Practical Philosophy, Again

I continue to find myself puzzled by John Holbo.  This statement makes no sense to me:

In all seriousness: I realize I have been arguing, for several posts now, at an unsatisfactorily high level of abstraction. (I have seized on the strange case of McArdle because she started it, insisting on talking only at the philosophical level, thereby giving me an excuse to continue in that vein.) But there is a point. Philosophically, there just isn't a case to be made against reform unless it's this simple one: if you don't have any money, you shouldn't be entitled to any medicine. McArdle is very indignant when people accuse her of indifference to the fate of the poor, but - honestly - if it isn't that, then it's nothing. At the philosophical level.

This echoes his earlier post.  John Holbo, who is, I believe, a professor of philosophy, seems to believe that you can develop a philosophical opinion on a policy issue without reference to particulars. 

Imagine a universe consisting entirely of two identical blue spheres.  Is there a right to national health care in that universe?  Please show your work.

Obviously you need a very large number of specific priors before you can even think about developing a "philosophical" opinion on health care.  Of course, we do need to operate at some level of abstraction. But Holbo's response to me consists of abstracting away all of the potential problems with national health care, and then demanding to know why I don't support it--I mean, apart from the fact that if millions of poor people die, there will be more room on the subway for me.  Libertarians think like that, you know.

So I'm not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement.  But let's see if we can't tone down the nastiness a little, and try to have a reasonable discussion. 

I'm afraid, however, that any discussion will include our assessment of the likely outcomes of our policy decisions.  It's not enough to defend the principles of communism if what you get in practice is a nasty, murderous dictatorship every time.

Some philosophic principles:

• We have some obligations to future generations, if not necessarily future individuals within those generations.  Extreme thought experiment to clarify the principle:  we cannot strip mine the earth and leave them to die.
• People have no obligation to perform labor for others.  I may not force a surgeon to save my mother at gunpoint. (To be sure, I might.  But society would justly punish me for doing so.)
• States have an absolute right to tax their citizens to provide public goods, i.e. goods that are broadly beneficial but non-excludable.  They have a right to enact other laws, such as public health rules, to achieve similar ends.  Both rights are constrained by the basic rights of their citizens.  You may perhaps quarantine Typhoid Mary.  You may not shoot her.
  
• Societies have a right to organize themselves to improve the justice of their income distribution.  That organization may include taxation. It may also include property rights, or outlawing behavior like blackmail.
• Property rights did not spring full-blown from the head of Zeus into a natural right.  They're contingent, evolving arrangements that happen to work really, really well for encouraging many sorts of beneficial economic activity.
  
• Just income distribution is not just a matter of relative position, but also of how the income is acquired, and absolute need.  I do not have any moral claim whatsoever on a dime of Warren Buffett's fortune, because I have a perfectly adequate lifestyle.  I still wouldn't have any claim on his fortune if he suddenly got 100 times richer, provided that he acquired that money through means that we regard as licit.
  
• Societies should strive to organize themselves so that everyone in the society can, if they desire, acquire the means to provide their basic needs.
  
• There is no per-se right to health care, since "health care" is not a thing, but a shifting collection of goods and services with amorphous boundaries.  Health care is a subset of the modern "basic needs" package, and therefore falls under broader distributional justice claims.  No matter what your distributional justice intuitions are, it would be perfectly acceptable, if impractical, to give very sick people the cash required to treat their cancer, and let them blow it on a trip around the world.
  
• No one should have to work more hours for the state than for themselves.  This should inform our approach to taxation.
  
• Taxation should strive to equalize the personal cost of taxation among all members of society, not the dollar amount or the percentage of income.  That is, it is appropriate for Warren Buffet to pay a higher percentage of his income in taxes for shared public goods than I do, because the personal cost of taking 25% of his income is much lower than the personal cost of taking 25% of mine.
• An equal distribution of misery is not a good social goal.  When policies to redistribute goods or money result in fewer or poorer quality goods being available, that cost should limit the redistributive impulse.
• If people will not comply with your regime, and their non-compliance may have unpleasant results for themselves or others, this is an important side constraint.
  
• The government should not interfere in voluntary transactions unless there are significant direct externalities.  The fact that you get stressed or unhappy thinking about something does not qualify as a direct negative externality.  Nor does the cultural miasma that emanates from these transactions.
  
• The government certainly should not forbid anyone to purchase something on the grounds that other people are not able to purchase that thing.

I am sure that John Holbo would quarrel with some of these principles.  But on the broad package that he thinks leads to national health care, we're probably in rough agreement.

Yet I do not think that they lead to national health care!  How can this be?

Mr. Holbo's answer is that I am an evil idiot who hates poor people, doesn't understand how markets and governments really work, and is philosophically incoherent.  My more boring answer is that we have different assessments of how the world to which we would like to apply these philosophical principles works.

For starters, Holbo has a very simplistic view of rationing--or perhaps, the objection to rationing that most libertarians have.  Either it is Britain in World War II, and the government has forbidden you to purchase more than 6 bandaids, or we don't have rationing. 

This is not true either philosophically, or technically.  That last principle I articulated is only one of the possible objections to rationing--one that I take it Mr. Holbo and I share, unless he is simply unwilling to come out and say he favors letting rich people die if poor people can't get a given treatment.  I might point out that rationing interferes with voluntary transactions, and that if the government wants to redistribute things, it should damn well raise the taxes and buy them.  I could question the justice of whatever regime you come up with.  These are all actual problems with any of the proposals that will be passed.

But even after you get beyond that, the more "practical" considerations remain.  If the government crowds out private health insurance for many people--a result that a number of analysts on both right and left think (hope) is likely, then the government rationing regime becomes actual rationing for the majority of the population.  There is also the fact that private insurers often base their services around what the government does, setting their rates as a percentage of Medicare rates, using Medicare to define what standard medical practice is, and so forth.

The core problem with rationing, for most libertarians, is that even if you think that the government's interference is just--and hey, in the case of World War II, I am probably willing to listen--that it has other effects we recognize as bad.  Black markets breed crime.  Government rules are necessarily extremely broad and will make some people worse off.  But the core issue is that when you disable the price signal, you usually severely degrade the production and distribution of the good in question.  I hate to drag out Hayek again, but that old chestnut is still the single best exposition of why you might choose not to ration, set price floors/ceilings, or otherwise disable the price mechanism, even if you would like to see some more just distribution of the goods in question:

Assume that somewhere in the world a new opportunity for the use of some raw material, say, tin, has arisen, or that one of the sources of supply of tin has been eliminated. It does not matter for our purpose--and it is very significant that it does not matter--which of these two causes has made tin more scarce. All that the users of tin need to know is that some of the tin they used to consume is now more profitably employed elsewhere and that, in consequence, they must economize tin. There is no need for the great majority of them even to know where the more urgent need has arisen, or in favor of what other needs they ought to husband the supply. If only some of them know directly of the new demand, and switch resources over to it, and if the people who are aware of the new gap thus created in turn fill it from still other sources, the effect will rapidly spread throughout the whole economic system and influence not only all the uses of tin but also those of its substitutes and the substitutes of these substitutes, the supply of all the things made of tin, and their substitutes, and so on; and all his without the great majority of those instrumental in bringing about these substitutions knowing anything at all about the original cause of these changes. The whole acts as one market, not because any of its members survey the whole field, but because their limited individual fields of vision sufficiently overlap so that through many intermediaries the relevant information is communicated to all. The mere fact that there is one price for any commodity--or rather that local prices are connected in a manner determined by the cost of transport, etc.--brings about the solution which (it is just conceptually possible) might have been arrived at by one single mind possessing all the information which is in fact dispersed among all the people involved in the process.

Mechanisms to distribute tin without prices have been tried, and found wanting.  So have mechanisms to distribute practically every other good you can think of, from housing to hotdogs.  Rent control distorts the housing market and discourages landlords from building or improving their housing stock.  Price controls on bread result in shortages, and often distort the non-controlled sectors of the market. Fuel subsidies result in your precious tax dollars being diverted to Columbian roadside vendors who will siphon the gas out of your tank at great danger to themselves and pay something closer to market rates for it.  Etc.

I mean, fine, let's not call it rationing.  Let's call it "Fred".  You'll still end up with a crappy, overcrowded housing stock and shortages of basic goods.  What philosophical principal favors this?

Holbo says I'm oscillating between endorsing rationing, and abhoring it.  As it happens, I'm not "oscillating" between anything.  For one thing, I'm not particularly worried about IMAC denying treatments to people, though I think it's perfectly rational that seniors are, because frankly right now they get a really great deal.

There are two entirely separate questions here.  The first is that we would like everyone to have all the health care they could ever possibly consume, but we can't.  This is true of other goods, like food and housing.  I find the process of figuring out what to produce, or provide, fascinating, which is why I am a business journalist. It is especially important in medicine because of the somewhat unique market.   Whether the government is paying, or private companies are, there will continue to be core tensions between what the doctors want, and what the people writing the checks will approve.  Right now, Medicare and Medicaid handle these problems somewhat differently--they simply slash the reimbursements until some providers refuse to take their patients.  But if the government comes to dominate health care payment, that problem will become more explicit.  One way or another, we're going to have to confront the fact that we can't all have everything we want--and that not having everything we want, in this case, probably includes suffering and earlier death for at least some people.

The second problem, which makes a less stirring Sunday supplement article, is that this allocative process can get badly screwed up when the government gets involved.  To take one small example:  we have a comprehensive national health care plan for seniors.  Yet we have a shortage of geriatricians, the one specialty that you would think would be booming.  Why?  Because Medicare sets a single price for the services of geriatricians, and it is low.  Since the field is not particularly enticing (though arguably it really should be, since geriatricians have extremely high job satisfaction compared to many more popular specialties), very few people go into it.  It's one of relatively few specialties that consistently has most of its slots and fellowships unfilled.

I've already discussed what I think will happen to new medical technology and prescription drugs under a more comprehensive government system.  For the same reason:  prices are very useful things.  And contra the liberals who keep saying I am maintaining this belief in the face of overwhelming evidence, we in fact have overwhelming evidence for two things:

1. National health care systems control the prices of inputs, especially the prices of inputs produced by corporations:  medical technology and drugs.
   
2. Price controls lead to shortages and other suboptimal results that decrease the general welfare, even though they may very well benefit some specific people.

People talking about how Europe is not paying its "fair share" of drug development costs have the problem wrong.  Drug companies charge what the market will bear.  Drugs wouldn't be any cheaper here if Europe dropped its price controls.  What we would have is more drugs.  But this is a hidden cost.  And governments almost always prefer hidden costs to explicit ones.  It's just electoral logic.

I understand that progressives object to price rationing because it implies that people who don't have the money aren't worth saving.  But the number of people who actually don't get treatment they would benefit from because of their insurance status is small, and there are more direct ways to deal with this problem.  You don't gut rehab an entire industry because 2% of the population can't afford its products.  You figure out a way to help them buy the products.

Let me close with two thoughts. 

John Holbo challenged me in a former post to say what I would think about the various proposals, or a putative single payer system, if it worked just the way progressives think it will.  I thought I had, but I'll do it again.  The answer is that I would be against it because I don't believe in taking money from the rich to subsidize the middle class--I don't think that people whose basic needs are taken care of have any distributional claim on people with more money, even though it is perfectly fair to ask the wealthy to pay more for goods that are broadly publicly enjoyed. 

If it were up to me, I'd combine a broad income subsidy like the EITC with some sort of reinsurance pool for high-risk patients, then I'd probably force everyone to buy some sort of catastrophic medical coverage on the grounds that otherwise, people with adequate income but few assets will be too tempted to freeload off the generosity of the public.  But anything that involved price controls I would shoot down faster than a duck at an NRA convention.

That said, if we end up with some sort of single payer system, and I turn out to be totally wrong and there's no issue with innovation and quality stays high, I will be happy.  I will still object, in principle, to middle class subsidies.  But as an issue for me, it will recede to somewhere between public highways, and the words "under God" in the pledge of allegiance.

Now, having embraced Holbo's thought experiment, and hopefully illuminating the principles by which I am evaluating future health care plans, I'd hope he'd return the favor.  I've asked once before, but Holbo has so far ignored the question in favor of long disquisitions on what he thinks rationing is.  So here goes again:

I've answered your thought experiment, saying what I would do if everything went just as you think and hope it will.  Now please turn the question around and try the same thought experiment.  What if everything goes the way I think it will?  What if converting the United States to a single payer system causes the pace of medical innovation to slow to a crawl?  People who have diseases for which there are not now good therapies lose all hope, because there is virtually no pharma or medtech industry which might invent something to save their life.  Lifespans stop lengthening.  Pharma and medtech turn into fat, soft, government suppliers, using the regulatory power of the healthcare agencies to keep out incumbents.  There are periodic shortages of various treatments because the government has a budget problem, or has gotten the prices wrong--and knowing us, the whole system comes with a "buy American" mandate.

Is that a tradeoff you would make?  Save the few thousand who might be kept alive by healthcare they now can't afford, and take the possibility of new treatments from the millions who might be cured, or at least have their conditions improved?

It's no good dismissing it on the grounds that it's unlikely, because you can't think it any more unlikely than I think the notion of a healthcare reform that is all upside, no downside.

I can see the arguments for both sides.  There's no right answer, and certainly no happy one.  I'm well aware that there are real people who may die because of my preferences.  And other real people who may die because of yours.  None of them are any less worthy of life than any other.

That's why I found the First Things article interesting:  because it faced up to the fact that on the margin, any choice we make about healthcare has terrible implications.  When it comes to healthcare, we cannot help but play God.  And unlike Him, we are cursed with imperfect knowledge.  All we have is our intuitions, our observations of the world, and our best guess about the future.

Comments

John Thacker September 1, 2009 6:43 PM

Is that a tradeoff you would make? Save the few thousand who might be kept alive by healthcare they now can't afford, and take the possibility of new treatments from the millions who might be cured, or at least have their conditions improved?

The odd thing is that some of the same people that don't quite grasp this argument on healthcare have no problem understanding it with global warming.

It is a hard question, without an easy answer.

I also recommend Keith Hennessey's recent discussions.

Jon (Replying to: John Thacker) September 1, 2009 10:03 PM

Re: Save the few thousand who might be kept alive by healthcare they now can't afford, and take the possibility of new treatments from the millions who might be cured, or at least have their conditions improved?

The problem that I have with this is here: If millions of people are really going to demand something and that something is possible (e.g., they are not asking for a perpetual motion machine) then why wouldn't that demand be met? How can providing something for a few thousand people in the here-and-now abnegate the demand of millions in, say, 2053? OK, there might be convoluted contingencies: someone isn't born at all who would cure AIDS. But that sort of thing is a danger in any action whatsoever since we can never know any but the most immediate and obvious consequences of our actions. And as far as money goes, the money we spend today, is money we spend today. It won't be available for the future no matter what we do with it. The future has to earn its own income. And along those lines Lomberg and others have made the argument vis-a-vis environmental issues that long term problems should be solved in the long term since the future is likely to be richer than we are, and much better informed about its circumstances. So why doesn't that apply here? Why sacrifice the lives of people who are alive right now today, for the sake of those who aren't even as real as ghosts or memories yet, when they will be better equipped to handle their problems than we are anyway?

Glen Raphael (Replying to: Jon) September 1, 2009 11:33 PM

Easy: that demand wouldn't be met because there's no profit in it.

If the *way* we provide something for the few is by setting up a system which then makes "windfall profits" impossible, nobody will do the research to discover the thing demanded is possible. And even if the fact that the thing demanded is possible is discovered by accident, nobody will then invest a billion dollars in bringing that thing to market unless there's a financial upside possibility - a decent chance of making back several times the money invested. Which, in our hypothetical, there isn't.

Currently, companies are willing to invest over a billion dollars to get a new drug developed and tested and approved only because they expect they will be *allowed* to charge high prices for the drug - prices that are proportional to the value customers get from it, not prices that are set by regulators at levels pleasing to pandering politicians. Change that dynamic, and new drugs are likely to stop getting developed or approved. Which means millions of people suffer or die who could have been helped at great expense initially or at a much lesser expense later when the drug goes generic.

Jon (Replying to: Glen Raphael) September 2, 2009 6:51 AM

Re: Easy: that demand wouldn't be met because there's no profit in it.

Why wouldn't there be? If millions of people are demanding something seems to me that something could be supplied profitably based on volume alone. (A drug that only is demanded by a small minority is another matter: even today medical innovation that benefits tiny numbers if people tends to be put on the back burner). Adn if cost controls are a problem, then the future is perfectly free to adjust what it is paying. Nothing we do on this today limits what people can do fifty year from now. We will mnake our choices and they will make theirs. We are not responsible for them and they are not for us. I noted this on another theread: if some researcher discovers, say, a cure for AIDS or lung cancer or some other such disease, but that cure cannot be brought to market due to pricing issues, it's a no-brainer that those price regs would quickly be changed due to public demand. Remember ACT-UP in the 90s and how the FDA streamlined its approval process?

Matt C (Replying to: Jon) September 2, 2009 7:39 AM

If millions of people are really going to demand something and that something is possible (e.g., they are not asking for a perpetual motion machine) then why wouldn't that demand be met?

You blissfully ignore why medical technology innovation continues at the pace it does today - because even in disease states with low prevelance, profitability is possible.

If you have a health care service and - yes - a drug/medical technology payment system fully or mostly controlled by a government body with the stated goal of reducing costs there is not endgame but lower profitability for these technologies. It will take time, but eventually venture capital will find its way into different markets, and R&D will slowly grind to a more anemic pace.

To put this more simply: we as consumers are not what drive medical technology investment and R&D. We do not create the "demand." However, we are the market opportunity via the diseases that we carry. The "demand" side of the medical technology market is represented by both the medical community and the payers (i.e. health insurance companies.) In our current system, these two groups are generally aligned to foment demand for new technologies that reduce disease prevalence at a greater rate than older technologies. If you, by way of legal fiat, change the incentives for either of these demand-side entities, you run the risk of altering the risk calculation for medical technology investors.

I think we can all agree on this: if we woke up and had a single-payer health care coverage system tomorrow, we wouldn't go out and buy more shares of Genzyme or Genentech or Amgen or Pfizer.

Sarah Natividad (Replying to: Jon) September 2, 2009 12:41 PM

The problem lies in asserting that possibility implies profitability at some level of production.

People create stuff for others for one of two reasons. Either they are motivated by their own altruism, or they expect to get something (money, fame, eternal life, whatever) from the act. Now the laws of economics tell us that not everything can be produced at a price that will make it profitable. To take just a simple example, I make baby booties. If I charge less than they cost to make, I can't make money; and if I charge more than people are willing to pay, I can't make money either. When the amount people are willing to pay is less than the cost, I can't make money selling baby booties. It matters not whether I make one pair or 1000 pairs for sale; I will not make any money and will indeed be paying for the privilege of selling booties.

So if the country wants new medical treatments but the amount they're willing to pay is less than the cost, the profit motive is eliminated, leaving only altruism and non-monetary rewards as motivations to create new medical treatments and drugs. Theoretically it's possible for a person or entity to derive great pleasure, fame, or some other non-monetary reward out of donating billions to medical research for the cause of helping mankind. The question you have to ask yourself is, do you want to bet your entire health care system on the perpetual existence of a sugar daddy?

Jon (Replying to: John Thacker) September 1, 2009 10:03 PM

Re: Save the few thousand who might be kept alive by healthcare they now can't afford, and take the possibility of new treatments from the millions who might be cured, or at least have their conditions improved?

The problem that I have with this is here: If millions of people are really going to demand something and that something is possible (e.g., they are not asking for a perpetual motion machine) then why wouldn't that demand be met? How can providing something for a few thousand people in the here-and-now abnegate the demand of millions in, say, 2053? OK, there might be convoluted contingencies: someone isn't born at all who would cure AIDS. But that sort of thing is a danger in any action whatsoever since we can never know any but the most immediate and obvious consequences of our actions. And as far as money goes, the money we spend today, is money we spend today. It won't be available for the future no matter what we do with it. The future has to earn its own income. And along those lines Lomberg and others have made the argument vis-a-vis environmental issues that long term problems should be solved in the long term since the future is likely to be richer than we are, and much better informed about its circumstances. So why doesn't that apply here? Why sacrifice the lives of people who are alive right now today, for the sake of those who aren't even as real as ghosts or memories yet, when they will be better equipped to handle their problems than we are anyway?

Glen Raphael (Replying to: Jon) September 1, 2009 11:33 PM

Easy: that demand wouldn't be met because there's no profit in it.

If the *way* we provide something for the few is by setting up a system which then makes "windfall profits" impossible, nobody will do the research to discover the thing demanded is possible. And even if the fact that the thing demanded is possible is discovered by accident, nobody will then invest a billion dollars in bringing that thing to market unless there's a financial upside possibility - a decent chance of making back several times the money invested. Which, in our hypothetical, there isn't.

Currently, companies are willing to invest over a billion dollars to get a new drug developed and tested and approved only because they expect they will be *allowed* to charge high prices for the drug - prices that are proportional to the value customers get from it, not prices that are set by regulators at levels pleasing to pandering politicians. Change that dynamic, and new drugs are likely to stop getting developed or approved. Which means millions of people suffer or die who could have been helped at great expense initially or at a much lesser expense later when the drug goes generic.

Jon (Replying to: Glen Raphael) September 2, 2009 6:51 AM

Re: Easy: that demand wouldn't be met because there's no profit in it.

Why wouldn't there be? If millions of people are demanding something seems to me that something could be supplied profitably based on volume alone. (A drug that only is demanded by a small minority is another matter: even today medical innovation that benefits tiny numbers if people tends to be put on the back burner). Adn if cost controls are a problem, then the future is perfectly free to adjust what it is paying. Nothing we do on this today limits what people can do fifty year from now. We will mnake our choices and they will make theirs. We are not responsible for them and they are not for us. I noted this on another theread: if some researcher discovers, say, a cure for AIDS or lung cancer or some other such disease, but that cure cannot be brought to market due to pricing issues, it's a no-brainer that those price regs would quickly be changed due to public demand. Remember ACT-UP in the 90s and how the FDA streamlined its approval process?

Matt C (Replying to: Jon) September 2, 2009 7:39 AM

If millions of people are really going to demand something and that something is possible (e.g., they are not asking for a perpetual motion machine) then why wouldn't that demand be met?

You blissfully ignore why medical technology innovation continues at the pace it does today - because even in disease states with low prevelance, profitability is possible.

If you have a health care service and - yes - a drug/medical technology payment system fully or mostly controlled by a government body with the stated goal of reducing costs there is not endgame but lower profitability for these technologies. It will take time, but eventually venture capital will find its way into different markets, and R&D will slowly grind to a more anemic pace.

To put this more simply: we as consumers are not what drive medical technology investment and R&D. We do not create the "demand." However, we are the market opportunity via the diseases that we carry. The "demand" side of the medical technology market is represented by both the medical community and the payers (i.e. health insurance companies.) In our current system, these two groups are generally aligned to foment demand for new technologies that reduce disease prevalence at a greater rate than older technologies. If you, by way of legal fiat, change the incentives for either of these demand-side entities, you run the risk of altering the risk calculation for medical technology investors.

I think we can all agree on this: if we woke up and had a single-payer health care coverage system tomorrow, we wouldn't go out and buy more shares of Genzyme or Genentech or Amgen or Pfizer.

Sarah Natividad (Replying to: Jon) September 2, 2009 12:41 PM

The problem lies in asserting that possibility implies profitability at some level of production.

People create stuff for others for one of two reasons. Either they are motivated by their own altruism, or they expect to get something (money, fame, eternal life, whatever) from the act. Now the laws of economics tell us that not everything can be produced at a price that will make it profitable. To take just a simple example, I make baby booties. If I charge less than they cost to make, I can't make money; and if I charge more than people are willing to pay, I can't make money either. When the amount people are willing to pay is less than the cost, I can't make money selling baby booties. It matters not whether I make one pair or 1000 pairs for sale; I will not make any money and will indeed be paying for the privilege of selling booties.

So if the country wants new medical treatments but the amount they're willing to pay is less than the cost, the profit motive is eliminated, leaving only altruism and non-monetary rewards as motivations to create new medical treatments and drugs. Theoretically it's possible for a person or entity to derive great pleasure, fame, or some other non-monetary reward out of donating billions to medical research for the cause of helping mankind. The question you have to ask yourself is, do you want to bet your entire health care system on the perpetual existence of a sugar daddy?

Glen Raphael (Replying to: Jon) September 1, 2009 11:33 PM

Easy: that demand wouldn't be met because there's no profit in it.

If the *way* we provide something for the few is by setting up a system which then makes "windfall profits" impossible, nobody will do the research to discover the thing demanded is possible. And even if the fact that the thing demanded is possible is discovered by accident, nobody will then invest a billion dollars in bringing that thing to market unless there's a financial upside possibility - a decent chance of making back several times the money invested. Which, in our hypothetical, there isn't.

Currently, companies are willing to invest over a billion dollars to get a new drug developed and tested and approved only because they expect they will be *allowed* to charge high prices for the drug - prices that are proportional to the value customers get from it, not prices that are set by regulators at levels pleasing to pandering politicians. Change that dynamic, and new drugs are likely to stop getting developed or approved. Which means millions of people suffer or die who could have been helped at great expense initially or at a much lesser expense later when the drug goes generic.

Jon (Replying to: Glen Raphael) September 2, 2009 6:51 AM

Re: Easy: that demand wouldn't be met because there's no profit in it.

Why wouldn't there be? If millions of people are demanding something seems to me that something could be supplied profitably based on volume alone. (A drug that only is demanded by a small minority is another matter: even today medical innovation that benefits tiny numbers if people tends to be put on the back burner). Adn if cost controls are a problem, then the future is perfectly free to adjust what it is paying. Nothing we do on this today limits what people can do fifty year from now. We will mnake our choices and they will make theirs. We are not responsible for them and they are not for us. I noted this on another theread: if some researcher discovers, say, a cure for AIDS or lung cancer or some other such disease, but that cure cannot be brought to market due to pricing issues, it's a no-brainer that those price regs would quickly be changed due to public demand. Remember ACT-UP in the 90s and how the FDA streamlined its approval process?

Jon (Replying to: Glen Raphael) September 2, 2009 6:51 AM

Re: Easy: that demand wouldn't be met because there's no profit in it.

Why wouldn't there be? If millions of people are demanding something seems to me that something could be supplied profitably based on volume alone. (A drug that only is demanded by a small minority is another matter: even today medical innovation that benefits tiny numbers if people tends to be put on the back burner). Adn if cost controls are a problem, then the future is perfectly free to adjust what it is paying. Nothing we do on this today limits what people can do fifty year from now. We will mnake our choices and they will make theirs. We are not responsible for them and they are not for us. I noted this on another theread: if some researcher discovers, say, a cure for AIDS or lung cancer or some other such disease, but that cure cannot be brought to market due to pricing issues, it's a no-brainer that those price regs would quickly be changed due to public demand. Remember ACT-UP in the 90s and how the FDA streamlined its approval process?

Matt C (Replying to: Jon) September 2, 2009 7:39 AM

If millions of people are really going to demand something and that something is possible (e.g., they are not asking for a perpetual motion machine) then why wouldn't that demand be met?

