one user of the commons can stop all the other users from exhausting his investment.
No one but government can create a universal guarantee that every American will always have health insurance -- that no matter how poor you are, you will never be unable to afford to have your finger sewn back on if you accidentally cut it off with a circular saw, or to have a bullet taken out of you if you show up at a hospital with a gunshot wound. Even today, your guarantee of being treated for a gunshot wound is a government-supplied public good -- it is government that mandates that hospital emergency rooms must treat all comers. Of course it's possible to decide not to have this public good. All other wealthy countries have the public good of universal health insurance, while we do not. And many poorer countries do not mandate that hospital emergency rooms must treat all comers; they don't even have that public good. Countries can always decide not to treat health insurance as a public good, and not to make it available to everyone. And English towns can decide to take that green square and sell it off to a private real-estate developer, in which case they would no longer have a commons.
"If you have, say, 10 billion dollars in one bucket you can have a team of experts figure out the optimal allocation of those resources across a broad range of needs."
This strikes me as a remarkably naive view of how government actually works. For example, government has a huge pot of money for building roads and infrastructure. It is not distributed in an optimal manner. It is distrubuted according to political power. That is why the federal government spends money on the bridge to nowhere. Why would anyone think that government controlled charity would be any different?
An even larger problem is how would one define an optimal allocation of charitable giving. That would depend on the value systems of the individual contributors. One obvious example: is access to abortion for poor people a good or bad use of public charity? With government controlled charity, the values recognized would be those of the majority. This certainly would result in a less than optimal allocation from the viewpoint of anyone in the minority. In all likelihood, everyone would be in the minority on at least some aspects of public charitable spending. A private system of charity allows each individual donor to optimize the allocation of charitable giving in accordance with his own values. This could never happen in a centralized model.
brooksfoe,
you have been totally discredited from having any intelligent discourse because you fail to comprehend the most fundamental base axiom of economics with respect to tradable goods.
People trade real goods and services. Money, stock certificates, bonds, insurance policies are all accounting gimmicks to that effect.
Don't even start in with public parks gibberish.
Mark,
apparently the last 600 years of capitalism is just an accounting gimmick.
You're an essentialist. 100 years ago, you would have been a Marxist.
"If you have, say, 10 billion dollars in one bucket you can have a team of political experts figure out the optimal allocation of those resources to buy the most votes for the incumbents."
Fixed it for you.
Large-scale private charities will often fail, but government charity is practically guaranteed to waste most of the money collected from taxpayers.
brooksfoe,
No real-world good perfectly fits the theoretical definition of either a public or private good. Your claim about public parks also applies to, say, the national defense, or the national highway system, or the criminal justice system. But these goods are close enough approximations to the ideal for the definition to be meaningful.
The health care system, in contrast, does not even come close to meeting the conditions of a public good. Drugs and tests and surgeries are both clearly rival and easily excludable.
You say, "No one but government can create a universal guarantee that every American will always have health insurance." But that is not the issue. No one but the government can guarantee, say, building codes, or food safety standards, or consumer product safety standards. But that doesn't mean housing and food and consumer products are public goods. They are clearly not. We don't rely on the government to fund them, and we don't rely on the government to deliver them. The same applies to health care.
brooksfoe,
By the way, you didn't answer my question about what kind of health care reform you are proposing. What exactly is your health care plan? One of your goals seems to be "universal coverage." Why, exactly, do you consider this goal to be so important? How do you propose to achieve it? And what about funding? Are you proposing a radical reform of health care funding (single payer, perhaps), or just some tweaks to the existing funding system? Or what?
brooksfoe,
Suppose I were a commie with omnipotent powers of foresight. As all central planners claim to believe.
I would have to direct farmers to produce enough food to feed the construction workers who were building a factory that wouldn't be operable for another 3 years.
I would also have to direct farmers to produce enough food to feed my fellow apparachniks.
I wouldn't issue too many coupons and I would set prices just high enough so that markets clear.
Call me a commie if yeh wants. But I'd be a better commie than John Law was a capitalist.