You blissfully ignore why medical technology innovation continues at the pace it does today - because even in disease states with low prevelance, profitability is possible.

If you have a health care service and - yes - a drug/medical technology payment system fully or mostly controlled by a government body with the stated goal of reducing costs there is not endgame but lower profitability for these technologies. It will take time, but eventually venture capital will find its way into different markets, and R&D will slowly grind to a more anemic pace.

To put this more simply: we as consumers are not what drive medical technology investment and R&D. We do not create the "demand." However, we are the market opportunity via the diseases that we carry. The "demand" side of the medical technology market is represented by both the medical community and the payers (i.e. health insurance companies.) In our current system, these two groups are generally aligned to foment demand for new technologies that reduce disease prevalence at a greater rate than older technologies. If you, by way of legal fiat, change the incentives for either of these demand-side entities, you run the risk of altering the risk calculation for medical technology investors.

I think we can all agree on this: if we woke up and had a single-payer health care coverage system tomorrow, we wouldn't go out and buy more shares of Genzyme or Genentech or Amgen or Pfizer.

Sarah Natividad (Replying to: Jon) September 2, 2009 12:41 PM

The problem lies in asserting that possibility implies profitability at some level of production.

People create stuff for others for one of two reasons. Either they are motivated by their own altruism, or they expect to get something (money, fame, eternal life, whatever) from the act. Now the laws of economics tell us that not everything can be produced at a price that will make it profitable. To take just a simple example, I make baby booties. If I charge less than they cost to make, I can't make money; and if I charge more than people are willing to pay, I can't make money either. When the amount people are willing to pay is less than the cost, I can't make money selling baby booties. It matters not whether I make one pair or 1000 pairs for sale; I will not make any money and will indeed be paying for the privilege of selling booties.

So if the country wants new medical treatments but the amount they're willing to pay is less than the cost, the profit motive is eliminated, leaving only altruism and non-monetary rewards as motivations to create new medical treatments and drugs. Theoretically it's possible for a person or entity to derive great pleasure, fame, or some other non-monetary reward out of donating billions to medical research for the cause of helping mankind. The question you have to ask yourself is, do you want to bet your entire health care system on the perpetual existence of a sugar daddy?

Ken Magalnik September 1, 2009 6:55 PM

"I don't think that people whose basic needs are taken care of have any distributional claim on people with more money, even though it is perfectly fair to ask the wealthy to pay more for goods that are broadly publicly enjoyed. "

"Taxation should strive to equalize the personal cost of taxation among all members of society, not the dollar amount or the percentage of income. That is, it is appropriate for Warren Buffet to pay a higher percentage of his income in taxes for shared public goods than I do, because the personal cost of taking 25% of his income is much lower than the personal cost of taking 25% of mine."

Can someone explain these two statements to me? Because they sound a great deal like "You don't need your money as much as I do mine"

cmfrank (Replying to: Ken Magalnik) September 1, 2009 7:07 PM

She's simply arguing that taxation should be equally *painful* for everyone, and that the percentage of income that involves depends on a whole host of things, including personal financial circumstances, cost of living, etc., etc.

For example, someone who makes $30,000 a year probably would care deeply if his tax burden went up by a few hundred dollars, because it would make a noticeable impact on his financial freedom, while a person making $300,000 probably wouldn't care very much, because he wouldn't be hurt by it. Less obviously (but relevantly to the segment of population that seems to believe that the superrich are all conservative Republicans, an opinion utterly unsupported by data), the lawyer or doctor making $300,000 a year notices and is hurt by a 5% increase in taxation. The financial tycoon or baseball player or entertainer who makes $30 million a year couldn't care less - it doesn't affect his lifestyle in the slightest.

Ken Magalnik (Replying to: cmfrank) September 1, 2009 7:23 PM

Based upon that, we should consider cost of living as well as absolute income. A person making 60k in a densely populated area should pay a lower tax than one making the same amount in a sparsely populated area. And if that was the case, there would be no incentive to develop new land.

Peter (Replying to: Ken Magalnik) September 2, 2009 1:19 AM

Considering cost of living is impractical. It would also open us up to all sorts of horrible maneuvering in congress.

And if that was the case, there would be no incentive to develop new land.

Wrong. Companies still like have lower costs, people like space, and there's a limit to how dense you can make urban environments.

Matt C (Replying to: Ken Magalnik) September 2, 2009 7:48 AM

Ken - I don't think you will find many tax analysts who disagree with your statement above. Income as a standard of living proxy is an arcane metric.

market karma (Replying to: Ken Magalnik) September 1, 2009 7:13 PM

I will add:

"Societies have a right to organize themselves to improve the justice of their income distribution. That organization may include taxation."

"Just income distribution is not just a matter of relative position, but also of how the income is acquired, and absolute need."

Pretty surprising coming from a self identified libertarian, even moreso one that quotes Hayek in the same blog post.

Justice is a subjective term, and the State can pretty much rationalize anything it may want to do to an individual as being necessary for "justice". Heck -- armed with those two statements, a coercive government could rationalize taking anything it wants from its citizens.

cmfrank (Replying to: Ken Magalnik) September 1, 2009 7:07 PM

She's simply arguing that taxation should be equally *painful* for everyone, and that the percentage of income that involves depends on a whole host of things, including personal financial circumstances, cost of living, etc., etc.

For example, someone who makes $30,000 a year probably would care deeply if his tax burden went up by a few hundred dollars, because it would make a noticeable impact on his financial freedom, while a person making $300,000 probably wouldn't care very much, because he wouldn't be hurt by it. Less obviously (but relevantly to the segment of population that seems to believe that the superrich are all conservative Republicans, an opinion utterly unsupported by data), the lawyer or doctor making $300,000 a year notices and is hurt by a 5% increase in taxation. The financial tycoon or baseball player or entertainer who makes $30 million a year couldn't care less - it doesn't affect his lifestyle in the slightest.

Ken Magalnik (Replying to: cmfrank) September 1, 2009 7:23 PM

Based upon that, we should consider cost of living as well as absolute income. A person making 60k in a densely populated area should pay a lower tax than one making the same amount in a sparsely populated area. And if that was the case, there would be no incentive to develop new land.

Peter (Replying to: Ken Magalnik) September 2, 2009 1:19 AM

Considering cost of living is impractical. It would also open us up to all sorts of horrible maneuvering in congress.

And if that was the case, there would be no incentive to develop new land.

Wrong. Companies still like have lower costs, people like space, and there's a limit to how dense you can make urban environments.

Matt C (Replying to: Ken Magalnik) September 2, 2009 7:48 AM

Ken - I don't think you will find many tax analysts who disagree with your statement above. Income as a standard of living proxy is an arcane metric.

Ken Magalnik (Replying to: cmfrank) September 1, 2009 7:23 PM

Based upon that, we should consider cost of living as well as absolute income. A person making 60k in a densely populated area should pay a lower tax than one making the same amount in a sparsely populated area. And if that was the case, there would be no incentive to develop new land.

Peter (Replying to: Ken Magalnik) September 2, 2009 1:19 AM

Considering cost of living is impractical. It would also open us up to all sorts of horrible maneuvering in congress.

And if that was the case, there would be no incentive to develop new land.

Wrong. Companies still like have lower costs, people like space, and there's a limit to how dense you can make urban environments.

Matt C (Replying to: Ken Magalnik) September 2, 2009 7:48 AM

Ken - I don't think you will find many tax analysts who disagree with your statement above. Income as a standard of living proxy is an arcane metric.

Peter (Replying to: Ken Magalnik) September 2, 2009 1:19 AM

Considering cost of living is impractical. It would also open us up to all sorts of horrible maneuvering in congress.

And if that was the case, there would be no incentive to develop new land.

Wrong. Companies still like have lower costs, people like space, and there's a limit to how dense you can make urban environments.

Matt C (Replying to: Ken Magalnik) September 2, 2009 7:48 AM

Ken - I don't think you will find many tax analysts who disagree with your statement above. Income as a standard of living proxy is an arcane metric.

market karma (Replying to: Ken Magalnik) September 1, 2009 7:13 PM

I will add:

"Societies have a right to organize themselves to improve the justice of their income distribution. That organization may include taxation."

"Just income distribution is not just a matter of relative position, but also of how the income is acquired, and absolute need."

Pretty surprising coming from a self identified libertarian, even moreso one that quotes Hayek in the same blog post.

Justice is a subjective term, and the State can pretty much rationalize anything it may want to do to an individual as being necessary for "justice". Heck -- armed with those two statements, a coercive government could rationalize taking anything it wants from its citizens.

msully September 1, 2009 7:12 PM

The first seems more about the distribution of funds, the second more about the collection. If you have the resources for good health (whether or not you apply the resources to that end) then you don't have a claim on other people's money.

For those that do have a 'claim', it's moral to take disproportionately more from the rich than from the poor.

Greg Q September 1, 2009 7:34 PM

Nice post. I don't agree with all of it (of course :-) ), but it's certainly good food for thought.

Rob Lyman September 1, 2009 7:35 PM

But anything that involved price controls I would shoot down faster than a duck at an NRA convention.

I'm not sure this analogy works, insofar as ducks at NRA conventions most likely have other things on their mind than shooting down price controls.

No, I don't have anything useful to say.

Yancey Ward (Replying to: Rob Lyman) September 1, 2009 8:33 PM

Ducks are smart enough to stay away from those conventions anyway.

Matt C (Replying to: Rob Lyman) September 2, 2009 7:14 AM

But anything that involved price controls I would shoot down faster than a duck at an NRA convention

There goes McArdle again! Trying to intimidate her opponents, and create a climate of violence, by bring a gun to the debate. Save the ducks!

Yancey Ward (Replying to: Rob Lyman) September 1, 2009 8:33 PM

Ducks are smart enough to stay away from those conventions anyway.

Matt C (Replying to: Rob Lyman) September 2, 2009 7:14 AM

But anything that involved price controls I would shoot down faster than a duck at an NRA convention

There goes McArdle again! Trying to intimidate her opponents, and create a climate of violence, by bring a gun to the debate. Save the ducks!

Nimed September 1, 2009 8:06 PM

This was, overall, a very nice and well-argued post, one that reminds me why I began reading Asymmetric Information in the first place.

That is, until you click on the link to John Holbo's original post and read the whole thing, as opposed to the excerpt Megan picked.

From Holbo's post:

(...)‘rationing’ means securing for everyone a minimum share by ensuring that no one gets more than than a certain maximum share. You do the former by doing the latter. The castaways adrift on a raft with limited fresh water logic of this arrangement is clear enough. Mixing fresh water with pie: you cannot grow the pie, so you are very careful about cutting the pie into fair slices, because fairness is good; and it is especially good when being fair will keep people from dying unnecessarily. Call this the substantive sense of ‘rationing'.
No one is proposing health care rationing in the substantive sense, pretty much for the simple reason that making it illegal for granny to buy a pacemaker doesn’t make pacemakers for anyone else. You don’t ensure minimums for anyone by enforcing maximums for anyone, in this case.

Short Holbo's point: it's silly to call it rationing, because you will not be forbidden to consume more health care if you have the money for it.

Holbo's post revolves around the misuse of the rationing. It's a response to the Why not address this point instead of quoting the second to last paragraph and responding to it as if it were the whole post?

Bergamot (Replying to: Nimed) September 1, 2009 8:14 PM

"it's silly to call it rationing, because you will not be forbidden to consume more health care if you have the money for it."

And short Megan's point: It doesn't matter whether it's actually forbidden to seek out alternatives if those alternatives are all priced out of business

stonetools (Replying to: Bergamot) September 1, 2009 8:42 PM

There must be many countries where private health insurance companies have all been priced out of business when those countries moved to nationnal health insurance. Surely , you can prove your point by naming three. Thank you in advance

Alsadius (Replying to: stonetools) September 2, 2009 1:19 AM

Well, I'll start the list - in Canada, private coverage for things covered by the public system is not just unheard of, it is often outright illegal.

Skullberg (Replying to: stonetools) September 2, 2009 12:41 PM

In the UK, if you do try to go outside the system (say for Herceptin) you lose all rights to the public medical establishment for your treatment. That essentially prices those procedures/drugs/protocols out of reach.

Nimed (Replying to: Bergamot) September 1, 2009 8:45 PM

How does that work? In most countries (if not all) where there is universal health care, you are perfectly welcome to pay out of pocket for any additional treatments and procedures you wish. In most countries with a government insurance, you also retain the option to buy more expensive private insurance that provides you greater coverage.

As long as there are people willing to pay for more expensive stuff, there will be hospitals and insurance companies willing to sell it, right? Why wouldn't the market work its magic in this case?

samX (Replying to: Nimed) September 1, 2009 10:55 PM

It seems strange to me that someone would throw a monkey wrench into a functioning machine and then disdainfully tell tell the engineer to built the machine, "if your magical machine works like you say it does this shouldn't be a problem."

Ryan W. (Replying to: Nimed) September 2, 2009 1:23 AM

If you want coverage outside the British system, you have to give up your national healthcare. It's a stupid rule, but the fact that it is a rule is an interesting commentary about how national healthcare systems tend to behave and evolve in a real political context. After all, what rational reason is there for a system to punish someone for spending his own resources rather than the public's?

Sean Healy (Replying to: Nimed) September 2, 2009 11:11 AM

In Ireland you can both buy private insurance to supplement State provision AND there are private hospitals which provide care outside the system. There are even so-called co-located hospitals dispensing both private and public care, sometimes even on the same wards. Overall, though, the average standard of care is far worse than what is available right now in the US.

One other thing: there is ENORMOUS political pressure to regulate the private insurance and hospitals out of existence b/c once something gets provided by the State, it is regarded as a RIGHT, not a service. Therefore, people demand not only equal access, but equal outcomes. In other words, it must be shitty for everyone!

Nimed (Replying to: Nimed) September 1, 2009 8:51 PM

Ops. Awful last paragraph. Should read:

Holbo's post revolves around the misuse of the word rationing. It's a response to Megan's post Confronting the "R-word". Why not address his main point instead of quoting the second to last paragraph and responding to it as if it were the whole post?

Megan McArdle (Replying to: Nimed) September 2, 2009 7:35 AM

Because this is part of an ongoing conversation, and because I did. John Holbo doesn't understand what my problems are with a government rationing system, and therefore uses it inappropriately restrictively while granting himself open usage to cover pricing.

Bergamot (Replying to: Nimed) September 1, 2009 8:14 PM

"it's silly to call it rationing, because you will not be forbidden to consume more health care if you have the money for it."

And short Megan's point: It doesn't matter whether it's actually forbidden to seek out alternatives if those alternatives are all priced out of business

stonetools (Replying to: Bergamot) September 1, 2009 8:42 PM

There must be many countries where private health insurance companies have all been priced out of business when those countries moved to nationnal health insurance. Surely , you can prove your point by naming three. Thank you in advance

Alsadius (Replying to: stonetools) September 2, 2009 1:19 AM

Well, I'll start the list - in Canada, private coverage for things covered by the public system is not just unheard of, it is often outright illegal.

Skullberg (Replying to: stonetools) September 2, 2009 12:41 PM

In the UK, if you do try to go outside the system (say for Herceptin) you lose all rights to the public medical establishment for your treatment. That essentially prices those procedures/drugs/protocols out of reach.

Nimed (Replying to: Bergamot) September 1, 2009 8:45 PM

How does that work? In most countries (if not all) where there is universal health care, you are perfectly welcome to pay out of pocket for any additional treatments and procedures you wish. In most countries with a government insurance, you also retain the option to buy more expensive private insurance that provides you greater coverage.

As long as there are people willing to pay for more expensive stuff, there will be hospitals and insurance companies willing to sell it, right? Why wouldn't the market work its magic in this case?

samX (Replying to: Nimed) September 1, 2009 10:55 PM

It seems strange to me that someone would throw a monkey wrench into a functioning machine and then disdainfully tell tell the engineer to built the machine, "if your magical machine works like you say it does this shouldn't be a problem."

Ryan W. (Replying to: Nimed) September 2, 2009 1:23 AM

If you want coverage outside the British system, you have to give up your national healthcare. It's a stupid rule, but the fact that it is a rule is an interesting commentary about how national healthcare systems tend to behave and evolve in a real political context. After all, what rational reason is there for a system to punish someone for spending his own resources rather than the public's?

Sean Healy (Replying to: Nimed) September 2, 2009 11:11 AM

In Ireland you can both buy private insurance to supplement State provision AND there are private hospitals which provide care outside the system. There are even so-called co-located hospitals dispensing both private and public care, sometimes even on the same wards. Overall, though, the average standard of care is far worse than what is available right now in the US.

One other thing: there is ENORMOUS political pressure to regulate the private insurance and hospitals out of existence b/c once something gets provided by the State, it is regarded as a RIGHT, not a service. Therefore, people demand not only equal access, but equal outcomes. In other words, it must be shitty for everyone!

stonetools (Replying to: Bergamot) September 1, 2009 8:42 PM

There must be many countries where private health insurance companies have all been priced out of business when those countries moved to nationnal health insurance. Surely , you can prove your point by naming three. Thank you in advance

Alsadius (Replying to: stonetools) September 2, 2009 1:19 AM

Well, I'll start the list - in Canada, private coverage for things covered by the public system is not just unheard of, it is often outright illegal.

Skullberg (Replying to: stonetools) September 2, 2009 12:41 PM

In the UK, if you do try to go outside the system (say for Herceptin) you lose all rights to the public medical establishment for your treatment. That essentially prices those procedures/drugs/protocols out of reach.

Alsadius (Replying to: stonetools) September 2, 2009 1:19 AM

Well, I'll start the list - in Canada, private coverage for things covered by the public system is not just unheard of, it is often outright illegal.

Skullberg (Replying to: stonetools) September 2, 2009 12:41 PM

In the UK, if you do try to go outside the system (say for Herceptin) you lose all rights to the public medical establishment for your treatment. That essentially prices those procedures/drugs/protocols out of reach.

Nimed (Replying to: Bergamot) September 1, 2009 8:45 PM

How does that work? In most countries (if not all) where there is universal health care, you are perfectly welcome to pay out of pocket for any additional treatments and procedures you wish. In most countries with a government insurance, you also retain the option to buy more expensive private insurance that provides you greater coverage.

As long as there are people willing to pay for more expensive stuff, there will be hospitals and insurance companies willing to sell it, right? Why wouldn't the market work its magic in this case?

samX (Replying to: Nimed) September 1, 2009 10:55 PM

It seems strange to me that someone would throw a monkey wrench into a functioning machine and then disdainfully tell tell the engineer to built the machine, "if your magical machine works like you say it does this shouldn't be a problem."

Ryan W. (Replying to: Nimed) September 2, 2009 1:23 AM

If you want coverage outside the British system, you have to give up your national healthcare. It's a stupid rule, but the fact that it is a rule is an interesting commentary about how national healthcare systems tend to behave and evolve in a real political context. After all, what rational reason is there for a system to punish someone for spending his own resources rather than the public's?

Sean Healy (Replying to: Nimed) September 2, 2009 11:11 AM

In Ireland you can both buy private insurance to supplement State provision AND there are private hospitals which provide care outside the system. There are even so-called co-located hospitals dispensing both private and public care, sometimes even on the same wards. Overall, though, the average standard of care is far worse than what is available right now in the US.

One other thing: there is ENORMOUS political pressure to regulate the private insurance and hospitals out of existence b/c once something gets provided by the State, it is regarded as a RIGHT, not a service. Therefore, people demand not only equal access, but equal outcomes. In other words, it must be shitty for everyone!

samX (Replying to: Nimed) September 1, 2009 10:55 PM

It seems strange to me that someone would throw a monkey wrench into a functioning machine and then disdainfully tell tell the engineer to built the machine, "if your magical machine works like you say it does this shouldn't be a problem."

Ryan W. (Replying to: Nimed) September 2, 2009 1:23 AM

If you want coverage outside the British system, you have to give up your national healthcare. It's a stupid rule, but the fact that it is a rule is an interesting commentary about how national healthcare systems tend to behave and evolve in a real political context. After all, what rational reason is there for a system to punish someone for spending his own resources rather than the public's?

Sean Healy (Replying to: Nimed) September 2, 2009 11:11 AM

In Ireland you can both buy private insurance to supplement State provision AND there are private hospitals which provide care outside the system. There are even so-called co-located hospitals dispensing both private and public care, sometimes even on the same wards. Overall, though, the average standard of care is far worse than what is available right now in the US.

One other thing: there is ENORMOUS political pressure to regulate the private insurance and hospitals out of existence b/c once something gets provided by the State, it is regarded as a RIGHT, not a service. Therefore, people demand not only equal access, but equal outcomes. In other words, it must be shitty for everyone!

Nimed (Replying to: Nimed) September 1, 2009 8:51 PM

Ops. Awful last paragraph. Should read:

Holbo's post revolves around the misuse of the word rationing. It's a response to Megan's post Confronting the "R-word". Why not address his main point instead of quoting the second to last paragraph and responding to it as if it were the whole post?

Megan McArdle (Replying to: Nimed) September 2, 2009 7:35 AM

Because this is part of an ongoing conversation, and because I did. John Holbo doesn't understand what my problems are with a government rationing system, and therefore uses it inappropriately restrictively while granting himself open usage to cover pricing.

Megan McArdle (Replying to: Nimed) September 2, 2009 7:35 AM

Because this is part of an ongoing conversation, and because I did. John Holbo doesn't understand what my problems are with a government rationing system, and therefore uses it inappropriately restrictively while granting himself open usage to cover pricing.

Mark T September 1, 2009 8:08 PM

"Philosophically, there just isn't a case to be made against reform unless it's this simple one: if you don't have any money, you shouldn't be entitled to any medicine."

As phrased, there are a number of points one can make about why one disagrees with this.

A) The proposed "Reform" varies greatly from the "simple" proposition. For example, one could say, I oppose subsidizing insurance purchases. I oppose subsidizing insurance purchases by people making 3X or 4X the poverty level. I can agree that poor people get some treatment - in fact, they already do, but reject the "Reform" because it greatly exceeds that. I could point out that there are many expenditures in the government that could be diverted to help the poor and oppose "reform" because it doesn't optimize existing expenditures. One could go on and on about the other aspects of the "Reform" that exceed the "simple" proposition.

B) I have no idea what he means by "no money". No money ever?
What does that imply re copays etc. More generally, how much money should everyone else be required to spend on people who will never make a contribution to their own upkeep. Not that we might choose to spend out of the goodness of our heart but we might require certain people to fork over. I doubt it would be unlimited.

C) The phrase "entitled to any medicine" raises two questions that permit legitimate disagreement: a) "entitled" against whom? Any doctor one wants, when one wants, etc. "Entitled" against all citizens or only 2% specified as subsidizers in the proposed reform? b) is the reform limited to "any medicine" or all kinds of "medicine" about which rational people could say, you know, I feel quite charitable in general, but that seems like that is more medicine than one should be able to ask me to pay for.

Nelson September 1, 2009 8:11 PM

Here's an idea...

If you think someone needs more health care and they can't afford it, pay for it yourself instead of asking everyone else to.

stonetools (Replying to: Nelson) September 1, 2009 8:38 PM

"Are there no prisons? Are there no workhouses?"

Generally, its always the uncharitable who think that private charity is sufficient to solve major social problems.

McNamara (Replying to: stonetools) September 1, 2009 9:22 PM

If you define "charitable" as "committed to spending other people's money on the problem instead of one's own", you've once again demonstrated the value of circular reasoning on the internet. If you define "charitable" as the rest of us do, you're wrong in the old-fashioned way.

silentbeep (Replying to: McNamara) September 1, 2009 9:34 PM

McNamara: oh? and how do the "rest of us" define charitable?

Nelson:

"Here's an idea...

If you think someone needs more health care and they can't afford it, pay for it yourself instead of asking everyone else to."

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

Nelson (Replying to: McNamara) September 2, 2009 1:16 AM

Silentbeep,

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

I'm saying if you feel compelled in your heart to help someone, do it with your own resources and don't force others to do your good deeds for you through laws, taxes or other means of compulsion.

mischief (Replying to: McNamara) September 2, 2009 10:43 AM

You can't solve major social problems through private charity.

Has anyone ever "solved" a major social problem?

Ryan W. (Replying to: stonetools) September 2, 2009 2:58 AM

I don't see anything particularly charitable in insisting that someone else pay for a service for the poor. As Nelson said; charity is what you do with your own money. Trying to play Robin Hood does not make you charitable.

-- Although liberal families' incomes average 6 percent higher than those of conservative families, conservative-headed households give, on average, 30 percent more to charity than the average liberal-headed household ($1,600 per year vs. $1,227).

-- Conservatives also donate more time and give more blood.

-- Residents of the states that voted for John Kerry in 2004 gave smaller percentages of their incomes to charity than did residents of states that voted for George Bush.

-- Bush carried 24 of the 25 states where charitable giving was above average.

-- In the 10 reddest states, in which Bush got more than 60 percent majorities, the average percentage of personal income donated to charity was 3.5. Residents of the bluest states, which gave Bush less than 40 percent, donated just 1.9 percent.

-- People who reject the idea that "government has a responsibility to reduce income inequality" give an average of four times more than people who accept that proposition.

Brooks demonstrates a correlation between charitable behavior and "the values that lie beneath" liberal and conservative labels. Two influences on charitable behavior are religion and attitudes about the proper role of government.

The single biggest predictor of someone's altruism, Willett says, is religion. It increasingly correlates with conservative political affiliations because, as Brooks' book says, "the percentage of self-described Democrats who say they have 'no religion' has more than quadrupled since the early 1970s." America is largely divided between religious givers and secular nongivers, and the former are disproportionately conservative. One demonstration that religion is a strong determinant of charitable behavior is that the least charitable cohort is a relatively small one -- secular conservatives.

http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html

stonetools (Replying to: Ryan W.) September 2, 2009 8:16 AM

You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things. That's why most countries changed things. If we could solve the problem of ensuring health care for the poor through private charity, it would have already happened. It wasn't. QED.
Indeed, I'm pretty sure that neither Ryan W. or Nelson has ever gone up to a poor person and paid for their medical care. They can correct me if I'm wrong about this. When they do that, then I'll be believe that private charity can solve this problem

Nelson (Replying to: Ryan W.) September 2, 2009 8:50 AM

You can't solve major social problems through private charity.

I don't see health care as a major social problem. The way I see it, we're all going to die anyway, why should I be forced to keep some poor person alive I don't even know? I can understand relatively inexpensive first aid care that would prevent them from dieing immediately, but what about some long protracted expensive to treat illness? It's just not worth it. Now if it's an immediate family member, then yes, I'd feel some responsibility to keep them alive with my own money (up to a point). But if a person has no money, no family and no friends, what makes their life worth devoting a lot of resources towards? And I'm also saying that we can have a difference of opinion here and you are more than welcome to keep that person alive with your resources. But you aren't allowed to take mine to do it.

Col Sanders (Replying to: Ryan W.) September 2, 2009 9:15 AM

@Stonetools

"You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things."

No, in fact the private charities were working just fine. We changed things so politicians could A) have more power and B) buy more votes.

Government is force. Force is violence. If you believe a problem requires a government solution, then you must first believe that violence is the answer.