Mixner,
none of the universal health insurance plans currently on the table in the US (Edwards's, Clinton's or Obama's) involve the government providing health care. All involve the government providing some public health insurance and regulating private health insurance, while health care itself continues to be provided by the same mix of public and private entities that supply it now. In practice, there's only one advanced economy that has literally nationalized the health care system and made all doctors government employees, and that is the UK. That system apparently has its merits and disadvantages, but it's not really the argument we're having in the US; everyone agrees that it's close to unthinkable that a system like that could get adopted in the US. What liberals in America want is coverage for everyone. Single-payer coverage, like Canada, is one option. A consortium of all public and private insurers which channels payment through a central regulated broker, like France, is another. Regulated private insurance backstopped by public insurance for everyone who can't get it, plus a mandate that everyone must have health insurance, like the Netherlands and Scandinavia, is a third. (Germany is similar but I think lacks a mandate, but for some reason they get within 0.2% of universal coverage so apparently it's not an issue.)
At the current stage of the argument, there is no reason to choose between these options. My understanding is that the French system actually works the best. But it may be harder to argue for in the US and involve a more difficult reform process. The Scandinavian and Dutch systems seem easier to implement in the US. Romney-care in Massachussetts is quite close to the Dutch system, as are the Edwards, Clinton, and Obama proposals. I and other liberals will be satisfied with any of the Democratic proposals; Ezra Klein certainly is.
Most libertarians on this blog seem to agree that America should be providing subsidized health insurance for people who are really poor -- i.e. Medicaid. In that case, what the whole argument comes down to, at the simple level, is whether we ought to regulate insurers (mainly so they aren't forced by market forces to exclude people or try to drop those who actually get sick), whether we ought to decouple insurance from employment so people can switch jobs without losing their coverage, and whether we ought to have a mandate that everyone must buy insurance. These are practical questions, and we could probably have a reasonable small-scale debate on them and avoid the theoretical donnybrook about whether health insurance is a public good. But if we must get into that, the point is that universal health insurance is a public good; if it's not public, it can't be universal, and vice versa.
The thorniest issue here may be the mandate. One way to look at this is that anyone who risks going without coverage even though they can pay for it, because they like their odds, is going to wind up sticking the public with a bill if they lose. So it's like motorcycle helmet laws: we don't allow you to take the risk, because we bear some of the cost. But in another sense, the public externality of people declining to insure themselves is much more direct: when healthy people don't buy insurance, they directly raise the premiums for everyone who does buy insurance, as the pool of the insured becomes less healthy. Not only are they running the risk that they'll get sick, be unable to pay, and wind up on everyone else's tab. They're also directly raising your bill if you do have insurance. This isn't like other goods; if I don't buy cheese, I don't raise the price of your cheese -- I lower it. Just another of the many ways in which the market in health insurance is different from normal markets, and requires different approaches.
p.s. One indication that liberal advocates of universal health insurance are not Communists is that libertarians think we will have trouble with the argument "Why not have the government provide food, then?" Communists, obviously, have no trouble with this argument; they respond, "Yes! The government should also provide food."
Okay, brooksfoe, let's go through the main points.
1. Universal health insurance is not a public good. Public good is a technical economic term with a particular definition. Universal health insurance simply doesn't meet the definition. Obviously, you believe universal insurance would be good policy but that's not the same thing.
2. Single-payer and quasi-single-payer proposals have essentially zero chance of being passed in the U.S. for the foreseeable future. The people don't want single-payer. The health insurers don't want it. The drug companies don't want it. The medical equipment industry doesn't want it. The doctors don't want it. Nobody wants it except a few naive paleoliberals. The three main Democratic candidates understand this, which is why none of their health care reform proposals is even remotely close to single-payer. It's not clear that any of them even propose a workable mechanism for achieving universal coverage. Assuming we have a Democratic president and a Democratic-controlled congress after the next election, you might be able to get some watered-down provisions of one or more of the proposals passed into law. But realistically, you're not likely to get much more than that. And then the issue will be off the table for another decade or more.