Ryan W. (Replying to: Ryan W.) September 2, 2009 1:18 PM

stonetools - First of all, private charity was far more robust around 1932 than it is today. People, on average, were poorer, certainly, but that shouldn't be confused with the effectiveness of the institutions of the time. Spending government money doesn't add cash to the economy unless you go into debt, as we have. But so far as I can tell, private charity was effective not simply at its intended purpose but also at reducing ancillary problems. Welfare, for instance, has coincided with a dramatic rise in out-of-wedlock births. If we could infer some degree of causation from that correlation (since the trend is not isolated to the US) we might pause and ask what sociological problems public works are likely to cause. More to the point, Brittan removes anyone from their healthcare system if they seek private medical help. Public works projects tend to evolve in pathological ways.

I don't see any evidence that countries changed things because their current system wasn't working. I don't see any such careful weighing of cause and effect. There was some panic during the Great Depression. I've had conversations with people from Europe who considered what US companies charge for drugs to be exploitative and didn't seem to consider whether that financial carrot might be helping pull the drug development cart they were riding. I could go on for a bit longer, but the point is that I really don't see the careful deliberation you describe. I see short term thinking without an understanding of the long term costs. I hear, repeatedly, people saying "I can't afford this now, so the government should pay for it" without acknowledgment that their desires made manifest might have a cost to the general public, including the poor. Also, the # of people without insurance has been doctored to make the need for universal healthcare seem higher than it is.

I hear people referring to average lifespans as a proxy for the efficacy of a healthcare system without accounting for diet, lifestyle, differing rates of violence (are there more murders in the US because of our healthcare system? I'm sure someone would try making that stretch, but I doubt it) differing accounting methods for when a baby is considered stillborn vs having a lifespan of 1 day, say, in America and Europe, the effect of the US saving more premies has on lifespan (premies are more sickly), or acknowledgement that the US healthcare system is better at treating cancer and heart disease than any other nation in the world. If I heard these things more often, I'd be more willing to credit those who disagreed with me with making an informed and deliberate decision.

And for what its worth, I have helped a lot of people research their conditions so that they could make sustainable medical decisions (including one woman who had stolen several thousand from me already.) I showed her how she could be treating her condition with a wider classification of drugs than her doctors recommended because all her allergic reactions were due to propionic acid derivatives. She clearly wasn't allergic to all NSAIDS as she had been told by her doctors (and had even taken aspirin without ill effect, which should have been a tipoff), and didn't need to keep going into the hospital for injections to control her pain, because she could treat it with off the shelf medicine. I also discussed several supplements with her which could help her condition.

I've bought supplements and cooked food for a lot of people to try and help improve their health, and helped them research their options and find cheaper yet effective alternatives when I have the chance. I've spent a few weeks combing the medical abstracts because a friend of mine had cancer ( he wanted to treat himself without chemotherapy, and did so successfully.) I'm a big believer in diet and lifestyle modifications whenever possible, especially since doctors seem overly eager to proscribe drugs as a solution to various problems. So that's the contribution that I make, and I've put a fair bit of time into it.

If you believe that advice from a doctor is worth something, consider that a donation. Other people might help in other ways.

Skullberg (Replying to: stonetools) September 2, 2009 12:46 PM

Generally, its always the uncharitable who think that private charity is sufficient to solve major social problems.

You mean how Evangelicals in particular and conservatives in general provide far more money to charity than liberals?

http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html

Joshua Lyle (Replying to: stonetools) September 2, 2009 12:56 PM

Okay, you do understand that prisons and workhouses are government programs, right? I mean, Beginning-of-Book-Scrooge is, at least tacitly, in your camp: he's not against having these government programs, he just implies that he regards them as sufficient. End-of-Book-Scrooge shows real charity: he gives of his own wealth out of a sense of virtuous generosity, and, by implication given the Dickensonian context, disapproves of the uncharitable government programs.

I don't particularly want to endorse Dickens, but the interpretation is pretty obvious.

stonetools (Replying to: Nelson) September 1, 2009 8:38 PM

"Are there no prisons? Are there no workhouses?"

Generally, its always the uncharitable who think that private charity is sufficient to solve major social problems.

McNamara (Replying to: stonetools) September 1, 2009 9:22 PM

If you define "charitable" as "committed to spending other people's money on the problem instead of one's own", you've once again demonstrated the value of circular reasoning on the internet. If you define "charitable" as the rest of us do, you're wrong in the old-fashioned way.

silentbeep (Replying to: McNamara) September 1, 2009 9:34 PM

McNamara: oh? and how do the "rest of us" define charitable?

Nelson:

"Here's an idea...

If you think someone needs more health care and they can't afford it, pay for it yourself instead of asking everyone else to."

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

Nelson (Replying to: McNamara) September 2, 2009 1:16 AM

Silentbeep,

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

I'm saying if you feel compelled in your heart to help someone, do it with your own resources and don't force others to do your good deeds for you through laws, taxes or other means of compulsion.

mischief (Replying to: McNamara) September 2, 2009 10:43 AM

You can't solve major social problems through private charity.

Has anyone ever "solved" a major social problem?

Ryan W. (Replying to: stonetools) September 2, 2009 2:58 AM

I don't see anything particularly charitable in insisting that someone else pay for a service for the poor. As Nelson said; charity is what you do with your own money. Trying to play Robin Hood does not make you charitable.

-- Although liberal families' incomes average 6 percent higher than those of conservative families, conservative-headed households give, on average, 30 percent more to charity than the average liberal-headed household ($1,600 per year vs. $1,227).

-- Conservatives also donate more time and give more blood.

-- Residents of the states that voted for John Kerry in 2004 gave smaller percentages of their incomes to charity than did residents of states that voted for George Bush.

-- Bush carried 24 of the 25 states where charitable giving was above average.

-- In the 10 reddest states, in which Bush got more than 60 percent majorities, the average percentage of personal income donated to charity was 3.5. Residents of the bluest states, which gave Bush less than 40 percent, donated just 1.9 percent.

-- People who reject the idea that "government has a responsibility to reduce income inequality" give an average of four times more than people who accept that proposition.

Brooks demonstrates a correlation between charitable behavior and "the values that lie beneath" liberal and conservative labels. Two influences on charitable behavior are religion and attitudes about the proper role of government.

The single biggest predictor of someone's altruism, Willett says, is religion. It increasingly correlates with conservative political affiliations because, as Brooks' book says, "the percentage of self-described Democrats who say they have 'no religion' has more than quadrupled since the early 1970s." America is largely divided between religious givers and secular nongivers, and the former are disproportionately conservative. One demonstration that religion is a strong determinant of charitable behavior is that the least charitable cohort is a relatively small one -- secular conservatives.

http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html

stonetools (Replying to: Ryan W.) September 2, 2009 8:16 AM

You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things. That's why most countries changed things. If we could solve the problem of ensuring health care for the poor through private charity, it would have already happened. It wasn't. QED.
Indeed, I'm pretty sure that neither Ryan W. or Nelson has ever gone up to a poor person and paid for their medical care. They can correct me if I'm wrong about this. When they do that, then I'll be believe that private charity can solve this problem

Nelson (Replying to: Ryan W.) September 2, 2009 8:50 AM

You can't solve major social problems through private charity.

I don't see health care as a major social problem. The way I see it, we're all going to die anyway, why should I be forced to keep some poor person alive I don't even know? I can understand relatively inexpensive first aid care that would prevent them from dieing immediately, but what about some long protracted expensive to treat illness? It's just not worth it. Now if it's an immediate family member, then yes, I'd feel some responsibility to keep them alive with my own money (up to a point). But if a person has no money, no family and no friends, what makes their life worth devoting a lot of resources towards? And I'm also saying that we can have a difference of opinion here and you are more than welcome to keep that person alive with your resources. But you aren't allowed to take mine to do it.

Col Sanders (Replying to: Ryan W.) September 2, 2009 9:15 AM

@Stonetools

"You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things."

No, in fact the private charities were working just fine. We changed things so politicians could A) have more power and B) buy more votes.

Government is force. Force is violence. If you believe a problem requires a government solution, then you must first believe that violence is the answer.

Ryan W. (Replying to: Ryan W.) September 2, 2009 1:18 PM

stonetools - First of all, private charity was far more robust around 1932 than it is today. People, on average, were poorer, certainly, but that shouldn't be confused with the effectiveness of the institutions of the time. Spending government money doesn't add cash to the economy unless you go into debt, as we have. But so far as I can tell, private charity was effective not simply at its intended purpose but also at reducing ancillary problems. Welfare, for instance, has coincided with a dramatic rise in out-of-wedlock births. If we could infer some degree of causation from that correlation (since the trend is not isolated to the US) we might pause and ask what sociological problems public works are likely to cause. More to the point, Brittan removes anyone from their healthcare system if they seek private medical help. Public works projects tend to evolve in pathological ways.

I don't see any evidence that countries changed things because their current system wasn't working. I don't see any such careful weighing of cause and effect. There was some panic during the Great Depression. I've had conversations with people from Europe who considered what US companies charge for drugs to be exploitative and didn't seem to consider whether that financial carrot might be helping pull the drug development cart they were riding. I could go on for a bit longer, but the point is that I really don't see the careful deliberation you describe. I see short term thinking without an understanding of the long term costs. I hear, repeatedly, people saying "I can't afford this now, so the government should pay for it" without acknowledgment that their desires made manifest might have a cost to the general public, including the poor. Also, the # of people without insurance has been doctored to make the need for universal healthcare seem higher than it is.

I hear people referring to average lifespans as a proxy for the efficacy of a healthcare system without accounting for diet, lifestyle, differing rates of violence (are there more murders in the US because of our healthcare system? I'm sure someone would try making that stretch, but I doubt it) differing accounting methods for when a baby is considered stillborn vs having a lifespan of 1 day, say, in America and Europe, the effect of the US saving more premies has on lifespan (premies are more sickly), or acknowledgement that the US healthcare system is better at treating cancer and heart disease than any other nation in the world. If I heard these things more often, I'd be more willing to credit those who disagreed with me with making an informed and deliberate decision.

And for what its worth, I have helped a lot of people research their conditions so that they could make sustainable medical decisions (including one woman who had stolen several thousand from me already.) I showed her how she could be treating her condition with a wider classification of drugs than her doctors recommended because all her allergic reactions were due to propionic acid derivatives. She clearly wasn't allergic to all NSAIDS as she had been told by her doctors (and had even taken aspirin without ill effect, which should have been a tipoff), and didn't need to keep going into the hospital for injections to control her pain, because she could treat it with off the shelf medicine. I also discussed several supplements with her which could help her condition.

I've bought supplements and cooked food for a lot of people to try and help improve their health, and helped them research their options and find cheaper yet effective alternatives when I have the chance. I've spent a few weeks combing the medical abstracts because a friend of mine had cancer ( he wanted to treat himself without chemotherapy, and did so successfully.) I'm a big believer in diet and lifestyle modifications whenever possible, especially since doctors seem overly eager to proscribe drugs as a solution to various problems. So that's the contribution that I make, and I've put a fair bit of time into it.

If you believe that advice from a doctor is worth something, consider that a donation. Other people might help in other ways.

Skullberg (Replying to: stonetools) September 2, 2009 12:46 PM

Generally, its always the uncharitable who think that private charity is sufficient to solve major social problems.

You mean how Evangelicals in particular and conservatives in general provide far more money to charity than liberals?

http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html

Joshua Lyle (Replying to: stonetools) September 2, 2009 12:56 PM

Okay, you do understand that prisons and workhouses are government programs, right? I mean, Beginning-of-Book-Scrooge is, at least tacitly, in your camp: he's not against having these government programs, he just implies that he regards them as sufficient. End-of-Book-Scrooge shows real charity: he gives of his own wealth out of a sense of virtuous generosity, and, by implication given the Dickensonian context, disapproves of the uncharitable government programs.

I don't particularly want to endorse Dickens, but the interpretation is pretty obvious.

McNamara (Replying to: stonetools) September 1, 2009 9:22 PM

If you define "charitable" as "committed to spending other people's money on the problem instead of one's own", you've once again demonstrated the value of circular reasoning on the internet. If you define "charitable" as the rest of us do, you're wrong in the old-fashioned way.

silentbeep (Replying to: McNamara) September 1, 2009 9:34 PM

McNamara: oh? and how do the "rest of us" define charitable?

Nelson:

"Here's an idea...

If you think someone needs more health care and they can't afford it, pay for it yourself instead of asking everyone else to."

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

Nelson (Replying to: McNamara) September 2, 2009 1:16 AM

Silentbeep,

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

I'm saying if you feel compelled in your heart to help someone, do it with your own resources and don't force others to do your good deeds for you through laws, taxes or other means of compulsion.

mischief (Replying to: McNamara) September 2, 2009 10:43 AM

You can't solve major social problems through private charity.

Has anyone ever "solved" a major social problem?

silentbeep (Replying to: McNamara) September 1, 2009 9:34 PM

McNamara: oh? and how do the "rest of us" define charitable?

Nelson:

"Here's an idea...

If you think someone needs more health care and they can't afford it, pay for it yourself instead of asking everyone else to."

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

Nelson (Replying to: McNamara) September 2, 2009 1:16 AM

Silentbeep,

So, does that mean you are implying: give your money to health care charities if you want, but not through a government program that forces people to provide money for what should be a charity program? or not?

I'm saying if you feel compelled in your heart to help someone, do it with your own resources and don't force others to do your good deeds for you through laws, taxes or other means of compulsion.

mischief (Replying to: McNamara) September 2, 2009 10:43 AM

You can't solve major social problems through private charity.

Has anyone ever "solved" a major social problem?

Ryan W. (Replying to: stonetools) September 2, 2009 2:58 AM

I don't see anything particularly charitable in insisting that someone else pay for a service for the poor. As Nelson said; charity is what you do with your own money. Trying to play Robin Hood does not make you charitable.

-- Although liberal families' incomes average 6 percent higher than those of conservative families, conservative-headed households give, on average, 30 percent more to charity than the average liberal-headed household ($1,600 per year vs. $1,227).

-- Conservatives also donate more time and give more blood.

-- Residents of the states that voted for John Kerry in 2004 gave smaller percentages of their incomes to charity than did residents of states that voted for George Bush.

-- Bush carried 24 of the 25 states where charitable giving was above average.

-- In the 10 reddest states, in which Bush got more than 60 percent majorities, the average percentage of personal income donated to charity was 3.5. Residents of the bluest states, which gave Bush less than 40 percent, donated just 1.9 percent.

-- People who reject the idea that "government has a responsibility to reduce income inequality" give an average of four times more than people who accept that proposition.

Brooks demonstrates a correlation between charitable behavior and "the values that lie beneath" liberal and conservative labels. Two influences on charitable behavior are religion and attitudes about the proper role of government.

The single biggest predictor of someone's altruism, Willett says, is religion. It increasingly correlates with conservative political affiliations because, as Brooks' book says, "the percentage of self-described Democrats who say they have 'no religion' has more than quadrupled since the early 1970s." America is largely divided between religious givers and secular nongivers, and the former are disproportionately conservative. One demonstration that religion is a strong determinant of charitable behavior is that the least charitable cohort is a relatively small one -- secular conservatives.

http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html

stonetools (Replying to: Ryan W.) September 2, 2009 8:16 AM

You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things. That's why most countries changed things. If we could solve the problem of ensuring health care for the poor through private charity, it would have already happened. It wasn't. QED.
Indeed, I'm pretty sure that neither Ryan W. or Nelson has ever gone up to a poor person and paid for their medical care. They can correct me if I'm wrong about this. When they do that, then I'll be believe that private charity can solve this problem

Nelson (Replying to: Ryan W.) September 2, 2009 8:50 AM

You can't solve major social problems through private charity.

I don't see health care as a major social problem. The way I see it, we're all going to die anyway, why should I be forced to keep some poor person alive I don't even know? I can understand relatively inexpensive first aid care that would prevent them from dieing immediately, but what about some long protracted expensive to treat illness? It's just not worth it. Now if it's an immediate family member, then yes, I'd feel some responsibility to keep them alive with my own money (up to a point). But if a person has no money, no family and no friends, what makes their life worth devoting a lot of resources towards? And I'm also saying that we can have a difference of opinion here and you are more than welcome to keep that person alive with your resources. But you aren't allowed to take mine to do it.

Col Sanders (Replying to: Ryan W.) September 2, 2009 9:15 AM

@Stonetools

"You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things."

No, in fact the private charities were working just fine. We changed things so politicians could A) have more power and B) buy more votes.

Government is force. Force is violence. If you believe a problem requires a government solution, then you must first believe that violence is the answer.

Ryan W. (Replying to: Ryan W.) September 2, 2009 1:18 PM

stonetools - First of all, private charity was far more robust around 1932 than it is today. People, on average, were poorer, certainly, but that shouldn't be confused with the effectiveness of the institutions of the time. Spending government money doesn't add cash to the economy unless you go into debt, as we have. But so far as I can tell, private charity was effective not simply at its intended purpose but also at reducing ancillary problems. Welfare, for instance, has coincided with a dramatic rise in out-of-wedlock births. If we could infer some degree of causation from that correlation (since the trend is not isolated to the US) we might pause and ask what sociological problems public works are likely to cause. More to the point, Brittan removes anyone from their healthcare system if they seek private medical help. Public works projects tend to evolve in pathological ways.

I don't see any evidence that countries changed things because their current system wasn't working. I don't see any such careful weighing of cause and effect. There was some panic during the Great Depression. I've had conversations with people from Europe who considered what US companies charge for drugs to be exploitative and didn't seem to consider whether that financial carrot might be helping pull the drug development cart they were riding. I could go on for a bit longer, but the point is that I really don't see the careful deliberation you describe. I see short term thinking without an understanding of the long term costs. I hear, repeatedly, people saying "I can't afford this now, so the government should pay for it" without acknowledgment that their desires made manifest might have a cost to the general public, including the poor. Also, the # of people without insurance has been doctored to make the need for universal healthcare seem higher than it is.

I hear people referring to average lifespans as a proxy for the efficacy of a healthcare system without accounting for diet, lifestyle, differing rates of violence (are there more murders in the US because of our healthcare system? I'm sure someone would try making that stretch, but I doubt it) differing accounting methods for when a baby is considered stillborn vs having a lifespan of 1 day, say, in America and Europe, the effect of the US saving more premies has on lifespan (premies are more sickly), or acknowledgement that the US healthcare system is better at treating cancer and heart disease than any other nation in the world. If I heard these things more often, I'd be more willing to credit those who disagreed with me with making an informed and deliberate decision.

And for what its worth, I have helped a lot of people research their conditions so that they could make sustainable medical decisions (including one woman who had stolen several thousand from me already.) I showed her how she could be treating her condition with a wider classification of drugs than her doctors recommended because all her allergic reactions were due to propionic acid derivatives. She clearly wasn't allergic to all NSAIDS as she had been told by her doctors (and had even taken aspirin without ill effect, which should have been a tipoff), and didn't need to keep going into the hospital for injections to control her pain, because she could treat it with off the shelf medicine. I also discussed several supplements with her which could help her condition.

I've bought supplements and cooked food for a lot of people to try and help improve their health, and helped them research their options and find cheaper yet effective alternatives when I have the chance. I've spent a few weeks combing the medical abstracts because a friend of mine had cancer ( he wanted to treat himself without chemotherapy, and did so successfully.) I'm a big believer in diet and lifestyle modifications whenever possible, especially since doctors seem overly eager to proscribe drugs as a solution to various problems. So that's the contribution that I make, and I've put a fair bit of time into it.

If you believe that advice from a doctor is worth something, consider that a donation. Other people might help in other ways.

stonetools (Replying to: Ryan W.) September 2, 2009 8:16 AM

You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things. That's why most countries changed things. If we could solve the problem of ensuring health care for the poor through private charity, it would have already happened. It wasn't. QED.
Indeed, I'm pretty sure that neither Ryan W. or Nelson has ever gone up to a poor person and paid for their medical care. They can correct me if I'm wrong about this. When they do that, then I'll be believe that private charity can solve this problem

Nelson (Replying to: Ryan W.) September 2, 2009 8:50 AM

You can't solve major social problems through private charity.

I don't see health care as a major social problem. The way I see it, we're all going to die anyway, why should I be forced to keep some poor person alive I don't even know? I can understand relatively inexpensive first aid care that would prevent them from dieing immediately, but what about some long protracted expensive to treat illness? It's just not worth it. Now if it's an immediate family member, then yes, I'd feel some responsibility to keep them alive with my own money (up to a point). But if a person has no money, no family and no friends, what makes their life worth devoting a lot of resources towards? And I'm also saying that we can have a difference of opinion here and you are more than welcome to keep that person alive with your resources. But you aren't allowed to take mine to do it.

Col Sanders (Replying to: Ryan W.) September 2, 2009 9:15 AM

@Stonetools

"You can't solve major social problems through private charity. It was tried until 1932 and it didn't work. That's why the we changed things."

No, in fact the private charities were working just fine. We changed things so politicians could A) have more power and B) buy more votes.

Government is force. Force is violence. If you believe a problem requires a government solution, then you must first believe that violence is the answer.

Ryan W. (Replying to: Ryan W.) September 2, 2009 1:18 PM

stonetools - First of all, private charity was far more robust around 1932 than it is today. People, on average, were poorer, certainly, but that shouldn't be confused with the effectiveness of the institutions of the time. Spending government money doesn't add cash to the economy unless you go into debt, as we have. But so far as I can tell, private charity was effective not simply at its intended purpose but also at reducing ancillary problems. Welfare, for instance, has coincided with a dramatic rise in out-of-wedlock births. If we could infer some degree of causation from that correlation (since the trend is not isolated to the US) we might pause and ask what sociological problems public works are likely to cause. More to the point, Brittan removes anyone from their healthcare system if they seek private medical help. Public works projects tend to evolve in pathological ways.

I don't see any evidence that countries changed things because their current system wasn't working. I don't see any such careful weighing of cause and effect. There was some panic during the Great Depression. I've had conversations with people from Europe who considered what US companies charge for drugs to be exploitative and didn't seem to consider whether that financial carrot might be helping pull the drug development cart they were riding. I could go on for a bit longer, but the point is that I really don't see the careful deliberation you describe. I see short term thinking without an understanding of the long term costs. I hear, repeatedly, people saying "I can't afford this now, so the government should pay for it" without acknowledgment that their desires made manifest might have a cost to the general public, including the poor. Also, the # of people without insurance has been doctored to make the need for universal healthcare seem higher than it is.

I hear people referring to average lifespans as a proxy for the efficacy of a healthcare system without accounting for diet, lifestyle, differing rates of violence (are there more murders in the US because of our healthcare system? I'm sure someone would try making that stretch, but I doubt it) differing accounting methods for when a baby is considered stillborn vs having a lifespan of 1 day, say, in America and Europe, the effect of the US saving more premies has on lifespan (premies are more sickly), or acknowledgement that the US healthcare system is better at treating cancer and heart disease than any other nation in the world. If I heard these things more often, I'd be more willing to credit those who disagreed with me with making an informed and deliberate decision.

And for what its worth, I have helped a lot of people research their conditions so that they could make sustainable medical decisions (including one woman who had stolen several thousand from me already.) I showed her how she could be treating her condition with a wider classification of drugs than her doctors recommended because all her allergic reactions were due to propionic acid derivatives. She clearly wasn't allergic to all NSAIDS as she had been told by her doctors (and had even taken aspirin without ill effect, which should have been a tipoff), and didn't need to keep going into the hospital for injections to control her pain, because she could treat it with off the shelf medicine. I also discussed several supplements with her which could help her condition.

I've bought supplements and cooked food for a lot of people to try and help improve their health, and helped them research their options and find cheaper yet effective alternatives when I have the chance. I've spent a few weeks combing the medical abstracts because a friend of mine had cancer ( he wanted to treat himself without chemotherapy, and did so successfully.) I'm a big believer in diet and lifestyle modifications whenever possible, especially since doctors seem overly eager to proscribe drugs as a solution to various problems. So that's the contribution that I make, and I've put a fair bit of time into it.

If you believe that advice from a doctor is worth something, consider that a donation. Other people might help in other ways.

Skullberg (Replying to: stonetools) September 2, 2009 12:46 PM

Generally, its always the uncharitable who think that private charity is sufficient to solve major social problems.

You mean how Evangelicals in particular and conservatives in general provide far more money to charity than liberals?

http://www.realclearpolitics.com/articles/2008/03/conservatives_more_liberal_giv.html

Joshua Lyle (Replying to: stonetools) September 2, 2009 12:56 PM

Okay, you do understand that prisons and workhouses are government programs, right? I mean, Beginning-of-Book-Scrooge is, at least tacitly, in your camp: he's not against having these government programs, he just implies that he regards them as sufficient. End-of-Book-Scrooge shows real charity: he gives of his own wealth out of a sense of virtuous generosity, and, by implication given the Dickensonian context, disapproves of the uncharitable government programs.

I don't particularly want to endorse Dickens, but the interpretation is pretty obvious.

movertyperguy September 1, 2009 8:13 PM

Megan,

You are really trying to piss up a wall here. You're debating people who have no intellectual honesty. Their arguments don't have to be logically consistent. Their philosophies don't have to make sense.

They aren't after health care for all; because we already provide health care to all Americans (you may debate the quality of what is provided if you like, but not the fact that anyone who requires health care in the United States is provided it.)

What they're after is power.

I was particularly impressed with the debate you had the other day on bloggingheads with Michelle Goldberg. It illustrates what I'm talking about:

http://bloggingheads.tv/diavlogs/22192?in=26:39&out=27:50

You clearly had the philosophical, moral, ethical and logical high ground. You had the better argument here. She lost the debate on this issue with you. And yet, she just wouldn't give up her position.

She wouldn't give up because she's never going to give up.

They're never going to admit that you're right.

stonetools (Replying to: movertyperguy) September 1, 2009 8:52 PM

Er, thousands of uninsured in America died every year because of lack of health care. Megan herself admits it. Here is one study:

http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm

18,000 deaths blamed on lack of insurance

By Steve Sternberg, USA TODAY

WASHINGTON — More than 18,000 adults in the USA die each year because they are uninsured and can't get proper health care, researchers report in a landmark study released Tuesday.

The 193-page report, "Care Without Coverage: Too Little, Too Late," examines the plight of 30 million — one in seven — working-age Americans whose employers don't provide insurance and who don't qualify for government medical care.

About 10 million children lack insurance; elderly Americans are covered by Medicare.

It is the second in a planned series of six reports by the Institute of Medicine (IOM) examining the impact of the nation's fragmented health system. The IOM is a non-profit organization of experts that advises Congress on health issues.

Overall, the researchers say, 18,314 people die in the USA each year because they lack preventive services, a timely diagnosis or appropriate care.

The estimated death toll includes about 1,400 people with high blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV.

"Our purpose is simply to deliver the facts, and the facts are unequivocal," says Reed Tuckson, an author of the report and vice president for consumer health at UnitedHealth Group in Minnetonka, Minn.

There are those stupid things called facts. Get acquainted with a few before you go spouting off about health care.

jmo3 (Replying to: stonetools) September 1, 2009 9:11 PM

About 10 million children lack insurance

SCHIP? Please try and keep up.

http://en.wikipedia.org/wiki/State_Children's_Health_Insurance_Program

Last Years Man (Replying to: jmo3) September 2, 2009 10:27 AM

Isn't SCHIP just an example of the socialized medicine regime you hate? Same with medicare.