3. Your argument that the health insurance market isn't like "normal" markets makes no sense. Premiums for homeowners' insurance, renters' insurance, car insurance, life insurance, disability insurance, credit card insurance, mortgage insurance, and every other kind of insurance might also be lower if such insurance were universal. That's not a sufficient reason to make it mandatory. Ditto for health insurance.
Public good is a technical economic term with a particular definition. Universal health insurance simply doesn't meet the definition.
We've been over this three times already. There are at least two competing technical economic definitions of "public good". The one you used is worse; the other one has to do with whether a good has any negative externalities if the government purchases more of it. In any case, universal health insurance does meet the definition you provide. You keep going back and forth on whether you agree with this; each time you decide you disagree with it, you're making me explain it again. Go back and re-read the explanation I provided. Just like clean air, universal health insurance is not decreased when more people use it, partly because you have to understand what you mean by "using" health insurance: you're using it whether or not it's paying out to you. The purpose of insurance is not to give you money, it is to insure you against loss. A shipper who is insured with Lloyd's is not failing to use his insurance if his ships don't sink. Do you understand what I am saying? There are probably shippers who have paid Lloyd's ten million dollars and never received a single payout; were they dumb businessmen buying something they never used? Of course not. If I have a million-dollar liability insurance with Geico, and then you come along and also purchase a million-dollar liability insurance with Geico, the world supply of insurance is not decreased, and neither of our premiums will rise; Geico is insuring either of us against the odds of a payout, and your new premium covers the added risk. Insurance is not a fixed commodity, it's a calculation based on risk. All that is required to make this a public good that one can't exclude anyone from using is to ensure that everyone has it -- just like pretty much every other public good you can name. It is a public good if we decide we want it to be one.
2. Single-payer and quasi-single-payer proposals have essentially zero chance of being passed in the U.S. for the foreseeable future. The people don't want single-payer....The doctors don't want single-payer.
There's no reason for me to get into this debate, because I'm agnostic on the merits of single-payer Canadian-style systems versus multiple-insurer French or Dutch-style systems. But just to let you know, a large and active portion of doctors would prefer a single-payer system, and are lobbying for one. Their interest group, Physicians for Social Responsibility, has tens of thousands of members. Doctors generally dislike the current system; the billing system sucks and they have HMOs breathing down their necks and sometimes refusing payment. That community is sharply divided on this question. As for whether the public wants single-payer, people who have coverage are generally scared of what would happen if there were a change. This is a descriptive statement about the political situation; it's not an argument about which kind of system is more just or works better.
3. Your argument that the health insurance market isn't like "normal" markets makes no sense.
You started to make an argument, but then you didn't make it. Where is it?
Premiums for homeowners' insurance, renters' insurance, car insurance, life insurance, disability insurance, credit card insurance, mortgage insurance, and every other kind of insurance might also be lower if such insurance were universal. That's not a sufficient reason to make it mandatory.
Actually, depending on public choices, it is. Car insurance is, in fact, mandatory for anyone who owns a car, because drivers are likely to cause more damage than they can pay for. Health insurance is like that to the extent that people who don't buy it can cause the public a lot of damage if they become dependent on us. The fact that premiums can go down as the number of buyers goes up is another argument for it, and it's prima facie evidence that the market in health insurance is not like the market in, say, oil, where the price certainly does not go down when demand goes up.
And yet, I still have to have coverage for uninsured drivers...
So, what makes you think that, just because the government says, everyone must have health insurance, that it will make it so?
And how are illegal aliens, who generally don't have car insurance, going to be treated to "universal health insurance?"
brooksfoe,
There are at least two competing technical economic definitions of "public good". The one you used is worse; the other one has to do with whether a good has any negative externalities if the government purchases more of it.
No, there are not multiple definitions. The public good/private good distinction is defined in terms of whether the good is rival and excludable. You don't know what you're talking about.
Just like clean air, universal health insurance is not decreased when more people use it, partly because you have to understand what you mean by "using" health insurance: you're using it whether or not it's paying out to you.