I've seen a lot of people touting those life expectancy numbers adjusted for violent deaths that showed us number 1. But others have pointed out that the numbers are being boosted by the extra care being added on after age 65, which is of course *ahem* the year that medicare kicks in.

Ryan W. (Replying to: jmo3) September 2, 2009 3:57 PM

@Last Years Man -

1. If you prefer, look at cancer treatment rates in the US vs. Europe. Putting distribution aside, the US has superior outcomes for those who are in the system. That's worth noting.

2. A lot of people have tried to use life expectancy as a proxy for the quality of a healthcare system. Unfortunately, this doesn't work for a number of reasons; More premies are saved in the US who have a lower life expectency, the US is more likely to record live births as live births rather than stillbirths as in Europe, violence in the US as you mentioned, Higher drug use in the US (gov't treatment programs have almost no benefit. They can move people from heroin to methadone and prevent infection from needles. That's about it.)

I think the point here is that showing European nations with higher life expectancy does not prove what many people think it proves.

Incidentally, I'm fine with some socialized medicine for kids, especially things like vaccines and antibiotics which are highly cost effective and prevent externalities. I'd like to see them administered at school (with parental consent) so we know kids take the full course and don't spread antibiotic resistant bugs. I'd like to see government coverage for seniors removed, but that's not a medical reality. There's no reason to redistribute money away from young people raising families and healthy businesses employing people productively into tremendously expensive care for seniors. The costs dwarf the benefits.

movertyperguy (Replying to: stonetools) September 1, 2009 10:46 PM

Bullshit.

"The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash."

The report does not state that people without insurance are unable to get health care. It says they are more likely to receive too little of it by some claimed subjective measure. It questions the quality of the care they got.

These people did not die, as you claim "because of lack of health care." They died, many of them, of their injuries, which were being treated in hospitals. They were all receiving free health care - the quality of which is up for all the debate you want to have.

Did you even read the report?

stonetools (Replying to: movertyperguy) September 2, 2009 8:24 AM

I did read this:

Among the study's findings is a comparison of the uninsured with the insured:

Uninsured people with colon or breast cancer face a 50% higher risk of death.
Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.
About 25% of adult diabetics without insurance for a year or more went without a checkup for two years. That boosts their risk of death, blindness and amputations resulting from poor circulation.
Being uninsured also magnifies the risk of death and disability for chronically sick and mentally ill patients, poor people and minorities, who disproportionately lack access to medical care, the landmark study states.

Now if you have evidence disputing those findings, by all means present it. If you can't present such EVIDENCE, then you need to accept reality.

The Ninja Zombie (Replying to: movertyperguy) September 2, 2009 12:39 PM

Stonetools, the report (such as it is) does not appear to have any useful controls.

It does not compare, e.g., uninsured white males making $50-60k/year to insured white males making $50-60k/year. It simply compares the uninsured to the insured.

There are major demographic differences between the uninsured and the insured which make such a comparison worthless.

Phlinn (Replying to: stonetools) September 2, 2009 5:24 PM

Your terms are incorrect. They didn't die because of lack of care, they died because of whatever medical conditions actually killed them. The distinction is crucial. I am NOT responsible for situations unless actions I took actually caused them. In other words, if the situation would be unchanged if I had never existed, then I am not to blame for it even if I could have acted to prevent it. Claiming that lack of help caused something is confusing the issue, either deliberately or foolishly.

Inaction is a neutral act. Helping someone is a good act. Harming someone is a bad act. Both good and bad are not really quantifiable, all that is known is the sign, but people frequently try to measure such things, and then go on to claim that inaction is actually evil, or even that an insufficiently good act is evil.

PeorgieTirebiter (Replying to: movertyperguy) September 1, 2009 9:47 PM

Movertypeguy, speaking of intellectual honesty…

“(you may debate the quality of what is provided if you like, but not the fact that anyone who requires health care in the United States is provided it.)”

Please, tell us more about who provides what to anyone requiring health care, and please tell us how they're doing it.

movertyperguy (Replying to: PeorgieTirebiter) September 1, 2009 10:55 PM

I'll humor you for a moment:

The Catholic Church provides free health care to anyone in almost every major city in the United States by operating charity hospitals. They pay for this by millions of people donating money to the Catholic Church for the express purpose of providing free hospitals.

The Catholic Church isn't about providing "health reform." They're about providing "health care." So, they built some hospitals and staffed them with some doctors and nurses. See how that works? Seems pretty logical doesn't it?

Total number of hospitals Barack Obama has proposed building: Zero

stonetools (Replying to: movertyperguy) September 2, 2009 8:37 AM

Yet still the uninsured die more often for lack of health care, despite the heroic efforts of Catholic Church. Are you familiar with the Catholic Church's teaching on social justice? I can assure you that they are a far cry from libertarianism.

http://www.osjspm.org/catholic_social_teaching.aspx

The Catholic bishops on health care:

After all, the bishops as a body have been on record supporting some form of universal access to health care since 1919, when they declared that "the state should make comprehensive provision for insurance against illness, invalidity, unemployment and old age."

Thirteen years ago, they issued a pastoral letter, calling health care a "basic right" that government must provide. "It is the responsibility of the Federal Government to establish a comprehensive health care system that will insure a basic level of health care for all Americans," the letter said. "The Federal Government should also insure adequate funding for this basic level of care through a national health insurance program."

http://www.nytimes.com/1994/08/25/us/health-care-debate-catholic-church-catholic-leaders-dilemma-abortion-vs.html

Now they have problems with abortion. But that aside, The Catholic Church is for universal health insurance. Thanks for bringing up the Catholic Church.

jmo3 (Replying to: PeorgieTirebiter) September 1, 2009 11:53 PM

Please, tell us more about who provides what to anyone requiring health care, and please tell us how they're doing it.

So, are you not aware of the higher medicare reimbursements that are paid to public safety net hospitals to compensate them for all the free care they deliver?

Were you aware that no hospital run by the City of New York will charge you more than $3,500 no matter what is wrong with you?

Are you really this ignorant?

Last Years Man (Replying to: jmo3) September 2, 2009 10:14 AM

New York is not the whole country (despite what people who live there, including myself, think).

Any data on number of uninsured dying in NY vs. other parts of the country? (don't slap me for not researching, I'm at work.

stonetools (Replying to: movertyperguy) September 1, 2009 8:52 PM

Er, thousands of uninsured in America died every year because of lack of health care. Megan herself admits it. Here is one study:

http://www.usatoday.com/news/health/healthcare/2002-05-22-insurance-deaths.htm

18,000 deaths blamed on lack of insurance

By Steve Sternberg, USA TODAY

WASHINGTON — More than 18,000 adults in the USA die each year because they are uninsured and can't get proper health care, researchers report in a landmark study released Tuesday.

The 193-page report, "Care Without Coverage: Too Little, Too Late," examines the plight of 30 million — one in seven — working-age Americans whose employers don't provide insurance and who don't qualify for government medical care.

About 10 million children lack insurance; elderly Americans are covered by Medicare.

It is the second in a planned series of six reports by the Institute of Medicine (IOM) examining the impact of the nation's fragmented health system. The IOM is a non-profit organization of experts that advises Congress on health issues.

Overall, the researchers say, 18,314 people die in the USA each year because they lack preventive services, a timely diagnosis or appropriate care.

The estimated death toll includes about 1,400 people with high blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV.

"Our purpose is simply to deliver the facts, and the facts are unequivocal," says Reed Tuckson, an author of the report and vice president for consumer health at UnitedHealth Group in Minnetonka, Minn.

There are those stupid things called facts. Get acquainted with a few before you go spouting off about health care.

jmo3 (Replying to: stonetools) September 1, 2009 9:11 PM

About 10 million children lack insurance

SCHIP? Please try and keep up.

http://en.wikipedia.org/wiki/State_Children's_Health_Insurance_Program

Last Years Man (Replying to: jmo3) September 2, 2009 10:27 AM

Isn't SCHIP just an example of the socialized medicine regime you hate? Same with medicare.

I've seen a lot of people touting those life expectancy numbers adjusted for violent deaths that showed us number 1. But others have pointed out that the numbers are being boosted by the extra care being added on after age 65, which is of course *ahem* the year that medicare kicks in.

Ryan W. (Replying to: jmo3) September 2, 2009 3:57 PM

@Last Years Man -

1. If you prefer, look at cancer treatment rates in the US vs. Europe. Putting distribution aside, the US has superior outcomes for those who are in the system. That's worth noting.

2. A lot of people have tried to use life expectancy as a proxy for the quality of a healthcare system. Unfortunately, this doesn't work for a number of reasons; More premies are saved in the US who have a lower life expectency, the US is more likely to record live births as live births rather than stillbirths as in Europe, violence in the US as you mentioned, Higher drug use in the US (gov't treatment programs have almost no benefit. They can move people from heroin to methadone and prevent infection from needles. That's about it.)

I think the point here is that showing European nations with higher life expectancy does not prove what many people think it proves.

Incidentally, I'm fine with some socialized medicine for kids, especially things like vaccines and antibiotics which are highly cost effective and prevent externalities. I'd like to see them administered at school (with parental consent) so we know kids take the full course and don't spread antibiotic resistant bugs. I'd like to see government coverage for seniors removed, but that's not a medical reality. There's no reason to redistribute money away from young people raising families and healthy businesses employing people productively into tremendously expensive care for seniors. The costs dwarf the benefits.

movertyperguy (Replying to: stonetools) September 1, 2009 10:46 PM

Bullshit.

"The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash."

The report does not state that people without insurance are unable to get health care. It says they are more likely to receive too little of it by some claimed subjective measure. It questions the quality of the care they got.

These people did not die, as you claim "because of lack of health care." They died, many of them, of their injuries, which were being treated in hospitals. They were all receiving free health care - the quality of which is up for all the debate you want to have.

Did you even read the report?

stonetools (Replying to: movertyperguy) September 2, 2009 8:24 AM

I did read this:

Among the study's findings is a comparison of the uninsured with the insured:

Uninsured people with colon or breast cancer face a 50% higher risk of death.
Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.
About 25% of adult diabetics without insurance for a year or more went without a checkup for two years. That boosts their risk of death, blindness and amputations resulting from poor circulation.
Being uninsured also magnifies the risk of death and disability for chronically sick and mentally ill patients, poor people and minorities, who disproportionately lack access to medical care, the landmark study states.

Now if you have evidence disputing those findings, by all means present it. If you can't present such EVIDENCE, then you need to accept reality.

The Ninja Zombie (Replying to: movertyperguy) September 2, 2009 12:39 PM

Stonetools, the report (such as it is) does not appear to have any useful controls.

It does not compare, e.g., uninsured white males making $50-60k/year to insured white males making $50-60k/year. It simply compares the uninsured to the insured.

There are major demographic differences between the uninsured and the insured which make such a comparison worthless.

Phlinn (Replying to: stonetools) September 2, 2009 5:24 PM

Your terms are incorrect. They didn't die because of lack of care, they died because of whatever medical conditions actually killed them. The distinction is crucial. I am NOT responsible for situations unless actions I took actually caused them. In other words, if the situation would be unchanged if I had never existed, then I am not to blame for it even if I could have acted to prevent it. Claiming that lack of help caused something is confusing the issue, either deliberately or foolishly.

Inaction is a neutral act. Helping someone is a good act. Harming someone is a bad act. Both good and bad are not really quantifiable, all that is known is the sign, but people frequently try to measure such things, and then go on to claim that inaction is actually evil, or even that an insufficiently good act is evil.

jmo3 (Replying to: stonetools) September 1, 2009 9:11 PM

About 10 million children lack insurance

SCHIP? Please try and keep up.

http://en.wikipedia.org/wiki/State_Children's_Health_Insurance_Program

Last Years Man (Replying to: jmo3) September 2, 2009 10:27 AM

Isn't SCHIP just an example of the socialized medicine regime you hate? Same with medicare.

I've seen a lot of people touting those life expectancy numbers adjusted for violent deaths that showed us number 1. But others have pointed out that the numbers are being boosted by the extra care being added on after age 65, which is of course *ahem* the year that medicare kicks in.

Ryan W. (Replying to: jmo3) September 2, 2009 3:57 PM

@Last Years Man -

1. If you prefer, look at cancer treatment rates in the US vs. Europe. Putting distribution aside, the US has superior outcomes for those who are in the system. That's worth noting.

2. A lot of people have tried to use life expectancy as a proxy for the quality of a healthcare system. Unfortunately, this doesn't work for a number of reasons; More premies are saved in the US who have a lower life expectency, the US is more likely to record live births as live births rather than stillbirths as in Europe, violence in the US as you mentioned, Higher drug use in the US (gov't treatment programs have almost no benefit. They can move people from heroin to methadone and prevent infection from needles. That's about it.)

I think the point here is that showing European nations with higher life expectancy does not prove what many people think it proves.

Incidentally, I'm fine with some socialized medicine for kids, especially things like vaccines and antibiotics which are highly cost effective and prevent externalities. I'd like to see them administered at school (with parental consent) so we know kids take the full course and don't spread antibiotic resistant bugs. I'd like to see government coverage for seniors removed, but that's not a medical reality. There's no reason to redistribute money away from young people raising families and healthy businesses employing people productively into tremendously expensive care for seniors. The costs dwarf the benefits.

Last Years Man (Replying to: jmo3) September 2, 2009 10:27 AM

Isn't SCHIP just an example of the socialized medicine regime you hate? Same with medicare.

I've seen a lot of people touting those life expectancy numbers adjusted for violent deaths that showed us number 1. But others have pointed out that the numbers are being boosted by the extra care being added on after age 65, which is of course *ahem* the year that medicare kicks in.

Ryan W. (Replying to: jmo3) September 2, 2009 3:57 PM

@Last Years Man -

1. If you prefer, look at cancer treatment rates in the US vs. Europe. Putting distribution aside, the US has superior outcomes for those who are in the system. That's worth noting.

2. A lot of people have tried to use life expectancy as a proxy for the quality of a healthcare system. Unfortunately, this doesn't work for a number of reasons; More premies are saved in the US who have a lower life expectency, the US is more likely to record live births as live births rather than stillbirths as in Europe, violence in the US as you mentioned, Higher drug use in the US (gov't treatment programs have almost no benefit. They can move people from heroin to methadone and prevent infection from needles. That's about it.)

I think the point here is that showing European nations with higher life expectancy does not prove what many people think it proves.

Incidentally, I'm fine with some socialized medicine for kids, especially things like vaccines and antibiotics which are highly cost effective and prevent externalities. I'd like to see them administered at school (with parental consent) so we know kids take the full course and don't spread antibiotic resistant bugs. I'd like to see government coverage for seniors removed, but that's not a medical reality. There's no reason to redistribute money away from young people raising families and healthy businesses employing people productively into tremendously expensive care for seniors. The costs dwarf the benefits.

movertyperguy (Replying to: stonetools) September 1, 2009 10:46 PM

Bullshit.

"The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash."

The report does not state that people without insurance are unable to get health care. It says they are more likely to receive too little of it by some claimed subjective measure. It questions the quality of the care they got.

These people did not die, as you claim "because of lack of health care." They died, many of them, of their injuries, which were being treated in hospitals. They were all receiving free health care - the quality of which is up for all the debate you want to have.

Did you even read the report?

stonetools (Replying to: movertyperguy) September 2, 2009 8:24 AM

I did read this:

Among the study's findings is a comparison of the uninsured with the insured:

Uninsured people with colon or breast cancer face a 50% higher risk of death.
Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.
About 25% of adult diabetics without insurance for a year or more went without a checkup for two years. That boosts their risk of death, blindness and amputations resulting from poor circulation.
Being uninsured also magnifies the risk of death and disability for chronically sick and mentally ill patients, poor people and minorities, who disproportionately lack access to medical care, the landmark study states.

Now if you have evidence disputing those findings, by all means present it. If you can't present such EVIDENCE, then you need to accept reality.

The Ninja Zombie (Replying to: movertyperguy) September 2, 2009 12:39 PM

Stonetools, the report (such as it is) does not appear to have any useful controls.

It does not compare, e.g., uninsured white males making $50-60k/year to insured white males making $50-60k/year. It simply compares the uninsured to the insured.

There are major demographic differences between the uninsured and the insured which make such a comparison worthless.

stonetools (Replying to: movertyperguy) September 2, 2009 8:24 AM

I did read this:

Among the study's findings is a comparison of the uninsured with the insured:

Uninsured people with colon or breast cancer face a 50% higher risk of death.
Uninsured trauma victims are less likely to be admitted to the hospital, receive the full range of needed services, and are 37% more likely to die of their injuries.
About 25% of adult diabetics without insurance for a year or more went without a checkup for two years. That boosts their risk of death, blindness and amputations resulting from poor circulation.
Being uninsured also magnifies the risk of death and disability for chronically sick and mentally ill patients, poor people and minorities, who disproportionately lack access to medical care, the landmark study states.

Now if you have evidence disputing those findings, by all means present it. If you can't present such EVIDENCE, then you need to accept reality.

The Ninja Zombie (Replying to: movertyperguy) September 2, 2009 12:39 PM

Stonetools, the report (such as it is) does not appear to have any useful controls.

It does not compare, e.g., uninsured white males making $50-60k/year to insured white males making $50-60k/year. It simply compares the uninsured to the insured.

There are major demographic differences between the uninsured and the insured which make such a comparison worthless.

Phlinn (Replying to: stonetools) September 2, 2009 5:24 PM

Your terms are incorrect. They didn't die because of lack of care, they died because of whatever medical conditions actually killed them. The distinction is crucial. I am NOT responsible for situations unless actions I took actually caused them. In other words, if the situation would be unchanged if I had never existed, then I am not to blame for it even if I could have acted to prevent it. Claiming that lack of help caused something is confusing the issue, either deliberately or foolishly.

Inaction is a neutral act. Helping someone is a good act. Harming someone is a bad act. Both good and bad are not really quantifiable, all that is known is the sign, but people frequently try to measure such things, and then go on to claim that inaction is actually evil, or even that an insufficiently good act is evil.

PeorgieTirebiter (Replying to: movertyperguy) September 1, 2009 9:47 PM

Movertypeguy, speaking of intellectual honesty…

“(you may debate the quality of what is provided if you like, but not the fact that anyone who requires health care in the United States is provided it.)”

Please, tell us more about who provides what to anyone requiring health care, and please tell us how they're doing it.

movertyperguy (Replying to: PeorgieTirebiter) September 1, 2009 10:55 PM

I'll humor you for a moment:

The Catholic Church provides free health care to anyone in almost every major city in the United States by operating charity hospitals. They pay for this by millions of people donating money to the Catholic Church for the express purpose of providing free hospitals.

The Catholic Church isn't about providing "health reform." They're about providing "health care." So, they built some hospitals and staffed them with some doctors and nurses. See how that works? Seems pretty logical doesn't it?

Total number of hospitals Barack Obama has proposed building: Zero

stonetools (Replying to: movertyperguy) September 2, 2009 8:37 AM

Yet still the uninsured die more often for lack of health care, despite the heroic efforts of Catholic Church. Are you familiar with the Catholic Church's teaching on social justice? I can assure you that they are a far cry from libertarianism.

http://www.osjspm.org/catholic_social_teaching.aspx

The Catholic bishops on health care:

After all, the bishops as a body have been on record supporting some form of universal access to health care since 1919, when they declared that "the state should make comprehensive provision for insurance against illness, invalidity, unemployment and old age."

Thirteen years ago, they issued a pastoral letter, calling health care a "basic right" that government must provide. "It is the responsibility of the Federal Government to establish a comprehensive health care system that will insure a basic level of health care for all Americans," the letter said. "The Federal Government should also insure adequate funding for this basic level of care through a national health insurance program."

http://www.nytimes.com/1994/08/25/us/health-care-debate-catholic-church-catholic-leaders-dilemma-abortion-vs.html

Now they have problems with abortion. But that aside, The Catholic Church is for universal health insurance. Thanks for bringing up the Catholic Church.

jmo3 (Replying to: PeorgieTirebiter) September 1, 2009 11:53 PM

Please, tell us more about who provides what to anyone requiring health care, and please tell us how they're doing it.

So, are you not aware of the higher medicare reimbursements that are paid to public safety net hospitals to compensate them for all the free care they deliver?

Were you aware that no hospital run by the City of New York will charge you more than $3,500 no matter what is wrong with you?

Are you really this ignorant?

Last Years Man (Replying to: jmo3) September 2, 2009 10:14 AM

New York is not the whole country (despite what people who live there, including myself, think).

Any data on number of uninsured dying in NY vs. other parts of the country? (don't slap me for not researching, I'm at work.

movertyperguy (Replying to: PeorgieTirebiter) September 1, 2009 10:55 PM

I'll humor you for a moment:

The Catholic Church provides free health care to anyone in almost every major city in the United States by operating charity hospitals. They pay for this by millions of people donating money to the Catholic Church for the express purpose of providing free hospitals.

The Catholic Church isn't about providing "health reform." They're about providing "health care." So, they built some hospitals and staffed them with some doctors and nurses. See how that works? Seems pretty logical doesn't it?

Total number of hospitals Barack Obama has proposed building: Zero

stonetools (Replying to: movertyperguy) September 2, 2009 8:37 AM

Yet still the uninsured die more often for lack of health care, despite the heroic efforts of Catholic Church. Are you familiar with the Catholic Church's teaching on social justice? I can assure you that they are a far cry from libertarianism.

http://www.osjspm.org/catholic_social_teaching.aspx

The Catholic bishops on health care:

After all, the bishops as a body have been on record supporting some form of universal access to health care since 1919, when they declared that "the state should make comprehensive provision for insurance against illness, invalidity, unemployment and old age."

Thirteen years ago, they issued a pastoral letter, calling health care a "basic right" that government must provide. "It is the responsibility of the Federal Government to establish a comprehensive health care system that will insure a basic level of health care for all Americans," the letter said. "The Federal Government should also insure adequate funding for this basic level of care through a national health insurance program."

http://www.nytimes.com/1994/08/25/us/health-care-debate-catholic-church-catholic-leaders-dilemma-abortion-vs.html

Now they have problems with abortion. But that aside, The Catholic Church is for universal health insurance. Thanks for bringing up the Catholic Church.

stonetools (Replying to: movertyperguy) September 2, 2009 8:37 AM

Yet still the uninsured die more often for lack of health care, despite the heroic efforts of Catholic Church. Are you familiar with the Catholic Church's teaching on social justice? I can assure you that they are a far cry from libertarianism.

http://www.osjspm.org/catholic_social_teaching.aspx

The Catholic bishops on health care:

After all, the bishops as a body have been on record supporting some form of universal access to health care since 1919, when they declared that "the state should make comprehensive provision for insurance against illness, invalidity, unemployment and old age."

Thirteen years ago, they issued a pastoral letter, calling health care a "basic right" that government must provide. "It is the responsibility of the Federal Government to establish a comprehensive health care system that will insure a basic level of health care for all Americans," the letter said. "The Federal Government should also insure adequate funding for this basic level of care through a national health insurance program."

http://www.nytimes.com/1994/08/25/us/health-care-debate-catholic-church-catholic-leaders-dilemma-abortion-vs.html

Now they have problems with abortion. But that aside, The Catholic Church is for universal health insurance. Thanks for bringing up the Catholic Church.

jmo3 (Replying to: PeorgieTirebiter) September 1, 2009 11:53 PM

Please, tell us more about who provides what to anyone requiring health care, and please tell us how they're doing it.

So, are you not aware of the higher medicare reimbursements that are paid to public safety net hospitals to compensate them for all the free care they deliver?

Were you aware that no hospital run by the City of New York will charge you more than $3,500 no matter what is wrong with you?

Are you really this ignorant?

Last Years Man (Replying to: jmo3) September 2, 2009 10:14 AM

New York is not the whole country (despite what people who live there, including myself, think).

Any data on number of uninsured dying in NY vs. other parts of the country? (don't slap me for not researching, I'm at work.

Last Years Man (Replying to: jmo3) September 2, 2009 10:14 AM

New York is not the whole country (despite what people who live there, including myself, think).

Any data on number of uninsured dying in NY vs. other parts of the country? (don't slap me for not researching, I'm at work.

silentbeep September 1, 2009 8:19 PM

"Save the few thousand who might be kept alive by healthcare they now can't afford..."

Who are these few thousand? And what does "few" mean? In Los Angeles alone, almost 10,000 people showed up for a free-healthcare clinic that ran for a few days. Millions of people are now uninsured, and no just showing up at the emergency room is not a good way to guarantee healthcare for the uninsured. Millions more are at risk of being uninsured due to economic instabilty i.e. losing health benefits through loss of jobs. So, those 'thousands' do not represent a static number, and who are the potential "millions" that will be saved? what are we talking about here? Are you talking about potential AIDS research? Or Cancer research? What millions? I think this is where Holdbo is coming from here, some of your arguments have this quality of spinning farther and farther out into the future and are heavily abstract in nature when arguing against national health care. Now, i personally believe there is nothing wrong with an abstract philosophical argument and I have taken your thought experiment into account: what if you are right megan? this is a possiblity, I admit that, but I don't take that possiblity as a serious enough one that will actually happen, as to entirely dismiss arguments for national health care.(I think the "innovation will ground to a halt" scenario has a small likelihood of happening, versus the present reality of millions of uninsured, with inadequate access to efficient delivery of care which is happening, and will continue to happen) Becuase like you said "All we have is our intuitions, our observations of the world, and our best guess about the future."

Unlike others might, I don't think you are a crazy idealogue. I just don't agree with your ideas and I admit you have a point, just not a good enough one to dismiss national health care in my eyes.

Again this: "All we have is our intuitions, our observations of the world, and our best guess about the future."

Exactly right Megan. And I think there is such vehment disagreement between you and Holbo. Steinglass and perhaps E. Klein and maybe other commentars on this blog, including myself, because we are operating from different, intuitions, different observations of the world and our different best guesses about the future. And you are operating from a philosophy that is libertarian. That is the lense you are viewing this issue from. I am viewing this issue from my particulr lense as a liberal.

movertyperguy (Replying to: silentbeep) September 1, 2009 8:48 PM

"Millions more are at risk of being uninsured ..."

Huh? Is "being insured" now a right?

WTF?

If Barack Obama and the Democrats wanted to bring health care to people they should propose the construction of some hospitals.

When did the Democrats become the best friend of the wildly profitable insurance industry? Why this rush to require people to pay extortionist insurance rates?

Has the insurance industry bought off the Democrats?

If you want to bring health care to people, then stop talking about insurance and start talking about free doctors and free nurses and free medicine.

Quit talking about requiring me to buy insurance from your donors in the obscenely profitable insurance industry.

silentbeep (Replying to: movertyperguy) September 1, 2009 8:53 PM

It's not about insurance per se, it's about getting people efficient delivery of care. The fact that they don't have insurance in this country, means that millions of people are at risk for poor health care, including the millions that currently don't have insurance.

O.K. let's stop talking about buying insurance and let's talk about free doctors, free nurses and free medicine: would you support this? I'm serious.

movertyperguy (Replying to: silentbeep) September 1, 2009 10:05 PM

I would support that debate, yes. I will not debate forcing people to enrich fucking insurance agents at threat of IRS audits.