Your statements are becoming increasingly absurd. If health insurance (not "universal health insurance") were not "decreased when more people use it," it wouldn't cost any more to provide health insurance to everyone than to provide it to a single individual. Health insurance, like health care, is obviously a rival good. Every additional individual who is provided with health insurance increases the cost, because it increases the risk that the insurer will have to pay on a claim. You don't seem to have the slightest understanding of what the word "insurance" means.
But just to let you know, a large and active portion of doctors would prefer a single-payer system, and are lobbying for one. Their interest group, Physicians for Social Responsibility, has tens of thousands of members.
PSR is a physicians' organization that lobbies on environmental issues. You're probably thinking of Physicians for a National Health Program. PNHP is a small, special-interest physicians' organization. The American Medical Association, the world's largest physicians' organization, is strongly opposed to single-payer. American doctors earn two to three times more than their Canadian and European counterparts. Under a single-payer system, they would stand to lose a huge portion of their current income. Ditto for other U.S. health care professionals, such as nurses and pharmacists. Your chances of ever persuading them to support single-payer are remote.
brooksfoe,
Actually, depending on public choices, it is. Car insurance is, in fact, mandatory for anyone who owns a car, because drivers are likely to cause more damage than they can pay for.
In general, the only type of car insurance that is mandatory is third party liability insurance. There is no mandate for drivers to buy insurance to cover loss or harm to themselves.
Health insurance is like that to the extent that people who don't buy it can cause the public a lot of damage if they become dependent on us.
We don't require people to buy either car insurance or health insurance. A person who is disabled or seriously injured in a car accident could obviously "become dependent on us" just as a person who is injured or disabled through disease. In neither case do we require people to buy insurance against this risk. The example of car insurance doesn't support your position, it contradicts your position.
So do all other common forms of insurance. A homeowner may incur losses of tens or hundreds of thousands of dollars from fire, theft, flood, storm damage or other threats. A worker may incur losses of tens or hundreds of thousands of dollars as a result of becoming disabled. A family may incur losses of tens or hundreds of thousands of dollars if its breadwinner dies. But we do not require people to protect themselves against these risks. Homeowners' insurance is voluntary, not mandatory. Disability insurance is voluntary, not mandatory. Life insurance is voluntary, not mandatory. So why should health insurance be mandatory? Why don't you tell us, as clearly and concisely as you can, precisely what difference you think there is between health insurance and all other forms of insurance that you think justifies a mandate on health insurance, but not on those other kinds of insurance.
Well, one might be able to look at the National Flood Insurance Program and find some interesting lessons...
Mixner, you're right: I confused a discussion of externalities with an alternative definition of "public good". It actually wasn't an alternative definition but a separate but related set of issues.
Okay, so, back in we go. Why don't you tell us, as clearly and concisely as you can, how universal health insurance can be rival or excludable. Pick a country with universal health insurance, and show me how health insurance in that country is a rival or excludable good.
I think this is now the fourth time that we have come back to the point that whether something is rival and excludable usually depends on whether an owner or government decides to make it rival and excludable. Are operating systems rival and excludable? Depends: Linux, or Windows? Is an art museum rival and excludable? Depends: is it private, or public? And so on.
Why is a kind of good in the health care field different from the same class of goods not in the health care field? Can you think of a reason? Well, why are doctors legally mandated to provide emergency care, while car mechanics are not legally mandated to provide emergency repairs? Why is losing your leg worse than losing your home? Why is dying worse than going bankrupt? Hmm, toughie.
brooksfoe,
Why don't you tell us, as clearly and concisely as you can, how universal health insurance can be rival or excludable.
I just did explain it to you. I don't understand why you don't understand the explanation. Health insurance is rival because money spent on health insurance for one person is not available to spend on health insurance for another person. They are rivals for that insurance. Each additional insured person increases the total cost of insurance, because it increases the risk to the insurer that he will have to pay on a claim. What part of this don't you understand? Health insurance is excludable because a person can be deprived of it without depriving others of it. I can provide health insurance to Person A, and deny it to Person B. Again, what part of this don't you understand? It really does not seem to me difficult to understand these concepts.