If Barack Obama wants to give people health care then he should build hospitals with the $9 trillion of deficits over the next 10 years and staff them with doctors and nurses.

But Barack Obama isn't doing that, is he?. Instead, he's writing welfare checks to Bill Frist for $4,500. Does Bill Frist need $4,500 of government welfare to buy a new car?

http://green.autoblog.com/2009/08/25/sen-bill-frist-uses-cash-for-clunkers-junks-suburban-for-prius/

Or could we have bought a poor person a tonsillectomy instead? How much plaster of Paris can you buy with $4,500 to provide people with free casts for straightening crooked feet? A lot, I'd bet.

What's the President's priority based on what is actually occurring as opposed to his rhetoric? Seems to me Bill Frist got his check already.

$4,500 in welfare for a millionaire to buy himself a new car ... that's what Barack Obama has delivered.

silentbeep (Replying to: movertyperguy) September 1, 2009 8:55 PM

oh yeah, see stonetools above about what happens to people who are uninsured.

stonetools (Replying to: movertyperguy) September 1, 2009 9:05 PM

Well, I personally would be OK with socialized medicine, which seems to be what you are suggesting, but apparently the majority of Americans- including many libertarians-object to this and want to preserve the obscene profits of the private health insurance industry. Go figure, eh?

movertyperguy (Replying to: stonetools) September 1, 2009 10:11 PM

Nobody has proposed socialized medicine.

Barack Obama isn't interested in delivering health care to people. If he was, he'd be interviewing doctors for free clinics.

Instead, he's proposed forcing many people who have freely chosen not to purchase health insurance, many for religious reasons, to purchase it.

Everyone in the Untied States who requires health care receives it currently with no consideration for whether they can pay for it or not. If you have insurance, the insurance company pays. If you have the means to pay for it, you pay for it. If you don't legitimately have the means to pay for it, you do not pay for it.

We aren't debating health care.

We're debating Barack Obama's plan to force people to buy wildly overpriced insurance from his political donors.

Brian 2 (Replying to: silentbeep) September 2, 2009 12:12 AM

In Los Angeles alone, almost 10,000 people showed up for a free-healthcare clinic that ran for a few days.

And millions show up to KFC when they offer free chicken. Which establishes that people like free stuff, not that there's mass starvation. Ok, that's not quite the same; on the other hand, how many of those 10,000 were illegal immigrants?

Millions of people are now uninsured, and no just showing up at the emergency room is not a good way to guarantee healthcare for the uninsured.

Agreed. What about helping those who need it without upending the entire health care sector? We have food stamps, not government-run farms and grocery stores. (And farm subsidies that generally make things worse, but that's a separate issue).

Millions more are at risk of being uninsured due to economic instabilty i.e. losing health benefits through loss of jobs.

Almost everyone agrees that employers being the primary source of health insurance is idiotic. One exception being Barack Obama, who successfully demagogued McCain's proposal to transition away from it by ending the discriminatory tax treatment of individual policies.

So, those 'thousands' do not represent a static number, and who are the potential "millions" that will be saved? what are we talking about here? Are you talking about potential AIDS research? Or Cancer research?

I don't know, for the same reason I don't know what cool stuff Apple and Google will come up with in the next 10 years. I'm pretty sure it will be something though. For example a cure for Alzheimer's would massively increase the quality of life for millions of sufferers and their families.

I think the "innovation will ground to a halt" scenario has a small likelihood of happening

So do I, but I think "innovation will continue but at a significantly decreased level" is rather more likely. Decrease potential profits, and you decrease supply. Maybe that's a good tradeoff at the margin, but it is a tradeoff.

And you are operating from a philosophy that is libertarian. That is the lense you are viewing this issue from. I am viewing this issue from my particulr lense as a liberal.

Fair enough. Although I think the relevant content of my lens in this case is just "people respond to incentives".

silentbeep (Replying to: Brian 2) September 2, 2009 12:17 PM

"And millions show up to KFC when they offer free chicken. Which establishes that people like free stuff, not that there's mass starvation. Ok, that's not quite the same; on the other hand, how many of those 10,000 were illegal immigrants?"

No it's not the same thing. Especially when the hypoethical millions (or even thousands for that matter) don't show up to one KFC at one time to get the hypothetical free chicken, and get turned away even when they camped out overnight like it happened in Inglewood: "RAM officials said they had to turn away thousands of patients, many who had camped overnight to be seen by a doctor, despite admitting nearly 1,000 patients every day"

http://cbs2.com/local/Free.Clinic.Inglewood.2.1135997.html

Megan herself has admitted that there are millions of people without health insurance, which usually means inadequate access to healthcare. We don't have to guess how many illegal immigrants show up for free-healthcare in one city, during one week, to make a guess on how this affects american citizens. This free clinic was an example, only one, of the urgency of need that is out there.

"Agreed. What about helping those who need it without upending the entire health care sector? We have food stamps, not government-run farms and grocery stores. (And farm subsidies that generally make things worse, but that's a separate issue)."

I'm not sure where the "upending" is happening here because no one is proposing government-run hospitals.

"Decrease potential profits, and you decrease supply. Maybe that's a good tradeoff at the margin, but it is a tradeoff."

Exactly. I don't think there aren't tradeoffs here. I just think they are worth it.

"I don't know, for the same reason I don't know what cool stuff Apple and Google will come up with in the next 10 years. I'm pretty sure it will be something though. For example a cure for Alzheimer's would massively increase the quality of life for millions of sufferers and their families."

Right, I don't know either. I'm basing my support on national healthcare with the information that I have right now, which is a mass number of the uninsured who therefore do not have adequate access to healthcare, with the understanding that if the status quo does not change, such conditions will keep on happening. I am not basing my support on the possibility that something really cool may happen in the future (again I don't think innovation grounding to a halt or being slowed down to a significant degree is a high probability, this again is where I disagree with Megan).

movertyperguy (Replying to: silentbeep) September 1, 2009 8:48 PM

"Millions more are at risk of being uninsured ..."

Huh? Is "being insured" now a right?

WTF?

If Barack Obama and the Democrats wanted to bring health care to people they should propose the construction of some hospitals.

When did the Democrats become the best friend of the wildly profitable insurance industry? Why this rush to require people to pay extortionist insurance rates?

Has the insurance industry bought off the Democrats?

If you want to bring health care to people, then stop talking about insurance and start talking about free doctors and free nurses and free medicine.

Quit talking about requiring me to buy insurance from your donors in the obscenely profitable insurance industry.

silentbeep (Replying to: movertyperguy) September 1, 2009 8:53 PM

It's not about insurance per se, it's about getting people efficient delivery of care. The fact that they don't have insurance in this country, means that millions of people are at risk for poor health care, including the millions that currently don't have insurance.

O.K. let's stop talking about buying insurance and let's talk about free doctors, free nurses and free medicine: would you support this? I'm serious.

movertyperguy (Replying to: silentbeep) September 1, 2009 10:05 PM

I would support that debate, yes. I will not debate forcing people to enrich fucking insurance agents at threat of IRS audits.

If Barack Obama wants to give people health care then he should build hospitals with the $9 trillion of deficits over the next 10 years and staff them with doctors and nurses.

But Barack Obama isn't doing that, is he?. Instead, he's writing welfare checks to Bill Frist for $4,500. Does Bill Frist need $4,500 of government welfare to buy a new car?

http://green.autoblog.com/2009/08/25/sen-bill-frist-uses-cash-for-clunkers-junks-suburban-for-prius/

Or could we have bought a poor person a tonsillectomy instead? How much plaster of Paris can you buy with $4,500 to provide people with free casts for straightening crooked feet? A lot, I'd bet.

What's the President's priority based on what is actually occurring as opposed to his rhetoric? Seems to me Bill Frist got his check already.

$4,500 in welfare for a millionaire to buy himself a new car ... that's what Barack Obama has delivered.

silentbeep (Replying to: movertyperguy) September 1, 2009 8:55 PM

oh yeah, see stonetools above about what happens to people who are uninsured.

stonetools (Replying to: movertyperguy) September 1, 2009 9:05 PM

Well, I personally would be OK with socialized medicine, which seems to be what you are suggesting, but apparently the majority of Americans- including many libertarians-object to this and want to preserve the obscene profits of the private health insurance industry. Go figure, eh?

movertyperguy (Replying to: stonetools) September 1, 2009 10:11 PM

Nobody has proposed socialized medicine.

Barack Obama isn't interested in delivering health care to people. If he was, he'd be interviewing doctors for free clinics.

Instead, he's proposed forcing many people who have freely chosen not to purchase health insurance, many for religious reasons, to purchase it.

Everyone in the Untied States who requires health care receives it currently with no consideration for whether they can pay for it or not. If you have insurance, the insurance company pays. If you have the means to pay for it, you pay for it. If you don't legitimately have the means to pay for it, you do not pay for it.

We aren't debating health care.

We're debating Barack Obama's plan to force people to buy wildly overpriced insurance from his political donors.

silentbeep (Replying to: movertyperguy) September 1, 2009 8:53 PM

It's not about insurance per se, it's about getting people efficient delivery of care. The fact that they don't have insurance in this country, means that millions of people are at risk for poor health care, including the millions that currently don't have insurance.

O.K. let's stop talking about buying insurance and let's talk about free doctors, free nurses and free medicine: would you support this? I'm serious.

movertyperguy (Replying to: silentbeep) September 1, 2009 10:05 PM

I would support that debate, yes. I will not debate forcing people to enrich fucking insurance agents at threat of IRS audits.

If Barack Obama wants to give people health care then he should build hospitals with the $9 trillion of deficits over the next 10 years and staff them with doctors and nurses.

But Barack Obama isn't doing that, is he?. Instead, he's writing welfare checks to Bill Frist for $4,500. Does Bill Frist need $4,500 of government welfare to buy a new car?

http://green.autoblog.com/2009/08/25/sen-bill-frist-uses-cash-for-clunkers-junks-suburban-for-prius/

Or could we have bought a poor person a tonsillectomy instead? How much plaster of Paris can you buy with $4,500 to provide people with free casts for straightening crooked feet? A lot, I'd bet.

What's the President's priority based on what is actually occurring as opposed to his rhetoric? Seems to me Bill Frist got his check already.

$4,500 in welfare for a millionaire to buy himself a new car ... that's what Barack Obama has delivered.

movertyperguy (Replying to: silentbeep) September 1, 2009 10:05 PM

I would support that debate, yes. I will not debate forcing people to enrich fucking insurance agents at threat of IRS audits.

If Barack Obama wants to give people health care then he should build hospitals with the $9 trillion of deficits over the next 10 years and staff them with doctors and nurses.

But Barack Obama isn't doing that, is he?. Instead, he's writing welfare checks to Bill Frist for $4,500. Does Bill Frist need $4,500 of government welfare to buy a new car?

http://green.autoblog.com/2009/08/25/sen-bill-frist-uses-cash-for-clunkers-junks-suburban-for-prius/

Or could we have bought a poor person a tonsillectomy instead? How much plaster of Paris can you buy with $4,500 to provide people with free casts for straightening crooked feet? A lot, I'd bet.

What's the President's priority based on what is actually occurring as opposed to his rhetoric? Seems to me Bill Frist got his check already.

$4,500 in welfare for a millionaire to buy himself a new car ... that's what Barack Obama has delivered.

silentbeep (Replying to: movertyperguy) September 1, 2009 8:55 PM

oh yeah, see stonetools above about what happens to people who are uninsured.

stonetools (Replying to: movertyperguy) September 1, 2009 9:05 PM

Well, I personally would be OK with socialized medicine, which seems to be what you are suggesting, but apparently the majority of Americans- including many libertarians-object to this and want to preserve the obscene profits of the private health insurance industry. Go figure, eh?

movertyperguy (Replying to: stonetools) September 1, 2009 10:11 PM

Nobody has proposed socialized medicine.

Barack Obama isn't interested in delivering health care to people. If he was, he'd be interviewing doctors for free clinics.

Instead, he's proposed forcing many people who have freely chosen not to purchase health insurance, many for religious reasons, to purchase it.

Everyone in the Untied States who requires health care receives it currently with no consideration for whether they can pay for it or not. If you have insurance, the insurance company pays. If you have the means to pay for it, you pay for it. If you don't legitimately have the means to pay for it, you do not pay for it.

We aren't debating health care.

We're debating Barack Obama's plan to force people to buy wildly overpriced insurance from his political donors.

movertyperguy (Replying to: stonetools) September 1, 2009 10:11 PM

Nobody has proposed socialized medicine.

Barack Obama isn't interested in delivering health care to people. If he was, he'd be interviewing doctors for free clinics.

Instead, he's proposed forcing many people who have freely chosen not to purchase health insurance, many for religious reasons, to purchase it.

Everyone in the Untied States who requires health care receives it currently with no consideration for whether they can pay for it or not. If you have insurance, the insurance company pays. If you have the means to pay for it, you pay for it. If you don't legitimately have the means to pay for it, you do not pay for it.

We aren't debating health care.

We're debating Barack Obama's plan to force people to buy wildly overpriced insurance from his political donors.

Brian 2 (Replying to: silentbeep) September 2, 2009 12:12 AM

In Los Angeles alone, almost 10,000 people showed up for a free-healthcare clinic that ran for a few days.

And millions show up to KFC when they offer free chicken. Which establishes that people like free stuff, not that there's mass starvation. Ok, that's not quite the same; on the other hand, how many of those 10,000 were illegal immigrants?

Millions of people are now uninsured, and no just showing up at the emergency room is not a good way to guarantee healthcare for the uninsured.

Agreed. What about helping those who need it without upending the entire health care sector? We have food stamps, not government-run farms and grocery stores. (And farm subsidies that generally make things worse, but that's a separate issue).

Millions more are at risk of being uninsured due to economic instabilty i.e. losing health benefits through loss of jobs.

Almost everyone agrees that employers being the primary source of health insurance is idiotic. One exception being Barack Obama, who successfully demagogued McCain's proposal to transition away from it by ending the discriminatory tax treatment of individual policies.

So, those 'thousands' do not represent a static number, and who are the potential "millions" that will be saved? what are we talking about here? Are you talking about potential AIDS research? Or Cancer research?

I don't know, for the same reason I don't know what cool stuff Apple and Google will come up with in the next 10 years. I'm pretty sure it will be something though. For example a cure for Alzheimer's would massively increase the quality of life for millions of sufferers and their families.

I think the "innovation will ground to a halt" scenario has a small likelihood of happening

So do I, but I think "innovation will continue but at a significantly decreased level" is rather more likely. Decrease potential profits, and you decrease supply. Maybe that's a good tradeoff at the margin, but it is a tradeoff.

And you are operating from a philosophy that is libertarian. That is the lense you are viewing this issue from. I am viewing this issue from my particulr lense as a liberal.

Fair enough. Although I think the relevant content of my lens in this case is just "people respond to incentives".

silentbeep (Replying to: Brian 2) September 2, 2009 12:17 PM

"And millions show up to KFC when they offer free chicken. Which establishes that people like free stuff, not that there's mass starvation. Ok, that's not quite the same; on the other hand, how many of those 10,000 were illegal immigrants?"

No it's not the same thing. Especially when the hypoethical millions (or even thousands for that matter) don't show up to one KFC at one time to get the hypothetical free chicken, and get turned away even when they camped out overnight like it happened in Inglewood: "RAM officials said they had to turn away thousands of patients, many who had camped overnight to be seen by a doctor, despite admitting nearly 1,000 patients every day"

http://cbs2.com/local/Free.Clinic.Inglewood.2.1135997.html

Megan herself has admitted that there are millions of people without health insurance, which usually means inadequate access to healthcare. We don't have to guess how many illegal immigrants show up for free-healthcare in one city, during one week, to make a guess on how this affects american citizens. This free clinic was an example, only one, of the urgency of need that is out there.

"Agreed. What about helping those who need it without upending the entire health care sector? We have food stamps, not government-run farms and grocery stores. (And farm subsidies that generally make things worse, but that's a separate issue)."

I'm not sure where the "upending" is happening here because no one is proposing government-run hospitals.

"Decrease potential profits, and you decrease supply. Maybe that's a good tradeoff at the margin, but it is a tradeoff."

Exactly. I don't think there aren't tradeoffs here. I just think they are worth it.

"I don't know, for the same reason I don't know what cool stuff Apple and Google will come up with in the next 10 years. I'm pretty sure it will be something though. For example a cure for Alzheimer's would massively increase the quality of life for millions of sufferers and their families."

Right, I don't know either. I'm basing my support on national healthcare with the information that I have right now, which is a mass number of the uninsured who therefore do not have adequate access to healthcare, with the understanding that if the status quo does not change, such conditions will keep on happening. I am not basing my support on the possibility that something really cool may happen in the future (again I don't think innovation grounding to a halt or being slowed down to a significant degree is a high probability, this again is where I disagree with Megan).

silentbeep (Replying to: Brian 2) September 2, 2009 12:17 PM

"And millions show up to KFC when they offer free chicken. Which establishes that people like free stuff, not that there's mass starvation. Ok, that's not quite the same; on the other hand, how many of those 10,000 were illegal immigrants?"

No it's not the same thing. Especially when the hypoethical millions (or even thousands for that matter) don't show up to one KFC at one time to get the hypothetical free chicken, and get turned away even when they camped out overnight like it happened in Inglewood: "RAM officials said they had to turn away thousands of patients, many who had camped overnight to be seen by a doctor, despite admitting nearly 1,000 patients every day"

http://cbs2.com/local/Free.Clinic.Inglewood.2.1135997.html

Megan herself has admitted that there are millions of people without health insurance, which usually means inadequate access to healthcare. We don't have to guess how many illegal immigrants show up for free-healthcare in one city, during one week, to make a guess on how this affects american citizens. This free clinic was an example, only one, of the urgency of need that is out there.

"Agreed. What about helping those who need it without upending the entire health care sector? We have food stamps, not government-run farms and grocery stores. (And farm subsidies that generally make things worse, but that's a separate issue)."

I'm not sure where the "upending" is happening here because no one is proposing government-run hospitals.

"Decrease potential profits, and you decrease supply. Maybe that's a good tradeoff at the margin, but it is a tradeoff."

Exactly. I don't think there aren't tradeoffs here. I just think they are worth it.

"I don't know, for the same reason I don't know what cool stuff Apple and Google will come up with in the next 10 years. I'm pretty sure it will be something though. For example a cure for Alzheimer's would massively increase the quality of life for millions of sufferers and their families."

Right, I don't know either. I'm basing my support on national healthcare with the information that I have right now, which is a mass number of the uninsured who therefore do not have adequate access to healthcare, with the understanding that if the status quo does not change, such conditions will keep on happening. I am not basing my support on the possibility that something really cool may happen in the future (again I don't think innovation grounding to a halt or being slowed down to a significant degree is a high probability, this again is where I disagree with Megan).

Nimed September 1, 2009 8:38 PM

Forgot to make this point:

Is that a tradeoff you would make? Save the few thousand who might be kept alive by healthcare they now can't afford, and take the possibility of new treatments from the millions who might be cured, or at least have their conditions improved?

Hey guys, what shall we do with this bag of money? Do you want to spend it in saving a few thousand lives right now or millions of lives in the future?

But this is not the trade-off we face. Even if medical research uncovers new treatments for today's illnesses, people are still going to have to pay for them in the future.. Furthermore, if medical research follows the current trend, treatments are likely going to be more expensive and will prolong life for a relatively small number of years.

So the dilemma is more like - shall we spend X money to save people's lives right now, or pour it into research to save fewer lives (those who will be able to pay for future high cost treatments), probably for less time, in the future?

Now research is unpredictable, and who knows, maybe a treatment that provides immortality at a modest price is 20 years down the road. Research should obviously be greater than zero. I'm just saying that we shouldn't take for granted that money poured into research will save more lives down the road. Because it will may not do that at all.

mischief September 1, 2009 8:54 PM

On getting the problem wrong -- bosh. Europe is not paying its fair share of drug prices.

You seem to assume that anyone can object to this only because it might affect our prices. One can also object on the grounds that it means fewer drugs. One can also object on the grounds that it is immoral to enjoy the fruit of someone else's labor without paying for it, so enjoying the fruits of medical research without paying for it is immoral even if it wouldn't encourage more research.

Jim (Replying to: mischief) September 1, 2009 9:06 PM

Europe not paying its "fair share" of drug prices. That's pretty rich. Newsflash. Drug companies earn profits selling drugs in Europe. There are drugs being developed in Europe. There are even drugs being sold in Europe that don't have the benefit of being sold for ten times as much in the US.

brunojade (Replying to: Jim) September 2, 2009 8:41 AM

They only earn profits because once the R&D is done (and paid for by the US consumer) the drug companies only seek a profit above the manufacturing cost of the drug, which is just pennies per pill. The US pays for the innovation while Canada and Europe chip in for the assembly line.

Jim (Replying to: brunojade) September 2, 2009 9:32 AM

No. Drugs sold in Europe earn profits, including amortization of development costs. Additionally, new drugs that are developed and sold exclusively in Europe (ie...not approved for sale in US) earn profits for pharmaceutical companies.

The developed world does subsize R&D for the undeveloped world. However, Europe (and Canada and Australia) are part of the "profitable" developed world. Price bargaining done by national health care systems does not make selling drugs in those countries unprofitable, just less so. Big whup.

mischief (Replying to: brunojade) September 2, 2009 10:45 AM

Your newsflash suffers a small problem: It's not true. and it doesn't become true even if you repeat it.

Jim (Replying to: brunojade) September 2, 2009 2:37 PM

Let me break this down for you to help you understand. Last year Pfizer had 48 billion in sales and 19 billion in profit. 39% of that figure, or roughly 19 billion, was US sales. The Europe and Canada pay roughly 50% for their drugs vs the US. So, if drug prices in the US were on average the same as the average for Europe and Canada, that would have cut Pfizers revenue by 9.5 billion, leaving them with 8.5 billion in profit. Ergo, pharmaceutical companies such as Pfizer make a profit selling drugs to the rest of the world, exclusive of US sales.

Oh yeah, Pfizers R&D costs last year were 7.5 billion.

Chew on that for a while.

Jim (Replying to: mischief) September 1, 2009 9:06 PM

Europe not paying its "fair share" of drug prices. That's pretty rich. Newsflash. Drug companies earn profits selling drugs in Europe. There are drugs being developed in Europe. There are even drugs being sold in Europe that don't have the benefit of being sold for ten times as much in the US.

brunojade (Replying to: Jim) September 2, 2009 8:41 AM

They only earn profits because once the R&D is done (and paid for by the US consumer) the drug companies only seek a profit above the manufacturing cost of the drug, which is just pennies per pill. The US pays for the innovation while Canada and Europe chip in for the assembly line.

Jim (Replying to: brunojade) September 2, 2009 9:32 AM

No. Drugs sold in Europe earn profits, including amortization of development costs. Additionally, new drugs that are developed and sold exclusively in Europe (ie...not approved for sale in US) earn profits for pharmaceutical companies.

The developed world does subsize R&D for the undeveloped world. However, Europe (and Canada and Australia) are part of the "profitable" developed world. Price bargaining done by national health care systems does not make selling drugs in those countries unprofitable, just less so. Big whup.

mischief (Replying to: brunojade) September 2, 2009 10:45 AM

Your newsflash suffers a small problem: It's not true. and it doesn't become true even if you repeat it.

Jim (Replying to: brunojade) September 2, 2009 2:37 PM

Let me break this down for you to help you understand. Last year Pfizer had 48 billion in sales and 19 billion in profit. 39% of that figure, or roughly 19 billion, was US sales. The Europe and Canada pay roughly 50% for their drugs vs the US. So, if drug prices in the US were on average the same as the average for Europe and Canada, that would have cut Pfizers revenue by 9.5 billion, leaving them with 8.5 billion in profit. Ergo, pharmaceutical companies such as Pfizer make a profit selling drugs to the rest of the world, exclusive of US sales.

Oh yeah, Pfizers R&D costs last year were 7.5 billion.

Chew on that for a while.

brunojade (Replying to: Jim) September 2, 2009 8:41 AM

They only earn profits because once the R&D is done (and paid for by the US consumer) the drug companies only seek a profit above the manufacturing cost of the drug, which is just pennies per pill. The US pays for the innovation while Canada and Europe chip in for the assembly line.

Jim (Replying to: brunojade) September 2, 2009 9:32 AM

No. Drugs sold in Europe earn profits, including amortization of development costs. Additionally, new drugs that are developed and sold exclusively in Europe (ie...not approved for sale in US) earn profits for pharmaceutical companies.

The developed world does subsize R&D for the undeveloped world. However, Europe (and Canada and Australia) are part of the "profitable" developed world. Price bargaining done by national health care systems does not make selling drugs in those countries unprofitable, just less so. Big whup.

mischief (Replying to: brunojade) September 2, 2009 10:45 AM

Your newsflash suffers a small problem: It's not true. and it doesn't become true even if you repeat it.

Jim (Replying to: brunojade) September 2, 2009 2:37 PM

Let me break this down for you to help you understand. Last year Pfizer had 48 billion in sales and 19 billion in profit. 39% of that figure, or roughly 19 billion, was US sales. The Europe and Canada pay roughly 50% for their drugs vs the US. So, if drug prices in the US were on average the same as the average for Europe and Canada, that would have cut Pfizers revenue by 9.5 billion, leaving them with 8.5 billion in profit. Ergo, pharmaceutical companies such as Pfizer make a profit selling drugs to the rest of the world, exclusive of US sales.

Oh yeah, Pfizers R&D costs last year were 7.5 billion.

Chew on that for a while.

Jim (Replying to: brunojade) September 2, 2009 9:32 AM

No. Drugs sold in Europe earn profits, including amortization of development costs. Additionally, new drugs that are developed and sold exclusively in Europe (ie...not approved for sale in US) earn profits for pharmaceutical companies.

The developed world does subsize R&D for the undeveloped world. However, Europe (and Canada and Australia) are part of the "profitable" developed world. Price bargaining done by national health care systems does not make selling drugs in those countries unprofitable, just less so. Big whup.

mischief (Replying to: brunojade) September 2, 2009 10:45 AM

Your newsflash suffers a small problem: It's not true. and it doesn't become true even if you repeat it.

Jim (Replying to: brunojade) September 2, 2009 2:37 PM

Let me break this down for you to help you understand. Last year Pfizer had 48 billion in sales and 19 billion in profit. 39% of that figure, or roughly 19 billion, was US sales. The Europe and Canada pay roughly 50% for their drugs vs the US. So, if drug prices in the US were on average the same as the average for Europe and Canada, that would have cut Pfizers revenue by 9.5 billion, leaving them with 8.5 billion in profit. Ergo, pharmaceutical companies such as Pfizer make a profit selling drugs to the rest of the world, exclusive of US sales.

Oh yeah, Pfizers R&D costs last year were 7.5 billion.

Chew on that for a while.

Sancho September 1, 2009 9:02 PM

Nimed,

I personally would rather bet on science. There have been lots of times in history where it looked like we'd figured out everything we were ever going to figure out. Then discovery exploded (that isn't to say we should spent 98% of our GDP on medical research).

handlethetruth September 1, 2009 9:30 PM

Holbo's statement makes no sense to you because it makes no sense. It doesn't make sense because Holbo isn't good at arguments. Which ought to have disqualified him to be a philosophy professor. (I suppose it did disqualify him from such a position in the US.) He's not even skilled enough at argument to be a hack.

Rob Lyman September 1, 2009 9:34 PM

In most countries (if not all) where there is universal health care, you are perfectly welcome to pay out of pocket for any additional treatments and procedures you wish.

The UK's NHS, rather famously, will cut you off from all of its services if you go outside them. I don't know of any other country that does. I have seen it asserted (including in such right-wing propaganda organs as the NYT) that Canada forbids the private delivery of healthcare altogether, but that the law is widely ignored. I don't actually think that's true, or at least nobody has every been able to point me to the law that says that. I think people are just confusing health care with health insurance, which is all too common.

In most countries with a government insurance, you also retain the option to buy more expensive private insurance that provides you greater coverage.

That was not true in Canada until a few years ago, when the Supreme Court of Quebec ruled the law unconstitutional.

As long as there are people willing to pay for more expensive stuff, there will be hospitals and insurance companies willing to sell it, right?

The key question here is what the government will do if (say), you want to try out the fancy new cancer treatment, but the government beancounters only approve the generic. Will they give you enough money for the generic, and let you make up the difference personally, or will they insist you pay full price for the fancy treatment? The former case will help preserve a mass market for fancy stuff, whereas the latter will tend to make it available only to the rich, and therefore quite possibly unavailable.

Last Years Man (Replying to: Rob Lyman) September 1, 2009 10:46 PM

Governments may have ruled people out in ways like that when the plans were first administered but most now have figured out how to make allowances, even if it did take a Supreme Court case.

And you're wrong about the NHS as the recent Stephen Hawking case showed so well

Alsadius (Replying to: Rob Lyman) September 2, 2009 1:47 AM

The Canadian case is somewhat more complex than that. It was the Supreme Court of Canada that made the decision, but it only applied to the provisions in a charter of rights that only applied to Quebec, and the SCC declined to apply the ruling to the near-identical section of the Canadian Charter of Rights and Freedoms. As such, the ban on insurance in Quebec was struck down, but other, similar laws exist in other provinces.

stonetools (Replying to: Alsadius) September 2, 2009 7:58 AM

According to Wikipedia:

he Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so.

http://en.wikipedia.org/wiki/Universal_health_care

There is apparently no direct ban. The New England Journal of Medicine sums it up this way:

As explained in a 2003 report, the Canadian health care system is "unique in the world in that it bans coverage of . . . [physician and hospital] core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms. This ban constrains the emergence of a parallel private medical or hospital sector and puts pressure on the provinces to meet the expectations of middle-class Canadians."1 That only 70 percent of total health care funding in Canada comes from the public sector — less than in many European countries but considerably more than in the United States — reflects the fact that private payments are common for other expenditures, including drugs, dental services, optometry, and home care. Private insurance and private care are also common in niche areas, such as work-related injuries and cosmetic surgery.

http://content.nejm.org/cgi/content/full/354/16/1661

It sounds complex, as you say, put it's a long way from a complete ban on private health care.

Alsadius (Replying to: stonetools) September 2, 2009 4:43 PM

Private healthcare is not banned. Private insurance (for things covered by the government system) often is - it varies by province, but bans do exist. Sorry, I thought I'd made that clearer.

As for the Canada Health Act, it isn't actually healthcare legislation in the sense you're thinking of. What the CHA is is an agreement between the provinces and the feds - if the provinces follow federal rules, they get federal money. Constitutionally, healthcare is a provincial responsibility, but the feds are free to bribe provinces fairly widely, instead of funneling everything through highway money like in the US. If a province wanted to move to a 100% private system, I'm pretty sure that they'd be free to do so legally(though obviously not politically). They'd lose some billions of dollars a year, but it'd be legal to the best of my knowledge. The actual nuts and bolts of delivery and financing are decided at the provincial level, the feds just have a checklist and a chequebook.

Last Years Man (Replying to: Rob Lyman) September 1, 2009 10:46 PM

Governments may have ruled people out in ways like that when the plans were first administered but most now have figured out how to make allowances, even if it did take a Supreme Court case.

And you're wrong about the NHS as the recent Stephen Hawking case showed so well

Alsadius (Replying to: Rob Lyman) September 2, 2009 1:47 AM

The Canadian case is somewhat more complex than that. It was the Supreme Court of Canada that made the decision, but it only applied to the provisions in a charter of rights that only applied to Quebec, and the SCC declined to apply the ruling to the near-identical section of the Canadian Charter of Rights and Freedoms. As such, the ban on insurance in Quebec was struck down, but other, similar laws exist in other provinces.

stonetools (Replying to: Alsadius) September 2, 2009 7:58 AM

According to Wikipedia:

he Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so.

http://en.wikipedia.org/wiki/Universal_health_care

There is apparently no direct ban. The New England Journal of Medicine sums it up this way:

As explained in a 2003 report, the Canadian health care system is "unique in the world in that it bans coverage of . . . [physician and hospital] core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms. This ban constrains the emergence of a parallel private medical or hospital sector and puts pressure on the provinces to meet the expectations of middle-class Canadians."1 That only 70 percent of total health care funding in Canada comes from the public sector — less than in many European countries but considerably more than in the United States — reflects the fact that private payments are common for other expenditures, including drugs, dental services, optometry, and home care. Private insurance and private care are also common in niche areas, such as work-related injuries and cosmetic surgery.

http://content.nejm.org/cgi/content/full/354/16/1661

It sounds complex, as you say, put it's a long way from a complete ban on private health care.

Alsadius (Replying to: stonetools) September 2, 2009 4:43 PM

Private healthcare is not banned. Private insurance (for things covered by the government system) often is - it varies by province, but bans do exist. Sorry, I thought I'd made that clearer.

As for the Canada Health Act, it isn't actually healthcare legislation in the sense you're thinking of. What the CHA is is an agreement between the provinces and the feds - if the provinces follow federal rules, they get federal money. Constitutionally, healthcare is a provincial responsibility, but the feds are free to bribe provinces fairly widely, instead of funneling everything through highway money like in the US. If a province wanted to move to a 100% private system, I'm pretty sure that they'd be free to do so legally(though obviously not politically). They'd lose some billions of dollars a year, but it'd be legal to the best of my knowledge. The actual nuts and bolts of delivery and financing are decided at the provincial level, the feds just have a checklist and a chequebook.

stonetools (Replying to: Alsadius) September 2, 2009 7:58 AM

According to Wikipedia:

he Canada Health Act of 1984 "does not directly bar private delivery or private insurance for publicly insured services," but provides financial disincentives for doing so.

http://en.wikipedia.org/wiki/Universal_health_care

There is apparently no direct ban. The New England Journal of Medicine sums it up this way:

As explained in a 2003 report, the Canadian health care system is "unique in the world in that it bans coverage of . . . [physician and hospital] core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms. This ban constrains the emergence of a parallel private medical or hospital sector and puts pressure on the provinces to meet the expectations of middle-class Canadians."1 That only 70 percent of total health care funding in Canada comes from the public sector — less than in many European countries but considerably more than in the United States — reflects the fact that private payments are common for other expenditures, including drugs, dental services, optometry, and home care. Private insurance and private care are also common in niche areas, such as work-related injuries and cosmetic surgery.

http://content.nejm.org/cgi/content/full/354/16/1661

It sounds complex, as you say, put it's a long way from a complete ban on private health care.

Alsadius (Replying to: stonetools) September 2, 2009 4:43 PM

Private healthcare is not banned. Private insurance (for things covered by the government system) often is - it varies by province, but bans do exist. Sorry, I thought I'd made that clearer.

As for the Canada Health Act, it isn't actually healthcare legislation in the sense you're thinking of. What the CHA is is an agreement between the provinces and the feds - if the provinces follow federal rules, they get federal money. Constitutionally, healthcare is a provincial responsibility, but the feds are free to bribe provinces fairly widely, instead of funneling everything through highway money like in the US. If a province wanted to move to a 100% private system, I'm pretty sure that they'd be free to do so legally(though obviously not politically). They'd lose some billions of dollars a year, but it'd be legal to the best of my knowledge. The actual nuts and bolts of delivery and financing are decided at the provincial level, the feds just have a checklist and a chequebook.

Alsadius (Replying to: stonetools) September 2, 2009 4:43 PM

Private healthcare is not banned. Private insurance (for things covered by the government system) often is - it varies by province, but bans do exist. Sorry, I thought I'd made that clearer.

As for the Canada Health Act, it isn't actually healthcare legislation in the sense you're thinking of. What the CHA is is an agreement between the provinces and the feds - if the provinces follow federal rules, they get federal money. Constitutionally, healthcare is a provincial responsibility, but the feds are free to bribe provinces fairly widely, instead of funneling everything through highway money like in the US. If a province wanted to move to a 100% private system, I'm pretty sure that they'd be free to do so legally(though obviously not politically). They'd lose some billions of dollars a year, but it'd be legal to the best of my knowledge. The actual nuts and bolts of delivery and financing are decided at the provincial level, the feds just have a checklist and a chequebook.

PeorgieTirebiter September 1, 2009 10:04 PM

"The UK's NHS, rather famously, will cut you off from all of its services if you go outside them."

Not true, those with private supplemental insurance enjoy the convenience of private networks for their more mundane needs while, rather famously, rely on NHS for their more critical procedures.

PeorgieTirebiter September 1, 2009 10:11 PM

"Is that a tradeoff you would make? Save the few thousand who might be kept alive by healthcare they now can't afford, and take the possibility of new treatments from the millions who might be cured, or at least have their conditions improved?"

In the world of Megan's false dichotomies, C or none of the above is always your best bet.

jmo3 (Replying to: PeorgieTirebiter) September 1, 2009 11:48 PM

Peorgie,

You're ignorance is stunning.

Not true, those with private supplemental insurance enjoy the convenience of private networks for their more mundane needs while, rather famously, rely on NHS for their more critical procedures.

Or do you just enjoy spouting lies?

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

jmo3 (Replying to: jmo3) September 1, 2009 11:49 PM

You're ignorance is stunning.

Your... I meant your.

Grrrr...

jmo3 (Replying to: PeorgieTirebiter) September 1, 2009 11:48 PM

Peorgie,

You're ignorance is stunning.

Not true, those with private supplemental insurance enjoy the convenience of private networks for their more mundane needs while, rather famously, rely on NHS for their more critical procedures.

Or do you just enjoy spouting lies?

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

http://www.timesonline.co.uk/tol/life_and_style/health/article4040146.ece

jmo3 (Replying to: jmo3) September 1, 2009 11:49 PM

You're ignorance is stunning.

Your... I meant your.

Grrrr...

jmo3 (Replying to: jmo3) September 1, 2009 11:49 PM

You're ignorance is stunning.

Your... I meant your.

Grrrr...

Last Years Man September 1, 2009 10:30 PM

Megan,

Allow me to applaud you for what I think is a pretty honest post and I 'd like to apologize for some of the infective that's been directed at you from my side of the aisle.

"Mr. Holbo's answer is that I am an evil idiot who hates poor people, doesn't understand how markets and governments really work, and is philosophically incoherent. My more boring answer is that we have different assessments of how the world to which we would like to apply these philosophical principles works."

This is exactly right and I think part of the problem we're having is whether or not we can agree and also how to agree on a set of metrics that will help verify our intuitive observations and principles. For example:

"Price controls lead to shortages and other suboptimal results that decrease the general welfare, even though they may very well benefit some specific people."

Exactly what metric are you using to determine general welfare? I'm curious because it clearly differs from the WHO:

"The World Health Organization has carried out the first ever analysis of the world's health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan."

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th . Several small countries – San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy."

Now I don't know what the specific metrics of the WHO are and for all I know, you already have a handy way of disproving them at your disposal, but I would like to think that they take into account the arguments you are making about shortages as part of their assessments of these systems. This is not to say that the shortages don't exist. You have data which clearly shows they do. What I mean is that when placed against all the other data sets, I believe you will find that the negative impact of the shortages is not enough to off balance the gain of universal care. I also believe that the positive impact of the free market price mechanism does NOT offset the negative impact.

For the record, I lived in Japan for five years and LOVED the Japanese health care system. If I had to define "general welfare" by health care alone, I'd say mine was much higher in Japan than the US (alas, we can't, after all, define such things by healthcare alone)

I know you think that there is no right answer, but I'm not content to leave it at that. I think we should strive to find a model (and keep refining it) however imperfect it inevitably will be. This is the nature of public policy. If you want to be content to embrace the unknown, go with art.

Here are some other areass we differ on that I think are the source of your problems with liberals

1. I think you vastly underestimate the number of people affected by high insurance prices. It's not just the number of people without insurance, or the number of people dying because they don't have insurance, but also the number of people facing financial hardship because of their medical expenses.

2. I think you overestimate the number of people benefiting from the availability of drugs in the US. I do not think more drugs equals better care. This is just a different set of assumptions between us that I don't think can be reconciled. In fact, I think the profit motive forces drug companies to sell people drugs they don't need which, to borrow your phrase again, "decreases the general welfare."

3. I do not think the evidence supports the assertion that people in countries are not getting the drugs they need. Again, just having LESS drugs than the US alone, does not equal not having the drugs they need. Drugs are a unique commodity. I would wager that what accounts for the high volume of drugs in the US is companies aping off of each other, not innovation. Pardon me for not buying 100% into unregulated free market capitalism.

4. Medical care is unique as a product because there is no way for people to ration it themselves. This is where I think your tin analogy breaks down. If I sense that tin is scarce, I can cut down my usage of it to the bear essentials and still basically get by. Plus I can make my own choices about how to make those cuts. This is not the case with medical care. If I get cancer, I have no choice. I can get treatment or I die. This is why I think that price rationing is not an effective mechanism (with regards to health care)

The Ninja Zombie (Replying to: Last Years Man) September 1, 2009 11:40 PM

Now I don't know what the specific metrics of the WHO are

It isn't hard to find out. They build an index based on a weighted average of various factors:

25% health

25% health equality

12.5% responsiveness

12.5% responsiveness equality

25% financial equality

Even in the most charitable interpretation, only 37.5% of a nation's score actually comes from health care. (Equality is measured by summing the absolute value of the deviation from the mean, squared.)

Here is the report:

http://www.who.int/whr/2000/en/

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 12:29 AM

This just suggests to me that the other factors that people are worried are in fact being considered. I think we could quibble about their specific weighting but it seems fair to me.

mj (Replying to: Last Years Man) September 2, 2009 7:15 AM

You can't be serious. This ranking is used to claim the US has a worse healthcare system, the common refrain being we pay more but rank 37th. But our low position is largely driven by financial matters, essentially by the bureaucrats desire for a national system. So the circular reasoning is that we rank low because we don't have a national system, so therefore we need a national system. See how easy arguments can be when you simply define your position as good? These are political rankings, not healthcare rankings.

Megan McArdle (Replying to: Last Years Man) September 2, 2009 7:33 AM

Unless you would really rather get sick in Bogota than Berkely, or you are really almost indifferent betweeen being treated in the US, or in Canada, then the index made no sense. A poor Cuban coming here would get a big bump in the quality of the health care available to them. A poor American going there would experience a decline.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 8:17 AM

Perhaps you and others are worried about equality. It does not change the fact that "financial equality" != "health care". This index measures equality more than health care. Let me fix your statement for you:

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its equality, the report finds.

mischief (Replying to: Last Years Man) September 2, 2009 10:52 AM

Their worries are not our problem. They are certainly not, in matters of life and death, worth of consideration.

Denverflyer (Replying to: The Ninja Zombie) September 2, 2009 1:31 AM

Here's all you need to know about where the top quality healthcare is delivered: when European soccer players blow out their knees, including the ones in the English Premiership, they fly to the USA.

To me, arguing about who gets healthcare is a political economy discussion. How good that care is for those who do get it should be the only determinant for "healthcare quality."

Glen Raphael (Replying to: Last Years Man) September 2, 2009 12:09 AM

If I sense that tin is scarce, I can cut down my usage of it to the bear essentials and still basically get by. Plus I can make my own choices about how to make those cuts. This is not the case with medical care. If I get cancer, I have no choice. I can get treatment or I die.

With a proper market in medical care you could choose among different treatment options that have different costs and if your particular case were "on the margin" of whether it was worth treating or not you could decide appropriately based on the price signal whether it was worthwhile for you. That is just like the case of tin. Some tin users are price-insensitive while those on the margin find a substitute; ditto for some health care users.

And when it comes to health care you also *do* have the option to "cut your usage to the bare essentials and still get by" and many people probably *should* do that, because getting *too much* treatment is just as bad as getting too little. The annual number of deaths due to medical mistakes, prescription mistakes, and hospital-borne illnessed far dwarf the number being claimed result from undertreatment due to lack of coverage.

Last Years Man (Replying to: Glen Raphael) September 2, 2009 12:23 AM

I agree in certain cases which is why I think rationing is not necessarily a matter of life and death like Megan makes it. I think you can guarantee care in cases where the patient's life is threatened and ration in areas where it is not. However, under a price model, both are rationed. It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case. My specific answer was cancer. I hope we can both agree that when someone has cancer they should be treated.

By the way, the idea of holding studies to find out what things lead to "medical mistakes, prescription mistakes, and hospital-borne illnesses" is exactly what led to the death panel accusation

Glen Raphael (Replying to: Last Years Man) September 2, 2009 12:47 AM

It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case.

If the Rand Experiment is to be believed, it's not all that far from being the case. If you compare a group of people who get zero-deductible "free health care" with an equivalent goup that has to pay from the first dollar, the former group buys about twice as much care but isn't any healthier for it. Which suggests that least half of "our" health care spending is wasted in the sense that it does as much harm as good. People do seem to buy a lot less of the care that turns out in retrospect to have been useless when they are spending their own money than when they are spending somebody else's.

The Ninja Zombie (Replying to: Last Years Man) September 1, 2009 11:40 PM

Now I don't know what the specific metrics of the WHO are

It isn't hard to find out. They build an index based on a weighted average of various factors:

25% health

25% health equality

12.5% responsiveness

12.5% responsiveness equality

25% financial equality

Even in the most charitable interpretation, only 37.5% of a nation's score actually comes from health care. (Equality is measured by summing the absolute value of the deviation from the mean, squared.)

Here is the report:

http://www.who.int/whr/2000/en/

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 12:29 AM

This just suggests to me that the other factors that people are worried are in fact being considered. I think we could quibble about their specific weighting but it seems fair to me.

mj (Replying to: Last Years Man) September 2, 2009 7:15 AM

You can't be serious. This ranking is used to claim the US has a worse healthcare system, the common refrain being we pay more but rank 37th. But our low position is largely driven by financial matters, essentially by the bureaucrats desire for a national system. So the circular reasoning is that we rank low because we don't have a national system, so therefore we need a national system. See how easy arguments can be when you simply define your position as good? These are political rankings, not healthcare rankings.

Megan McArdle (Replying to: Last Years Man) September 2, 2009 7:33 AM

Unless you would really rather get sick in Bogota than Berkely, or you are really almost indifferent betweeen being treated in the US, or in Canada, then the index made no sense. A poor Cuban coming here would get a big bump in the quality of the health care available to them. A poor American going there would experience a decline.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 8:17 AM

Perhaps you and others are worried about equality. It does not change the fact that "financial equality" != "health care". This index measures equality more than health care. Let me fix your statement for you:

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its equality, the report finds.

mischief (Replying to: Last Years Man) September 2, 2009 10:52 AM

Their worries are not our problem. They are certainly not, in matters of life and death, worth of consideration.

Denverflyer (Replying to: The Ninja Zombie) September 2, 2009 1:31 AM

Here's all you need to know about where the top quality healthcare is delivered: when European soccer players blow out their knees, including the ones in the English Premiership, they fly to the USA.

To me, arguing about who gets healthcare is a political economy discussion. How good that care is for those who do get it should be the only determinant for "healthcare quality."

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 12:29 AM

This just suggests to me that the other factors that people are worried are in fact being considered. I think we could quibble about their specific weighting but it seems fair to me.

mj (Replying to: Last Years Man) September 2, 2009 7:15 AM

You can't be serious. This ranking is used to claim the US has a worse healthcare system, the common refrain being we pay more but rank 37th. But our low position is largely driven by financial matters, essentially by the bureaucrats desire for a national system. So the circular reasoning is that we rank low because we don't have a national system, so therefore we need a national system. See how easy arguments can be when you simply define your position as good? These are political rankings, not healthcare rankings.

Megan McArdle (Replying to: Last Years Man) September 2, 2009 7:33 AM

Unless you would really rather get sick in Bogota than Berkely, or you are really almost indifferent betweeen being treated in the US, or in Canada, then the index made no sense. A poor Cuban coming here would get a big bump in the quality of the health care available to them. A poor American going there would experience a decline.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 8:17 AM

Perhaps you and others are worried about equality. It does not change the fact that "financial equality" != "health care". This index measures equality more than health care. Let me fix your statement for you:

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its equality, the report finds.

mischief (Replying to: Last Years Man) September 2, 2009 10:52 AM

Their worries are not our problem. They are certainly not, in matters of life and death, worth of consideration.

mj (Replying to: Last Years Man) September 2, 2009 7:15 AM

You can't be serious. This ranking is used to claim the US has a worse healthcare system, the common refrain being we pay more but rank 37th. But our low position is largely driven by financial matters, essentially by the bureaucrats desire for a national system. So the circular reasoning is that we rank low because we don't have a national system, so therefore we need a national system. See how easy arguments can be when you simply define your position as good? These are political rankings, not healthcare rankings.

Megan McArdle (Replying to: Last Years Man) September 2, 2009 7:33 AM

Unless you would really rather get sick in Bogota than Berkely, or you are really almost indifferent betweeen being treated in the US, or in Canada, then the index made no sense. A poor Cuban coming here would get a big bump in the quality of the health care available to them. A poor American going there would experience a decline.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 8:17 AM

Perhaps you and others are worried about equality. It does not change the fact that "financial equality" != "health care". This index measures equality more than health care. Let me fix your statement for you:

The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its equality, the report finds.

mischief (Replying to: Last Years Man) September 2, 2009 10:52 AM

Their worries are not our problem. They are certainly not, in matters of life and death, worth of consideration.

Denverflyer (Replying to: The Ninja Zombie) September 2, 2009 1:31 AM

Here's all you need to know about where the top quality healthcare is delivered: when European soccer players blow out their knees, including the ones in the English Premiership, they fly to the USA.

To me, arguing about who gets healthcare is a political economy discussion. How good that care is for those who do get it should be the only determinant for "healthcare quality."

Glen Raphael (Replying to: Last Years Man) September 2, 2009 12:09 AM

If I sense that tin is scarce, I can cut down my usage of it to the bear essentials and still basically get by. Plus I can make my own choices about how to make those cuts. This is not the case with medical care. If I get cancer, I have no choice. I can get treatment or I die.

With a proper market in medical care you could choose among different treatment options that have different costs and if your particular case were "on the margin" of whether it was worth treating or not you could decide appropriately based on the price signal whether it was worthwhile for you. That is just like the case of tin. Some tin users are price-insensitive while those on the margin find a substitute; ditto for some health care users.

And when it comes to health care you also *do* have the option to "cut your usage to the bare essentials and still get by" and many people probably *should* do that, because getting *too much* treatment is just as bad as getting too little. The annual number of deaths due to medical mistakes, prescription mistakes, and hospital-borne illnessed far dwarf the number being claimed result from undertreatment due to lack of coverage.

Last Years Man (Replying to: Glen Raphael) September 2, 2009 12:23 AM

I agree in certain cases which is why I think rationing is not necessarily a matter of life and death like Megan makes it. I think you can guarantee care in cases where the patient's life is threatened and ration in areas where it is not. However, under a price model, both are rationed. It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case. My specific answer was cancer. I hope we can both agree that when someone has cancer they should be treated.

By the way, the idea of holding studies to find out what things lead to "medical mistakes, prescription mistakes, and hospital-borne illnesses" is exactly what led to the death panel accusation

Glen Raphael (Replying to: Last Years Man) September 2, 2009 12:47 AM

It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case.

If the Rand Experiment is to be believed, it's not all that far from being the case. If you compare a group of people who get zero-deductible "free health care" with an equivalent goup that has to pay from the first dollar, the former group buys about twice as much care but isn't any healthier for it. Which suggests that least half of "our" health care spending is wasted in the sense that it does as much harm as good. People do seem to buy a lot less of the care that turns out in retrospect to have been useless when they are spending their own money than when they are spending somebody else's.

Last Years Man (Replying to: Glen Raphael) September 2, 2009 12:23 AM

I agree in certain cases which is why I think rationing is not necessarily a matter of life and death like Megan makes it. I think you can guarantee care in cases where the patient's life is threatened and ration in areas where it is not. However, under a price model, both are rationed. It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case. My specific answer was cancer. I hope we can both agree that when someone has cancer they should be treated.

By the way, the idea of holding studies to find out what things lead to "medical mistakes, prescription mistakes, and hospital-borne illnesses" is exactly what led to the death panel accusation

Glen Raphael (Replying to: Last Years Man) September 2, 2009 12:47 AM

It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case.

If the Rand Experiment is to be believed, it's not all that far from being the case. If you compare a group of people who get zero-deductible "free health care" with an equivalent goup that has to pay from the first dollar, the former group buys about twice as much care but isn't any healthier for it. Which suggests that least half of "our" health care spending is wasted in the sense that it does as much harm as good. People do seem to buy a lot less of the care that turns out in retrospect to have been useless when they are spending their own money than when they are spending somebody else's.

Glen Raphael (Replying to: Last Years Man) September 2, 2009 12:47 AM

It'd be nice to say that all the treatment that patients are missing out on when they don't have health insurance is not necessary, but I think we know that is not the case.

If the Rand Experiment is to be believed, it's not all that far from being the case. If you compare a group of people who get zero-deductible "free health care" with an equivalent goup that has to pay from the first dollar, the former group buys about twice as much care but isn't any healthier for it. Which suggests that least half of "our" health care spending is wasted in the sense that it does as much harm as good. People do seem to buy a lot less of the care that turns out in retrospect to have been useless when they are spending their own money than when they are spending somebody else's.

Last Years Man September 1, 2009 10:34 PM

And one other point, I also do not think that impact of shortages is as dramatic as the impact of flat not having health insurance. With shortages in socialized countries, you can still get the treatment you need, just not at optimal speed. In cases where time is of the essence, the govts usually have an allowance for those situations built into the system. Not having health insurance, however, leaves you without medical care. Then you end up like certain members of my family having to go to Mexico to get treatment for cancer and dental work.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 8:23 AM

You might think that, but you'd be wrong. The impact on health of variations in health insurance is statistically insignificant.

http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/

Not having health insurance does not leave you without care. It simply leaves you without unnecessary care. The RAND experiment showed quite conclusively that medicine which people buy only at a marginal cost of $0 is worthless.

stonetools (Replying to: The Ninja Zombie) September 2, 2009 9:01 AM

So those uninsured are dying because they are not receiving "unnecessary care"?