Why is a kind of good in the health care field different from the same class of goods not in the health care field?
No, that isn't the question I asked. The question is: Why is a mandate on health insurance justified, but not a mandate on car insurance, homeowners' insurance, disability insurance, etc.? What is unique about health insurance that justifies this unique mandate?
Why is dying worse than going bankrupt?
Because it's a greater loss. And your point is...? Health insurance doesn't prevent you from dying. It may (or may not) prevent you from going bankrupt as a result of obtaining medical treatment intended to prevent you from dying, but that's obviously not the same thing as preventing you from dying. Why should insurance against possible bankruptcy due to illness be mandatory, but not insurance against possible bankruptcy due to other causes? Please answer the question this time, instead of evading it yet again.
brooksfoe,
I think this is now the fourth time that we have come back to the point that whether something is rival and excludable usually depends on whether an owner or government decides to make it rival and excludable.
No, whether a good is rival or excludable depends on the nature of the good, not on the choices of its provider. A rival good is still a rival good even if a provider chooses to provide it to all rivals. An excludable good is still an excludable good even if a provider chooses to exclude no one. Try to understand the difference between the ability to exclude and the choice to exclude. Again, the different concepts involved here really are not that hard to understand.
And here's one more way to express it.
Everybody already agrees that everyone in the US should get basic and emergency health care even if they're too poor to afford it.
Given that everyone agrees on this, the cheapest and most efficient way to do it is universal health insurance.
You can start to throw up all kinds of obstructions and pretend you don't believe that everyone should get basic and emergency health care. But if we start to work out the examples, I have faith that will find that you're actually unable to pretend that you believe poor people who get diabetes should be allowed to die of it, or that poor kids shouldn't get their cavities filled.
Finally, different kinds of insurance: disability insurance in the US is mandatory for anyone who works. It's called Social Security Disability Insurance. You contribute to it through payroll taxes. You also contribute to Medicaid through your general tax dollars, and to Medicare through payroll taxes. Why do we make these kinds of insurance mandatory, and not others? Maybe you could try thinking about it, or you could ask the voters.
Mixner, now you have changed your mind about whether public goods depend on the nature of the good or on the decision of how to provide it. Earlier in the thread, you conceded that there's no such thing as a perfect public good; now you're heading in the other direction.
Look, you know what's a perfectly classic public good? A novel. Any number of people can read it, the next person's reading it doesn't impinge on the first reader's enjoyment of it, there's no practical way to exclude anyone from reading it once it's out there. Anyone can copy it for a pittance and distribute it all over the place. And yet novels are not public goods. Why? Mostly because the government and publishing companies intercede to find ways to stop novels from being public goods. Read Tyler Cowen on how this works: things which seem like public goods can be prevented from being public goods. The question for a particular good is, would it be better for society to make it private, or would it be better to treat it as a public good? In the case of intellectual property, we decide that it's better to make it private property for a limited period and then let it become a public good. This is a choice our society makes about how to treat it. In the case of health insurance, it isn't, a priori, either a public good or not a public good. But universal health insurance can only be a public good.
I won't get caught up in the "should we, shouldn't we" debate on universal health insurance coverage, I just want to comment on the public good definition here. There aren't any "alternative" definitions as far as the field of economics is concerned. That's as silly as suggesting there are alternatives to the definition of fixed costs and average cost. There simply aren't. Certainly, there is debate about what is and isn't a public good, but the term's definition has already been established. And Mixner seems to have the definition right - a public good is nonrivalous and nonexcludable. The implication of the former property is that the marginal cost of the good, after it is initially produced, is zero. It costs nothing to provide it to the next consumer. The implication of the second property is that there is no practical way to exclude those who do not pay for the service from the benefits of that service. Because of those two traits, it is generally impossible for the free market to generate such goods - they aren't profitable.
Health insurance fails to meet both those criteria. The marginal cost of providing coverage to one more consumer is positive. It is also easily possible to exclude those who would be free riders. Consumers pay premiums and are given service through insurance coverage; people who don't pay premiums are not covered by the insurance. On top of that, the mere existence of a market with private production for health insurance pretty much establishes it as a private good.
Now, whether or not the government decides to provide or finance the good doesn't affect its status as a public good or private good. That's a political decision. Whether or not the government decides to provide such a good to all or to a smaller subset of the population, again, does not affect its status as a public good or private good. Health insurance is health insurance. If the government decides to provide it to all, some or nobody at all, health insurance would still be a private good no matter how the government involves itself in the market. In this vein, food is certainly a private good - and yet the government provides food stamps. It is also conceivable that the government good go further and provide food distribution centers and extend services at such centers to all. However, that would not make food a public good.
brooksfoe,
Everybody already agrees that everyone in the US should get basic and emergency health care even if they're too poor to afford it. Given that everyone agrees on this, the cheapest and most efficient way to do it is universal health insurance.
You offer no evidence either that everybody agrees that everyone should get those services or that universal health insurance would be the cheapest and most efficient way to provide them. Do you have any such evidence? And what do you mean by "basic" health care, anyway? What kind of health care services would that include, exactly?
But if we start to work out the examples, I have faith that will find that you're actually unable to pretend that you believe poor people who get diabetes should be allowed to die of it, or that poor kids shouldn't get their cavities filled.
What makes you think we can "disallow" everyone who gets diabetes from dying of it? And I certainly agree that poor kids "should" get their cavities filled, but that normative question is quite separate from the issue of public policy regarding dental treatment for poor kids. You keep confusing and conflating different issues and questions.
Finally, different kinds of insurance: disability insurance in the US is mandatory for anyone who works. It's called Social Security Disability Insurance. You contribute to it through payroll taxes. You also contribute to Medicaid through your general tax dollars, and to Medicare through payroll taxes. Why do we make these kinds of insurance mandatory, and not others?
I'm not sure. What's your answer?
Maybe you could try thinking about it, or you could ask the voters.
Yes, you could ask the voters why they support Medicare and social security, but not universal health insurance. That would be an interesting poll. If the voters wanted universal health insurance, we would have universal health insurance. Various efforts have been made to enact universal health insurance since at least the beginning of the 20th century. All have failed. That obviously suggests that the voters don't want it.
brooksfoe,
Mixner, now you have changed your mind about whether public goods depend on the nature of the good or on the decision of how to provide it.
No I haven't.
Earlier in the thread, you conceded that there's no such thing as a perfect public good; now you're heading in the other direction.
Yes, there's no such thing as a perfect public good. How does that mean I have "changed my mind" on the issue you describe above? You seem terribly confused.
The question for a particular good is, would it be better for society to make it private, or would it be better to treat it as a public good?
"Society" cannot make a public good a private good. A good is a public good if and only if it is non-rival and non-excludable. We've been over this.
In the case of health insurance, it isn't, a priori, either a public good or not a public good.
Of course it isn't a public good. Health insurance is both rival (money spent on health insurance for Person A does not provide health insurance for Person B) and it is excludable (anyone can be excluded from health insurance.) Health insurance is therefore, by definition, not a public good.
Consider: "Everyone already agrees that people in the U.S. shouldn't be blown up by terrorists. Given that everyone agrees on this, we should pursue Policy X." Would you agree with this argument? No, of course you wouldn't; it would depend on what Policy X was. If you didn't approve of Policy X -- say, torturing suspected terrorists -- you would say that we should sacrifice our goal rather than engaging in torture. Similarly, if Policy X is socialized medicine, then we should sacrifice our goal rather than engaging in it.
Oh, I don't think they should die; I think you should pay for it, since you care so much about it. You, and liberalrob, and the other supporters of socialized medicine here.You can't have it both ways; you can't argue that "everybody" agrees with you that X need be done but then argue that we need to coerce people at gunpoint into doing X. If "everybody" really agreed, then the government program wouldn't be necessary.