Nonsense on stilts.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 9:58 AM

The evidence suggests that the uninsured are not dying at a statistically significantly higher rate than the insured, after you control for exogenous variables.

This is the conclusion of many cross sectional studies as well as a controlled experiment (i.e., giving random people health insurance of varying quality).

If you have evidence to the contrary, please present it. Primary sources please, not breathless news reports.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:00 AM

From the website:

"How much could we cut? For the U.S. it seems reasonable to project the 30% cut in the RAND results to a 50% cut, since the U.S. spends so much more than other nations without obvious extra health gains. I thus claim: we could cut U.S. medical spending in half without substantial net health costs. This would give us the equivalent of an 8% pay raise."

This study is not a measure of the effects of not having health insurance. It is a study of the effects of medicine on people without catastrophic conditions. If anything, it seems to undercut Megan's argument because there does not seem to be a correlation between higher spending and better health (or to put it another way, higher cost and better health). I would agree with that. Part of the misunderstanding here is my own fault for being sloppy with my arguments, but when I talk about the effects of not having health insurance, I'm not talking about not getting prescription cold medicine in mid winter. I agree that a lot of what we spend on is wasteful. The problem is that the things that aren't wasteful (catastrophic care) are not any less high priced and we have no control over when we contract these conditions.

Will poor people be treated in emergency rooms? In some instances yes. But there are plenty of anecdotes of the opposite happening too. Plus the fact that they are likely to go bankrupt after doing so. All this study says to me is that because of our pricing, we are paying too much for things we don't need, while being completely priced out of things we do need.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:23 AM

The study measures the effect of health insurance with a $10,000 deductible ($37,419 in 2008 dollars, based on a start date of 1976). Below this amount, people were obligated to pay a variable portion of their own health costs (anywhere from 10% to 90%).

There was no measurable difference in health between the people who paid 90% of their own health costs and those who paid 10%.

Unless you believe there is some discontinuity between paying 90% and 100% of health care costs, it probably reasonable to extrapolate this to the case of no insurance.

As for catastrophic care, this is given to everyone in the US without regard to their ability to pay. So health insurance is irrelevant to that question.

At best, all we need to do is give people health insurance with a $37,500 deductible. The RAND experiment does not disprove the potential health benefits of such a policy (though I'd like to see some evidence it would be useful).

Last Years Man (Replying to: Last Years Man) September 2, 2009 10:47 AM

This is a reply to your post below:

What I'm saying is that when people are generally healthy ( ie absent of major health problems), there is likely no visible benefit of receiving health care. This is why young people don't buy insurance. So in that sense you're right. I just don't think it's relevant to what I'm saying, which is that if you develop a condition and you don't have insurance.

Let me give you an anecdotal example. My brother made too much money to qualify for medicaid but too little to afford health insurance (his employer didn't offer it).

One day he started developing pains in his arm. The doctor's found lumps but told him he would have to pay a cost of somewhere in the thousands (forgive my fuzzy memory) to have a biopsy. This is not something he could afford.

As a result, he went to Mexico and was diagnosed with Hodgkin's disease.

Did he receive care after coming back to the US? Yes, but he and his wife totally trashed their credit ratings in the process.

Even bankrupt, he was lucky. There are plenty of people in similar situations being denied treatment.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:53 AM

Your anecdote goes against your case. The poor have medicaid. The middle class pay out of pocket and sometimes trash their credit rating.

You still have yet to show evidence that anyone is dying as a result of lack of insurance.

(I'm not entirely sure why your middle class brother couldn't afford catastrophic care. Was he unlucky enough to live in a state which bans it?)

Last Years Man (Replying to: Last Years Man) September 2, 2009 11:22 AM

Right. And health care costs as they are now are not just pricing out the poor, they're pricing out the lower middle class as well. What I'd like to see is a medicaid style system applied to everyone. Or replaced with a public option with reasonably lower premiums then the 700 a month I pay now to have my wife insured on my company's plan. Basically I want what I had in Japan.

The argument is not just that people are or aren't receiving care or do or don't have insurance, it's also that the costs of these things is taking up too much of their budget and are still rising. I know we concentrate on the uninsured argument a lot and death and dying (I fell into the trap already) but it's not the whole case. I just basically think the benefits of what we have now do not outweigh the cost, and that the benefits of a France/Japan style system or even the Swiss system that Obama is proposing would outweigh whatever hidden costs there are because they would help eliminate the problems we have now.

As for why my brother didn't have catastrophic insurance, he'd have to answer himself. I think you could argue that he was irresponsible (this is the problem with anecdotes). But I would also point out that being above the poverty line for medicaid does not make you middle class. In fact, my brother got medicaid but had to quit his job to do so which involved all sorts of other costs (rent for one). Bankruptcy came from the way it all ballooned and spiralled.

BTW, catastrophic insurance is not all it's cracked up to be. See Karen Tumulty's article here: http://www.time.com/time/nation/article/0,8599,1883149,00.html

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 8:23 AM

You might think that, but you'd be wrong. The impact on health of variations in health insurance is statistically insignificant.

http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-in-half/

Not having health insurance does not leave you without care. It simply leaves you without unnecessary care. The RAND experiment showed quite conclusively that medicine which people buy only at a marginal cost of $0 is worthless.

stonetools (Replying to: The Ninja Zombie) September 2, 2009 9:01 AM

So those uninsured are dying because they are not receiving "unnecessary care"?

Nonsense on stilts.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 9:58 AM

The evidence suggests that the uninsured are not dying at a statistically significantly higher rate than the insured, after you control for exogenous variables.

This is the conclusion of many cross sectional studies as well as a controlled experiment (i.e., giving random people health insurance of varying quality).

If you have evidence to the contrary, please present it. Primary sources please, not breathless news reports.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:00 AM

From the website:

"How much could we cut? For the U.S. it seems reasonable to project the 30% cut in the RAND results to a 50% cut, since the U.S. spends so much more than other nations without obvious extra health gains. I thus claim: we could cut U.S. medical spending in half without substantial net health costs. This would give us the equivalent of an 8% pay raise."

This study is not a measure of the effects of not having health insurance. It is a study of the effects of medicine on people without catastrophic conditions. If anything, it seems to undercut Megan's argument because there does not seem to be a correlation between higher spending and better health (or to put it another way, higher cost and better health). I would agree with that. Part of the misunderstanding here is my own fault for being sloppy with my arguments, but when I talk about the effects of not having health insurance, I'm not talking about not getting prescription cold medicine in mid winter. I agree that a lot of what we spend on is wasteful. The problem is that the things that aren't wasteful (catastrophic care) are not any less high priced and we have no control over when we contract these conditions.

Will poor people be treated in emergency rooms? In some instances yes. But there are plenty of anecdotes of the opposite happening too. Plus the fact that they are likely to go bankrupt after doing so. All this study says to me is that because of our pricing, we are paying too much for things we don't need, while being completely priced out of things we do need.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:23 AM

The study measures the effect of health insurance with a $10,000 deductible ($37,419 in 2008 dollars, based on a start date of 1976). Below this amount, people were obligated to pay a variable portion of their own health costs (anywhere from 10% to 90%).

There was no measurable difference in health between the people who paid 90% of their own health costs and those who paid 10%.

Unless you believe there is some discontinuity between paying 90% and 100% of health care costs, it probably reasonable to extrapolate this to the case of no insurance.

As for catastrophic care, this is given to everyone in the US without regard to their ability to pay. So health insurance is irrelevant to that question.

At best, all we need to do is give people health insurance with a $37,500 deductible. The RAND experiment does not disprove the potential health benefits of such a policy (though I'd like to see some evidence it would be useful).

Last Years Man (Replying to: Last Years Man) September 2, 2009 10:47 AM

This is a reply to your post below:

What I'm saying is that when people are generally healthy ( ie absent of major health problems), there is likely no visible benefit of receiving health care. This is why young people don't buy insurance. So in that sense you're right. I just don't think it's relevant to what I'm saying, which is that if you develop a condition and you don't have insurance.

Let me give you an anecdotal example. My brother made too much money to qualify for medicaid but too little to afford health insurance (his employer didn't offer it).

One day he started developing pains in his arm. The doctor's found lumps but told him he would have to pay a cost of somewhere in the thousands (forgive my fuzzy memory) to have a biopsy. This is not something he could afford.

As a result, he went to Mexico and was diagnosed with Hodgkin's disease.

Did he receive care after coming back to the US? Yes, but he and his wife totally trashed their credit ratings in the process.

Even bankrupt, he was lucky. There are plenty of people in similar situations being denied treatment.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:53 AM

Your anecdote goes against your case. The poor have medicaid. The middle class pay out of pocket and sometimes trash their credit rating.

You still have yet to show evidence that anyone is dying as a result of lack of insurance.

(I'm not entirely sure why your middle class brother couldn't afford catastrophic care. Was he unlucky enough to live in a state which bans it?)

Last Years Man (Replying to: Last Years Man) September 2, 2009 11:22 AM

Right. And health care costs as they are now are not just pricing out the poor, they're pricing out the lower middle class as well. What I'd like to see is a medicaid style system applied to everyone. Or replaced with a public option with reasonably lower premiums then the 700 a month I pay now to have my wife insured on my company's plan. Basically I want what I had in Japan.

The argument is not just that people are or aren't receiving care or do or don't have insurance, it's also that the costs of these things is taking up too much of their budget and are still rising. I know we concentrate on the uninsured argument a lot and death and dying (I fell into the trap already) but it's not the whole case. I just basically think the benefits of what we have now do not outweigh the cost, and that the benefits of a France/Japan style system or even the Swiss system that Obama is proposing would outweigh whatever hidden costs there are because they would help eliminate the problems we have now.

As for why my brother didn't have catastrophic insurance, he'd have to answer himself. I think you could argue that he was irresponsible (this is the problem with anecdotes). But I would also point out that being above the poverty line for medicaid does not make you middle class. In fact, my brother got medicaid but had to quit his job to do so which involved all sorts of other costs (rent for one). Bankruptcy came from the way it all ballooned and spiralled.

BTW, catastrophic insurance is not all it's cracked up to be. See Karen Tumulty's article here: http://www.time.com/time/nation/article/0,8599,1883149,00.html

stonetools (Replying to: The Ninja Zombie) September 2, 2009 9:01 AM

So those uninsured are dying because they are not receiving "unnecessary care"?

Nonsense on stilts.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 9:58 AM

The evidence suggests that the uninsured are not dying at a statistically significantly higher rate than the insured, after you control for exogenous variables.

This is the conclusion of many cross sectional studies as well as a controlled experiment (i.e., giving random people health insurance of varying quality).

If you have evidence to the contrary, please present it. Primary sources please, not breathless news reports.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 9:58 AM

The evidence suggests that the uninsured are not dying at a statistically significantly higher rate than the insured, after you control for exogenous variables.

This is the conclusion of many cross sectional studies as well as a controlled experiment (i.e., giving random people health insurance of varying quality).

If you have evidence to the contrary, please present it. Primary sources please, not breathless news reports.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:00 AM

From the website:

"How much could we cut? For the U.S. it seems reasonable to project the 30% cut in the RAND results to a 50% cut, since the U.S. spends so much more than other nations without obvious extra health gains. I thus claim: we could cut U.S. medical spending in half without substantial net health costs. This would give us the equivalent of an 8% pay raise."

This study is not a measure of the effects of not having health insurance. It is a study of the effects of medicine on people without catastrophic conditions. If anything, it seems to undercut Megan's argument because there does not seem to be a correlation between higher spending and better health (or to put it another way, higher cost and better health). I would agree with that. Part of the misunderstanding here is my own fault for being sloppy with my arguments, but when I talk about the effects of not having health insurance, I'm not talking about not getting prescription cold medicine in mid winter. I agree that a lot of what we spend on is wasteful. The problem is that the things that aren't wasteful (catastrophic care) are not any less high priced and we have no control over when we contract these conditions.

Will poor people be treated in emergency rooms? In some instances yes. But there are plenty of anecdotes of the opposite happening too. Plus the fact that they are likely to go bankrupt after doing so. All this study says to me is that because of our pricing, we are paying too much for things we don't need, while being completely priced out of things we do need.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:23 AM

The study measures the effect of health insurance with a $10,000 deductible ($37,419 in 2008 dollars, based on a start date of 1976). Below this amount, people were obligated to pay a variable portion of their own health costs (anywhere from 10% to 90%).

There was no measurable difference in health between the people who paid 90% of their own health costs and those who paid 10%.

Unless you believe there is some discontinuity between paying 90% and 100% of health care costs, it probably reasonable to extrapolate this to the case of no insurance.

As for catastrophic care, this is given to everyone in the US without regard to their ability to pay. So health insurance is irrelevant to that question.

At best, all we need to do is give people health insurance with a $37,500 deductible. The RAND experiment does not disprove the potential health benefits of such a policy (though I'd like to see some evidence it would be useful).

Last Years Man (Replying to: Last Years Man) September 2, 2009 10:47 AM

This is a reply to your post below:

What I'm saying is that when people are generally healthy ( ie absent of major health problems), there is likely no visible benefit of receiving health care. This is why young people don't buy insurance. So in that sense you're right. I just don't think it's relevant to what I'm saying, which is that if you develop a condition and you don't have insurance.

Let me give you an anecdotal example. My brother made too much money to qualify for medicaid but too little to afford health insurance (his employer didn't offer it).

One day he started developing pains in his arm. The doctor's found lumps but told him he would have to pay a cost of somewhere in the thousands (forgive my fuzzy memory) to have a biopsy. This is not something he could afford.

As a result, he went to Mexico and was diagnosed with Hodgkin's disease.

Did he receive care after coming back to the US? Yes, but he and his wife totally trashed their credit ratings in the process.

Even bankrupt, he was lucky. There are plenty of people in similar situations being denied treatment.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:53 AM

Your anecdote goes against your case. The poor have medicaid. The middle class pay out of pocket and sometimes trash their credit rating.

You still have yet to show evidence that anyone is dying as a result of lack of insurance.

(I'm not entirely sure why your middle class brother couldn't afford catastrophic care. Was he unlucky enough to live in a state which bans it?)

Last Years Man (Replying to: Last Years Man) September 2, 2009 11:22 AM

Right. And health care costs as they are now are not just pricing out the poor, they're pricing out the lower middle class as well. What I'd like to see is a medicaid style system applied to everyone. Or replaced with a public option with reasonably lower premiums then the 700 a month I pay now to have my wife insured on my company's plan. Basically I want what I had in Japan.

The argument is not just that people are or aren't receiving care or do or don't have insurance, it's also that the costs of these things is taking up too much of their budget and are still rising. I know we concentrate on the uninsured argument a lot and death and dying (I fell into the trap already) but it's not the whole case. I just basically think the benefits of what we have now do not outweigh the cost, and that the benefits of a France/Japan style system or even the Swiss system that Obama is proposing would outweigh whatever hidden costs there are because they would help eliminate the problems we have now.

As for why my brother didn't have catastrophic insurance, he'd have to answer himself. I think you could argue that he was irresponsible (this is the problem with anecdotes). But I would also point out that being above the poverty line for medicaid does not make you middle class. In fact, my brother got medicaid but had to quit his job to do so which involved all sorts of other costs (rent for one). Bankruptcy came from the way it all ballooned and spiralled.

BTW, catastrophic insurance is not all it's cracked up to be. See Karen Tumulty's article here: http://www.time.com/time/nation/article/0,8599,1883149,00.html

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:23 AM

The study measures the effect of health insurance with a $10,000 deductible ($37,419 in 2008 dollars, based on a start date of 1976). Below this amount, people were obligated to pay a variable portion of their own health costs (anywhere from 10% to 90%).

There was no measurable difference in health between the people who paid 90% of their own health costs and those who paid 10%.

Unless you believe there is some discontinuity between paying 90% and 100% of health care costs, it probably reasonable to extrapolate this to the case of no insurance.

As for catastrophic care, this is given to everyone in the US without regard to their ability to pay. So health insurance is irrelevant to that question.

At best, all we need to do is give people health insurance with a $37,500 deductible. The RAND experiment does not disprove the potential health benefits of such a policy (though I'd like to see some evidence it would be useful).

Last Years Man (Replying to: Last Years Man) September 2, 2009 10:47 AM

This is a reply to your post below:

What I'm saying is that when people are generally healthy ( ie absent of major health problems), there is likely no visible benefit of receiving health care. This is why young people don't buy insurance. So in that sense you're right. I just don't think it's relevant to what I'm saying, which is that if you develop a condition and you don't have insurance.

Let me give you an anecdotal example. My brother made too much money to qualify for medicaid but too little to afford health insurance (his employer didn't offer it).

One day he started developing pains in his arm. The doctor's found lumps but told him he would have to pay a cost of somewhere in the thousands (forgive my fuzzy memory) to have a biopsy. This is not something he could afford.

As a result, he went to Mexico and was diagnosed with Hodgkin's disease.

Did he receive care after coming back to the US? Yes, but he and his wife totally trashed their credit ratings in the process.

Even bankrupt, he was lucky. There are plenty of people in similar situations being denied treatment.

The Ninja Zombie (Replying to: Last Years Man) September 2, 2009 10:53 AM

Your anecdote goes against your case. The poor have medicaid. The middle class pay out of pocket and sometimes trash their credit rating.

You still have yet to show evidence that anyone is dying as a result of lack of insurance.

(I'm not entirely sure why your middle class brother couldn't afford catastrophic care. Was he unlucky enough to live in a state which bans it?)

Last Years Man (Replying to: Last Years Man) September 2, 2009 11:22 AM

Right. And health care costs as they are now are not just pricing out the poor, they're pricing out the lower middle class as well. What I'd like to see is a medicaid style system applied to everyone. Or replaced with a public option with reasonably lower premiums then the 700 a month I pay now to have my wife insured on my company's plan. Basically I want what I had in Japan.

The argument is not just that people are or aren't receiving care or do or don't have insurance, it's also that the costs of these things is taking up too much of their budget and are still rising. I know we concentrate on the uninsured argument a lot and death and dying (I fell into the trap already) but it's not the whole case. I just basically think the benefits of what we have now do not outweigh the cost, and that the benefits of a France/Japan style system or even the Swiss system that Obama is proposing would outweigh whatever hidden costs there are because they would help eliminate the problems we have now.

As for why my brother didn't have catastrophic insurance, he'd have to answer himself. I think you could argue that he was irresponsible (this is the problem with anecdotes). But I would also point out that being above the poverty line for medicaid does not make you middle class. In fact, my brother got medicaid but had to quit his job to do so which involved all sorts of other costs (rent for one). Bankruptcy came from the way it all ballooned and spiralled.

BTW, catastrophic insurance is not all it's cracked up to be. See Karen Tumulty's article here: http://www.time.com/time/nation/article/0,8599,1883149,00.html

Ryan W. September 1, 2009 10:39 PM

Megan -

It is appropriate for Warren Buffet to pay a higher percentage of his income in taxes for shared public goods than I do, because the personal cost of taking 25% of his income is much lower than the personal cost of taking 25% of mine.

So then ideally we should we consider a person's income as a factor of the number of hours worked and factor in hours/years of education? That would actually make sense (though it would be hard to implement.) It doesn't make sense to tax doctors at such a high rate, given how long they have to spend in school, residency, etc.

Just income distribution is not just a matter of relative position, but also of how the income is acquired, and absolute need.
What about capacity? Why can't we disqualify someone from their claims of absolute need if they've been convicted of, say, methamphetamine use. Isn't that roughly equivalent to giving someone the money they need to treat cancer and letting them use it for an extravagant vacation. A person's problem in both cases come from their refusal to exercise their capacity.

Drug companies charge what the market will bear. Drugs wouldn't be any cheaper here if Europe dropped its price controls. What we would have is more drugs.

I usually don't mean to imply that US drugs would be cheaper if Europe paid "it's fair share." I simply don't like free riders as a matter of principle. However wouldn't you think there's a chance that an increase in competition might influence what price the market would bear?

samX September 1, 2009 10:46 PM

"You'll still end up with a crappy, overcrowded housing stock and shortages of basic goods."

Unfortunately those who support various forms of government intervention will always argue they have learned from previous experience and will not be so heavy handed and will tweak the rules every so slightly and incrementally.

It's increasingly clear and worrisome to many that communism/socialism by degrees, if not in name is coming. We really need a good political term that describes the corporatism/legal state that is coming down the road. I don't suggest it is here now, but I really don't see how the ever-expanding role of government, rules, regulations, etc. is not going to cause huge societal problems within 1-2 generations.

I don't believe Stalin (or, to make a less distasteful comparison, the more benign communists, if there is such a thing) really felt his policies were a failure. It was simply just a rule or a control that needed tweaking. And from his perspective, the system "worked". Russian hummed along for many years without any issue. And that is exactly where I see us. The many rules and interferences that are being put into the system is not collapsing it out right and there appears to be little (seen) costs. But a system which collapses in 60 years under its own weight is indeed a failure even though for many it appears to "work" during the interim.

kadzimiel September 1, 2009 11:00 PM

So, an enormous rambling post, with some unargued and simplistic "principles", an almost total absence of hard data, and some glib references to claims previously made and disproven. Well, I doubt Holbo will worry too much about this latest voyage through libertarian fantasy world. When will McArdle grasp that the market is generally extremely inefficient as a provider of resources for social concerns? Also, the market provides innovations for profit - and that's why it actually acts as a curb on innovation in many areas.

Ryan W. (Replying to: kadzimiel) September 2, 2009 12:53 AM

Huh? What alternative system are you suggesting is more innovative. The soviet communists claimed they were going to be much more efficient by eliminating the redundancy of the capitalist system and they developed next to nothing except for a few satellites, weapons and reactor designs.

There are some innovations which the market doesn't fund, but I'm hard pressed to think of any that it actively curbs.

Ryan W. (Replying to: kadzimiel) September 2, 2009 12:53 AM

Huh? What alternative system are you suggesting is more innovative. The soviet communists claimed they were going to be much more efficient by eliminating the redundancy of the capitalist system and they developed next to nothing except for a few satellites, weapons and reactor designs.

There are some innovations which the market doesn't fund, but I'm hard pressed to think of any that it actively curbs.

Nelson Alexander September 1, 2009 11:09 PM

Using "Market Thinking" Evades the Human and Political Issues.

This was a fine, substantive, time -consuming post by McArdle, and I hesitate to comment since I have not followed the debate. Many of her "principles" are practically socialist, if abstracted or universalized.

However, the language does not seem "libertarian" at all, in the classic, liberal, Lockean sense. (Which deserves congratulations. The world moves on.) But unless I missed a previous post, how is this to be construed in terms of legal "rights," the very essence of America's historical, "liberal" exceptionalism?

I am not sure from this list of principles what bill of "rights" a libertarian like McArdle would ideally extend to the legal citizens of a contemporary nation, aside from the old libertarian "protection of property." As an aside, it is interesting (philosophically) to note that Locke, for example, placed the first "property right" in the "property" of the individual's body. Would protection of the "property" of the body extend to a right to medical protection?

Obviously, this is treating Locke ahistorically, not to mention getting way too abstract. But what rights should a modern citizen have in McArdle's view? Police protection? Public education? Habeas corpus? Trial by jury (which is extremely expensive)? Should "rights" advance historically with social capability? Or remain frozen in time? This is a problem for libertarians, because "The Market" does not supply "rights." To function it must price people out. (The battle to legalize new "rights" has often been a struggle on the part of workers to keep abreast of ever advancing technological necessities, such as clean water or telephones.)

McArdle has often fudged this matter of principle by noting that poor people (and who knows where to divide "poor" from "middle class"?) will be treated in emergency rooms in America. This proves we capitalist Americans are not heartless beasts, letting fellow citizens die when we can clearly afford to do otherwise. She has said as much several times in response to European commenters.

But what kind of response is that? Should hospitals be free not to treat the poor if, for example, shareholders demand a "no-treatment" policy? And should we be proud that we are perhaps the only advanced nation that insists on treating its poorer citizens in the most expensive, least effective way possible? As everyone knows, this emergency room care costs everyone else, and is simply one of those capitalist conundrums that must be done so the system does not appear to "give goods away."

Here we see the old labor incentive problem. What is not a "right" is an undeserved "giveaway." No market system, for example, could come close to price-tolerance of trial by jury, which is why it has been all but eliminated. It remains a formal "right" (largely out of sentimentality) but rarely a market reality, at least for poorer citizens.

But again, is health care a "right" we extend to our citizens? I assume libertarians do not think so. Not at all. So be it. But if not, why treat people in emergency rooms? After all, this forces the rest of us to pay for it, in the most inefficient, costly way possible. Very costly. In some countries I have been to, people can and do die on the sidewalks. So it is perfectly thinkable, if that is how we construe the rights of U.S. citizens.

It seems to me that McArdle completely evades this problem, which is both philosophical and quite specific and pragmatic. Which is not surprising, since it represents one of those basic antinomies between a "constitutional republic" and "capitalism" that history is continually forcing on society "in reality" and that conservatives and libertarians are forced to avoid. Markets do not and cannot supply "rights." So as we become a wealthier nation, should "rights" change or not? For many, this is a matter, literally, of life and death. Who decides and how?

Rationing of some sort is obviously necessary. Buy-out options for the wealthy can be arranged (as they are for education, military service, taxes, transportation, and other public goods). But is some form of health care in some measure a "right" or not? McArdle and her fellow libertarians tend to wish away such problems through the metaphysics of "The Market." If we decide to minimize rights to medical care, then shareholders in hospital stock must have the legal right not to treat. Managers cannot honor their fiduciary rights to shareholders and extend to nonpaying citizens a right to the "product."

Megan McArdle (Replying to: Nelson Alexander) September 2, 2009 7:44 AM

1) You are assuming this list of principles is exhaustive. It isn't.

2) The libertarian concept of reasoning laws out from two or three first principles is naive. You could still mandate emergency treatment on the grounds that it's often not possible to determine ability to pay, in the same way that the law of the sea has various provisions for your responsibility to rescue someone that don't keep most libertarians awake at night.

3) I don't know where you got the idea that I spent a great deal of time waxing lyriical on the benefits of emergency room care for the poor. I have talked about the fact that attempts to divert the poor from emergency rooms often fail, and at best achieve modest improvements, because it turns out that poor people use emergency rooms for a number of reasons that aren't amenable to intervention by the health care system. So whether or not emergency room care is really much more expensive--it probably isn't, when you consider that the fixed costs of the plant would exist whether or not it treated ear infections in between gunshot wounds; liberals are confusing price with cost--we seem to be stuck with it.

4) Your endless complaints about libertarians have nothing to do with this post, and are really quite out of touch with what libertarians believe.

Nelson Alexander (Replying to: Megan McArdle) September 2, 2009 12:19 PM

Well, yes, my "endless complaints" are an attempt to determine what it is that young, contemporary "libertarians" believe. I am sincerely interested. I understand that there is no single answer and that it is even somewhat contradictory to suggest that someone "speaks for libertarians."

My concern is the way in which "government bad/market good" has become a populist (even emotionalist) dogma in the world's most powerful nation and an era of increasingly complex market interdependencies. You are hardly the worst in this respect, I admit, yet I still consider much of the reasoning incoherent, utterly ahistorical, and used quite promiscuously for dubious political ends (ends that are rarely at odds, to say the least, with the dearest hopes of corporate lobbyists).