None of those things are "insurance." (No, putting insurance in the name of a program doesn't make it such.) They're welfare. Putting aside the obvious difference between a voluntary and involuntary program, with insurance you pay premiums based on actuarial risk, which is based in part on the amount of payout received.And no, disability "insurance" is not "mandatory for anybody who works." Paying taxes is mandatory for anybody who works; whether the government pays out money to you is a separate matter.
Get me another bag of popcorn! I like this movie.
Will someone come along to call this an insular echo chamber? Stay tuned...
Mixner: Okay, I give up on the "rival" claim. You've convinced me that health insurance is rival in any system in which everyone doesn't already have it, and it's not really meaningful to talk about situations where everyone already has it. So health insurance is not a public good. As vecna says, this says nothing about whether or not it would be good for the government to guarantee it. The government properly does many things which have nothing to do with providing public goods. (In the case of intellectual property, for example, the government's crucial role is to turn something which is by nature a public good into private property, for the national benefit.)
Excludable is a different issue, and you refuse now to admit what you have already acknowledged: that most public goods could also be excludable in principle, and are non-excludable only by virtue of legal decisions about how to treat them. Health care is a non-excludable good in the UK: if a provider buys an MRI machine, anyone in the country has the same ability to use it as anyone else. So no one will invest in MRI machines but the government, since no one could recoup their costs. That simply reflects a social decision about how to structure medical care; it's not a quality of health care itself. This is no different from the fashion in which a public park is non-excludable in the US; obviously land is excludable, but a public park isn't, or it wouldn't be a public park.
David Nieporont's claims, in contrast to Mixner's, do not make any sense. If Social Security Disability Insurance is not "insurance", then Canadian health insurance is not insurance either. Neither is federal deposit insurance. Insurance is a promise to pay out an amount of money calculated according to agreed-upon rules under some set of adverse circumstances. The key is that it protects the beneficiary against adverse risk. Roulette also involves premiums and payouts made according to actuarial risk, but I don't call it "insurance"; would you? And, obviously, the government does calculate the odds of payout; otherwise it would have no idea how high to set the payroll payments needed to finance the program. The government also calculates the odds of payout on Social Security; that's how it knows whether the program is financially sound or not. You won't get very far in these issues by playing games with your definitions of the words involved.
David Nieporont also seems to be willing to let poor people with diabetes die for lack of treatment unless "liberals" -- i.e., people other than himself -- are willing to pay for it. Under current US law, hospitals are required to treat everyone who needs emergency care, while those too poor to buy health insurance (or who become too poor, after being drained by the expense of treatment) are, in principle, covered by Medicaid. In other words, medical care for people who cannot afford it is ultimately covered by the taxpayer. There is no political support in the US for switching to a system in which people who could not afford life-saving treatment would simply not be treated. That position has not been advanced by a single conservative political figure, media pundit, think-tank guru, or activist of note. That's because it is a fundamentally immoral, beastly, and vicious position, and one which seems incompatible with any concept of citizenship. I have no idea why anyone would fight to defend their fellow citizens from foreign invasion, when they would do nothing to protect these fellow citizens from death by curable disease.
brooksfoe,
As vecna says, this says nothing about whether or not it would be good for the government to guarantee it.
It says that the government should probably not be the primary funder or provider of it, because in general governments are effective at funding and providing only public goods like the national defense, not private goods like health care (or health insurance).
Excludable is a different issue, and you refuse now to admit what you have already acknowledged: that most public goods could also be excludable in principle, and are non-excludable only by virtue of legal decisions about how to treat them.
No, I do not "admit" that. The relevant criterion is whether individuals are effectively or realistically excludable, not whether they are excludable in principle. We could exclude individuals from public highways, but the costs of implementing an individualized highway access system would exceed the benefits (although that may change in the future with new technology). In contrast, it is easy to exclude people from health care services. All you need is a receptionist who authenticates their coverage when they request a service.
Health care is a non-excludable good in the UK
No, the UK government has chosen not to exclude anyone from health care. That's not the same thing as health care being "a non-excludable good." Once again, you are confusing a policy choice with an inherent characteristic of a good.