My reference to the emergency room comes, I believe, from an interview at FT, where opinion tends to be far less ideological and "market purist" than what we hear in the US. But this is a minor point. As to costs versus prices, are you really arguing for the cost efficiency of emergency room care? The main "cost" is in the cumulative stress on hospitals and the public effects of delayed and inconsistent treatment.

I assume that your list of libertarian principles is not exhaustive. But I still fail to see how libertarians of any stripe work out problems with "rights" and equal treatment under the law. To me, this really is the heart of the healthcare debate. Or at least one perfectly reasonable and traditional, American way to frame it.

Generally, when something is deemed a civil "right" or a necessary public function it must be removed, at least in part, from the market or purely competitive price system. Clearly, a functioning market must price some (or many) people out or price drops below cost. This works well for goods people can do without. It does not work well for goods such as your life. In fact it does not work well for any goods that become a normative social necessity, such as heating fuel, water, inspected meat, and today even such things as telephone access. Such goods, along with many collective goods, become informally, then formally defined as "rights." These tend to expand as market interdependencies expand.

(There was, for example, no healthcare "right" to clean water in 19th century cities. Water was controlled by private companies, like The Manhattan Bank, who used their badly tainted system to raise stock and bond funds while thousands died of cholera. The original toxic assets.)

So I stand by my main point that the market arguments evade the question of rights. Is there any legal right to healthcare? The question simply gets vaguely passed off to the government or the emergency rooms. Which might be okay, except then market purists complain about the costs and inefficiencies of government, where the ever accumulating externalities are dumped.

My point is that there is often a logical and material contradiction between the strong property rights claimed by libertarians and other more "abstract" rights, many of which are deeply interwoven with the property rights. This is not trivial. It was a major issue in 19th century sanitation and healthcare debates. At the time, no number of cholera outbreaks could convince landlords (read: "shareholders") they should pay for clean water. It infringed not just "property" rights but a presumed "right" to maximize ROI. There were actually housing models that were demonstrated to greatly improve tenant health. But they only earned 5 percent ROI, and land investors hoped for 20 percent, based usually on wild market fervor.

To leave healthcare for millions of people (I believe millions is accurate) in the grey area or legal limbo of emergency rooms and programs dependent on unfunded public debt is once again, in my opinion, to defer rational, democratic discussion in deference to the "higher ideal" of shareholder value. The anti-government creeds irresponsibly popularized by the right and the corporate lobbyists do not help, and lead to such absurdities as the fear that "the government will tamper with my medicare."

I am merely asking, in honest if leery curiosity, how such issues might be framed by libertarians in terms of "rights" as opposed to "prices." As I indicated, this logic of "rights" is very much in keeping with the liberal and libertarian heritage, yet seems to be translated these days into discussions of marginal utility and price theory. To what extent should basic healthcare coverage be treated as a right? I disagree that my "endless complaints" are uninformed and off-topic. They are hardly as "endless" as market boosterism and anti-regulatory complaints.

Megan McArdle (Replying to: Nelson Alexander) September 2, 2009 7:44 AM

1) You are assuming this list of principles is exhaustive. It isn't.

2) The libertarian concept of reasoning laws out from two or three first principles is naive. You could still mandate emergency treatment on the grounds that it's often not possible to determine ability to pay, in the same way that the law of the sea has various provisions for your responsibility to rescue someone that don't keep most libertarians awake at night.

3) I don't know where you got the idea that I spent a great deal of time waxing lyriical on the benefits of emergency room care for the poor. I have talked about the fact that attempts to divert the poor from emergency rooms often fail, and at best achieve modest improvements, because it turns out that poor people use emergency rooms for a number of reasons that aren't amenable to intervention by the health care system. So whether or not emergency room care is really much more expensive--it probably isn't, when you consider that the fixed costs of the plant would exist whether or not it treated ear infections in between gunshot wounds; liberals are confusing price with cost--we seem to be stuck with it.

4) Your endless complaints about libertarians have nothing to do with this post, and are really quite out of touch with what libertarians believe.

Nelson Alexander (Replying to: Megan McArdle) September 2, 2009 12:19 PM

Well, yes, my "endless complaints" are an attempt to determine what it is that young, contemporary "libertarians" believe. I am sincerely interested. I understand that there is no single answer and that it is even somewhat contradictory to suggest that someone "speaks for libertarians."

My concern is the way in which "government bad/market good" has become a populist (even emotionalist) dogma in the world's most powerful nation and an era of increasingly complex market interdependencies. You are hardly the worst in this respect, I admit, yet I still consider much of the reasoning incoherent, utterly ahistorical, and used quite promiscuously for dubious political ends (ends that are rarely at odds, to say the least, with the dearest hopes of corporate lobbyists).

My reference to the emergency room comes, I believe, from an interview at FT, where opinion tends to be far less ideological and "market purist" than what we hear in the US. But this is a minor point. As to costs versus prices, are you really arguing for the cost efficiency of emergency room care? The main "cost" is in the cumulative stress on hospitals and the public effects of delayed and inconsistent treatment.

I assume that your list of libertarian principles is not exhaustive. But I still fail to see how libertarians of any stripe work out problems with "rights" and equal treatment under the law. To me, this really is the heart of the healthcare debate. Or at least one perfectly reasonable and traditional, American way to frame it.

Generally, when something is deemed a civil "right" or a necessary public function it must be removed, at least in part, from the market or purely competitive price system. Clearly, a functioning market must price some (or many) people out or price drops below cost. This works well for goods people can do without. It does not work well for goods such as your life. In fact it does not work well for any goods that become a normative social necessity, such as heating fuel, water, inspected meat, and today even such things as telephone access. Such goods, along with many collective goods, become informally, then formally defined as "rights." These tend to expand as market interdependencies expand.

(There was, for example, no healthcare "right" to clean water in 19th century cities. Water was controlled by private companies, like The Manhattan Bank, who used their badly tainted system to raise stock and bond funds while thousands died of cholera. The original toxic assets.)

So I stand by my main point that the market arguments evade the question of rights. Is there any legal right to healthcare? The question simply gets vaguely passed off to the government or the emergency rooms. Which might be okay, except then market purists complain about the costs and inefficiencies of government, where the ever accumulating externalities are dumped.

My point is that there is often a logical and material contradiction between the strong property rights claimed by libertarians and other more "abstract" rights, many of which are deeply interwoven with the property rights. This is not trivial. It was a major issue in 19th century sanitation and healthcare debates. At the time, no number of cholera outbreaks could convince landlords (read: "shareholders") they should pay for clean water. It infringed not just "property" rights but a presumed "right" to maximize ROI. There were actually housing models that were demonstrated to greatly improve tenant health. But they only earned 5 percent ROI, and land investors hoped for 20 percent, based usually on wild market fervor.

To leave healthcare for millions of people (I believe millions is accurate) in the grey area or legal limbo of emergency rooms and programs dependent on unfunded public debt is once again, in my opinion, to defer rational, democratic discussion in deference to the "higher ideal" of shareholder value. The anti-government creeds irresponsibly popularized by the right and the corporate lobbyists do not help, and lead to such absurdities as the fear that "the government will tamper with my medicare."

I am merely asking, in honest if leery curiosity, how such issues might be framed by libertarians in terms of "rights" as opposed to "prices." As I indicated, this logic of "rights" is very much in keeping with the liberal and libertarian heritage, yet seems to be translated these days into discussions of marginal utility and price theory. To what extent should basic healthcare coverage be treated as a right? I disagree that my "endless complaints" are uninformed and off-topic. They are hardly as "endless" as market boosterism and anti-regulatory complaints.

Nelson Alexander (Replying to: Megan McArdle) September 2, 2009 12:19 PM

Well, yes, my "endless complaints" are an attempt to determine what it is that young, contemporary "libertarians" believe. I am sincerely interested. I understand that there is no single answer and that it is even somewhat contradictory to suggest that someone "speaks for libertarians."

My concern is the way in which "government bad/market good" has become a populist (even emotionalist) dogma in the world's most powerful nation and an era of increasingly complex market interdependencies. You are hardly the worst in this respect, I admit, yet I still consider much of the reasoning incoherent, utterly ahistorical, and used quite promiscuously for dubious political ends (ends that are rarely at odds, to say the least, with the dearest hopes of corporate lobbyists).

My reference to the emergency room comes, I believe, from an interview at FT, where opinion tends to be far less ideological and "market purist" than what we hear in the US. But this is a minor point. As to costs versus prices, are you really arguing for the cost efficiency of emergency room care? The main "cost" is in the cumulative stress on hospitals and the public effects of delayed and inconsistent treatment.

I assume that your list of libertarian principles is not exhaustive. But I still fail to see how libertarians of any stripe work out problems with "rights" and equal treatment under the law. To me, this really is the heart of the healthcare debate. Or at least one perfectly reasonable and traditional, American way to frame it.

Generally, when something is deemed a civil "right" or a necessary public function it must be removed, at least in part, from the market or purely competitive price system. Clearly, a functioning market must price some (or many) people out or price drops below cost. This works well for goods people can do without. It does not work well for goods such as your life. In fact it does not work well for any goods that become a normative social necessity, such as heating fuel, water, inspected meat, and today even such things as telephone access. Such goods, along with many collective goods, become informally, then formally defined as "rights." These tend to expand as market interdependencies expand.

(There was, for example, no healthcare "right" to clean water in 19th century cities. Water was controlled by private companies, like The Manhattan Bank, who used their badly tainted system to raise stock and bond funds while thousands died of cholera. The original toxic assets.)

So I stand by my main point that the market arguments evade the question of rights. Is there any legal right to healthcare? The question simply gets vaguely passed off to the government or the emergency rooms. Which might be okay, except then market purists complain about the costs and inefficiencies of government, where the ever accumulating externalities are dumped.

My point is that there is often a logical and material contradiction between the strong property rights claimed by libertarians and other more "abstract" rights, many of which are deeply interwoven with the property rights. This is not trivial. It was a major issue in 19th century sanitation and healthcare debates. At the time, no number of cholera outbreaks could convince landlords (read: "shareholders") they should pay for clean water. It infringed not just "property" rights but a presumed "right" to maximize ROI. There were actually housing models that were demonstrated to greatly improve tenant health. But they only earned 5 percent ROI, and land investors hoped for 20 percent, based usually on wild market fervor.

To leave healthcare for millions of people (I believe millions is accurate) in the grey area or legal limbo of emergency rooms and programs dependent on unfunded public debt is once again, in my opinion, to defer rational, democratic discussion in deference to the "higher ideal" of shareholder value. The anti-government creeds irresponsibly popularized by the right and the corporate lobbyists do not help, and lead to such absurdities as the fear that "the government will tamper with my medicare."

I am merely asking, in honest if leery curiosity, how such issues might be framed by libertarians in terms of "rights" as opposed to "prices." As I indicated, this logic of "rights" is very much in keeping with the liberal and libertarian heritage, yet seems to be translated these days into discussions of marginal utility and price theory. To what extent should basic healthcare coverage be treated as a right? I disagree that my "endless complaints" are uninformed and off-topic. They are hardly as "endless" as market boosterism and anti-regulatory complaints.

Col Sanders September 1, 2009 11:09 PM

"States have an absolute right to tax their citizens"

Hm... I'm most interested in this statement.

From where does a state derive this right?

Nelson Alexander (Replying to: Col Sanders) September 2, 2009 8:12 AM

There are many historical and philosophical answers to that question, of course. The first major crisis of our own state arose as a result of the unwillingness of "libertarian" factions to pay Washington's Continental Army. The nation had no mechanism for raising money, other than foreign borrowing and tariffs (which the Southern states also opposed).

The states, or former colonies, could tax, but did not want their local funds to be federalized. Thus bond holders who supported the war lost their money and the unpaid army actually marched on the Congress and came very close to a military coup to extract their pay, until Washington talked them out of it and Hamilton began to devise funding schemes. I am not sure what the "libertarian" solution would be. In fact, I am not sure how libertarians define a "state" that has no power to tax or impose tariffs on business. As the case of the unpaid revolutionary army and many other historical examples show, such a "state" simply devolves into pure force, with the military extracting direct tribute or labor.

I really don't know. What is an unfunded state? Or what are the state funding mechanisms typically proposed by radical anti-tax libertarians? Or would market libertarians like Col Sanders simply allow private armies like Blackwater who are "free" to "offer" protection rackets. ("Nice little country you got here. Shame if anything happened to it.")

Col Sanders (Replying to: Nelson Alexander) September 2, 2009 9:31 AM

Wow - that's your answer? All that writing to say one thing:

"I really don't know, but it has to have it because without it, it doesn't really work... It devolves into pure force or something..."

Government of any kind *is* pure force. It's not a discussion group, or a focus group, or a bunch of people having tea and asking you to do something nicely. It's people with guns...

Force...

For what it's worth, I'm not a libertarian either small "l" or big "L" so you can drop all that hand-wringing and sarcasm-disguised-as-debate. Guilt by association isn't really going to get you anywhere with me.

I'll pose the question again:

From where does the "state" derive an "absolute right" to tax?

stonetools (Replying to: Col Sanders) September 2, 2009 10:27 AM

From the consent of the governed. John Locke? Good enough for you ?
Anyway, its an irrelevant question. All intelligent people now accept that states have a right to tax, including the founding fathers and the writers of the US Constitution. If you want to find out why they accepted this, you can start with Hobbes "Leviathan" and read Locke, Rousseau, The Federalist Papers and the Anti-Federalists if you want. But that question has long been settled.
Now if think that the founding fathers are wrong and that the very idea of a United States of America was a mistake, well, you can go join Bearded Spock in the crazy corner.......

Nelson Alexander (Replying to: Col Sanders) September 2, 2009 12:47 PM

Thank you for your eloquent summaries of my "real" meanings. Sorry you did not find my anecdote about the Continental Army of any interest. I thought maybe, you being a Colonel...

Well, you answered the question yourself, and I agree with you. Hobbes is at some level irrefutable. The "right" to tax and the "right" to property and other "rights" are secured by violent power. There is nothing ahistorical or natural, for example, about our particular structure of property rights. The concept of exclusively "owning" an idea or a gene would strike most people in history as bizarre. Even in land, the Indians, the King of England, The Dutch East India Company, the Episcopal Church, and the Plantation Slavers did not share anything like our current view of "property." (At one time the most valuable class of property in America was Africans. And they reproduced!)

So taking your point, I do not quite understand the passion with which many people defend "absolute" property rights or refute "absolute" rights to taxation. The problem is managing and distributing the enormous complexities of power, which change over time. I simply do not share the faith of many here that a transcendental entity called "The Market" just naturally and automatically takes care of all that. Obviously the more property you have, the more power you have, including the power to get more property. A complex structure of property "rights," backed by "legitimate" force and named "The Market" will quite often lead to destabilizing concentrations of power, including closure of "markets" and power over the state apparatus.

Our nation began not only with a rejection of certain forms of "taxation," it began with a massive rejection of legitimate, even "sacred" property rights as they were then understood. But you are wrong to disparage discussion. Conservatives are usually impatient with "words" and quick to resort to force. Power comes not simply out of "violent force" but out of organization, and language is our most fundamental medium of social organization. I await your rewrite.

Col Sanders (Replying to: Col Sanders) September 2, 2009 2:20 PM

@Stonetools

How do you determine that you have the consent of the governed?

You can waive it off as irrelevant or call those who ask "kooks" but it is a legitimate question as was the first one.

@Nelson

All rights stem from either violence or contract. Might makes right, or we negotiate and come to an agreement. There is no middle ground between the two.

Violence or contract.

Fair trade or a gun barrel...

So which is it?

moptop (Replying to: Col Sanders) September 2, 2009 9:09 PM

The state has an absolute right to taxation due to their sovereign monopoly of violence. The state that eschews the right to taxation will be supplanted by a neighboring state which has more resources due to its assertion of the right to taxation.

Species have a right to reproduce because species which do not reproduce disappear and so cannot exist.

Col Sanders (Replying to: Col Sanders) September 2, 2009 9:40 PM

@Moptop

"The state has an absolute right to taxation due to their sovereign monopoly of violence."

That's what I said - why repeat it?

They didn't get it the first time I said it.

Nelson Alexander (Replying to: Col Sanders) September 2, 2009 8:12 AM

There are many historical and philosophical answers to that question, of course. The first major crisis of our own state arose as a result of the unwillingness of "libertarian" factions to pay Washington's Continental Army. The nation had no mechanism for raising money, other than foreign borrowing and tariffs (which the Southern states also opposed).

The states, or former colonies, could tax, but did not want their local funds to be federalized. Thus bond holders who supported the war lost their money and the unpaid army actually marched on the Congress and came very close to a military coup to extract their pay, until Washington talked them out of it and Hamilton began to devise funding schemes. I am not sure what the "libertarian" solution would be. In fact, I am not sure how libertarians define a "state" that has no power to tax or impose tariffs on business. As the case of the unpaid revolutionary army and many other historical examples show, such a "state" simply devolves into pure force, with the military extracting direct tribute or labor.

I really don't know. What is an unfunded state? Or what are the state funding mechanisms typically proposed by radical anti-tax libertarians? Or would market libertarians like Col Sanders simply allow private armies like Blackwater who are "free" to "offer" protection rackets. ("Nice little country you got here. Shame if anything happened to it.")

Col Sanders (Replying to: Nelson Alexander) September 2, 2009 9:31 AM

Wow - that's your answer? All that writing to say one thing:

"I really don't know, but it has to have it because without it, it doesn't really work... It devolves into pure force or something..."

Government of any kind *is* pure force. It's not a discussion group, or a focus group, or a bunch of people having tea and asking you to do something nicely. It's people with guns...

Force...

For what it's worth, I'm not a libertarian either small "l" or big "L" so you can drop all that hand-wringing and sarcasm-disguised-as-debate. Guilt by association isn't really going to get you anywhere with me.

I'll pose the question again:

From where does the "state" derive an "absolute right" to tax?

stonetools (Replying to: Col Sanders) September 2, 2009 10:27 AM

From the consent of the governed. John Locke? Good enough for you ?
Anyway, its an irrelevant question. All intelligent people now accept that states have a right to tax, including the founding fathers and the writers of the US Constitution. If you want to find out why they accepted this, you can start with Hobbes "Leviathan" and read Locke, Rousseau, The Federalist Papers and the Anti-Federalists if you want. But that question has long been settled.
Now if think that the founding fathers are wrong and that the very idea of a United States of America was a mistake, well, you can go join Bearded Spock in the crazy corner.......

Nelson Alexander (Replying to: Col Sanders) September 2, 2009 12:47 PM

Thank you for your eloquent summaries of my "real" meanings. Sorry you did not find my anecdote about the Continental Army of any interest. I thought maybe, you being a Colonel...

Well, you answered the question yourself, and I agree with you. Hobbes is at some level irrefutable. The "right" to tax and the "right" to property and other "rights" are secured by violent power. There is nothing ahistorical or natural, for example, about our particular structure of property rights. The concept of exclusively "owning" an idea or a gene would strike most people in history as bizarre. Even in land, the Indians, the King of England, The Dutch East India Company, the Episcopal Church, and the Plantation Slavers did not share anything like our current view of "property." (At one time the most valuable class of property in America was Africans. And they reproduced!)

So taking your point, I do not quite understand the passion with which many people defend "absolute" property rights or refute "absolute" rights to taxation. The problem is managing and distributing the enormous complexities of power, which change over time. I simply do not share the faith of many here that a transcendental entity called "The Market" just naturally and automatically takes care of all that. Obviously the more property you have, the more power you have, including the power to get more property. A complex structure of property "rights," backed by "legitimate" force and named "The Market" will quite often lead to destabilizing concentrations of power, including closure of "markets" and power over the state apparatus.

Our nation began not only with a rejection of certain forms of "taxation," it began with a massive rejection of legitimate, even "sacred" property rights as they were then understood. But you are wrong to disparage discussion. Conservatives are usually impatient with "words" and quick to resort to force. Power comes not simply out of "violent force" but out of organization, and language is our most fundamental medium of social organization. I await your rewrite.

Col Sanders (Replying to: Col Sanders) September 2, 2009 2:20 PM

@Stonetools

How do you determine that you have the consent of the governed?

You can waive it off as irrelevant or call those who ask "kooks" but it is a legitimate question as was the first one.

@Nelson

All rights stem from either violence or contract. Might makes right, or we negotiate and come to an agreement. There is no middle ground between the two.

Violence or contract.

Fair trade or a gun barrel...

So which is it?

moptop (Replying to: Col Sanders) September 2, 2009 9:09 PM

The state has an absolute right to taxation due to their sovereign monopoly of violence. The state that eschews the right to taxation will be supplanted by a neighboring state which has more resources due to its assertion of the right to taxation.

Species have a right to reproduce because species which do not reproduce disappear and so cannot exist.

Col Sanders (Replying to: Col Sanders) September 2, 2009 9:40 PM

@Moptop

"The state has an absolute right to taxation due to their sovereign monopoly of violence."

That's what I said - why repeat it?

They didn't get it the first time I said it.

Col Sanders (Replying to: Nelson Alexander) September 2, 2009 9:31 AM

Wow - that's your answer? All that writing to say one thing:

"I really don't know, but it has to have it because without it, it doesn't really work... It devolves into pure force or something..."

Government of any kind *is* pure force. It's not a discussion group, or a focus group, or a bunch of people having tea and asking you to do something nicely. It's people with guns...

Force...

For what it's worth, I'm not a libertarian either small "l" or big "L" so you can drop all that hand-wringing and sarcasm-disguised-as-debate. Guilt by association isn't really going to get you anywhere with me.

I'll pose the question again:

From where does the "state" derive an "absolute right" to tax?

stonetools (Replying to: Col Sanders) September 2, 2009 10:27 AM

From the consent of the governed. John Locke? Good enough for you ?
Anyway, its an irrelevant question. All intelligent people now accept that states have a right to tax, including the founding fathers and the writers of the US Constitution. If you want to find out why they accepted this, you can start with Hobbes "Leviathan" and read Locke, Rousseau, The Federalist Papers and the Anti-Federalists if you want. But that question has long been settled.
Now if think that the founding fathers are wrong and that the very idea of a United States of America was a mistake, well, you can go join Bearded Spock in the crazy corner.......

Nelson Alexander (Replying to: Col Sanders) September 2, 2009 12:47 PM

Thank you for your eloquent summaries of my "real" meanings. Sorry you did not find my anecdote about the Continental Army of any interest. I thought maybe, you being a Colonel...

Well, you answered the question yourself, and I agree with you. Hobbes is at some level irrefutable. The "right" to tax and the "right" to property and other "rights" are secured by violent power. There is nothing ahistorical or natural, for example, about our particular structure of property rights. The concept of exclusively "owning" an idea or a gene would strike most people in history as bizarre. Even in land, the Indians, the King of England, The Dutch East India Company, the Episcopal Church, and the Plantation Slavers did not share anything like our current view of "property." (At one time the most valuable class of property in America was Africans. And they reproduced!)

So taking your point, I do not quite understand the passion with which many people defend "absolute" property rights or refute "absolute" rights to taxation. The problem is managing and distributing the enormous complexities of power, which change over time. I simply do not share the faith of many here that a transcendental entity called "The Market" just naturally and automatically takes care of all that. Obviously the more property you have, the more power you have, including the power to get more property. A complex structure of property "rights," backed by "legitimate" force and named "The Market" will quite often lead to destabilizing concentrations of power, including closure of "markets" and power over the state apparatus.

Our nation began not only with a rejection of certain forms of "taxation," it began with a massive rejection of legitimate, even "sacred" property rights as they were then understood. But you are wrong to disparage discussion. Conservatives are usually impatient with "words" and quick to resort to force. Power comes not simply out of "violent force" but out of organization, and language is our most fundamental medium of social organization. I await your rewrite.

Col Sanders (Replying to: Col Sanders) September 2, 2009 2:20 PM

@Stonetools

How do you determine that you have the consent of the governed?

You can waive it off as irrelevant or call those who ask "kooks" but it is a legitimate question as was the first one.

@Nelson

All rights stem from either violence or contract. Might makes right, or we negotiate and come to an agreement. There is no middle ground between the two.

Violence or contract.

Fair trade or a gun barrel...

So which is it?

moptop (Replying to: Col Sanders) September 2, 2009 9:09 PM

The state has an absolute right to taxation due to their sovereign monopoly of violence. The state that eschews the right to taxation will be supplanted by a neighboring state which has more resources due to its assertion of the right to taxation.

Species have a right to reproduce because species which do not reproduce disappear and so cannot exist.

Col Sanders (Replying to: Col Sanders) September 2, 2009 9:40 PM

@Moptop

"The state has an absolute right to taxation due to their sovereign monopoly of violence."

That's what I said - why repeat it?

They didn't get it the first time I said it.

stonetools (Replying to: Col Sanders) September 2, 2009 10:27 AM

From the consent of the governed. John Locke? Good enough for you ?
Anyway, its an irrelevant question. All intelligent people now accept that states have a right to tax, including the founding fathers and the writers of the US Constitution. If you want to find out why they accepted this, you can start with Hobbes "Leviathan" and read Locke, Rousseau, The Federalist Papers and the Anti-Federalists if you want. But that question has long been settled.
Now if think that the founding fathers are wrong and that the very idea of a United States of America was a mistake, well, you can go join Bearded Spock in the crazy corner.......

Nelson Alexander (Replying to: Col Sanders) September 2, 2009 12:47 PM

Thank you for your eloquent summaries of my "real" meanings. Sorry you did not find my anecdote about the Continental Army of any interest. I thought maybe, you being a Colonel...

Well, you answered the question yourself, and I agree with you. Hobbes is at some level irrefutable. The "right" to tax and the "right" to property and other "rights" are secured by violent power. There is nothing ahistorical or natural, for example, about our particular structure of property rights. The concept of exclusively "owning" an idea or a gene would strike most people in history as bizarre. Even in land, the Indians, the King of England, The Dutch East India Company, the Episcopal Church, and the Plantation Slavers did not share anything like our current view of "property." (At one time the most valuable class of property in America was Africans. And they reproduced!)

So taking your point, I do not quite understand the passion with which many people defend "absolute" property rights or refute "absolute" rights to taxation. The problem is managing and distributing the enormous complexities of power, which change over time. I simply do not share the faith of many here that a transcendental entity called "The Market" just naturally and automatically takes care of all that. Obviously the more property you have, the more power you have, including the power to get more property. A complex structure of property "rights," backed by "legitimate" force and named "The Market" will quite often lead to destabilizing concentrations of power, including closure of "markets" and power over the state apparatus.

Our nation began not only with a rejection of certain forms of "taxation," it began with a massive rejection of legitimate, even "sacred" property rights as they were then understood. But you are wrong to disparage discussion. Conservatives are usually impatient with "words" and quick to resort to force. Power comes not simply out of "violent force" but out of organization, and language is our most fundamental medium of social organization. I await your rewrite.

Col Sanders (Replying to: Col Sanders) September 2, 2009 2:20 PM

@Stonetools

How do you determine that you have the consent of the governed?

You can waive it off as irrelevant or call those who ask "kooks" but it is a legitimate question as was the first one.

@Nelson

All rights stem from either violence or contract. Might makes right, or we negotiate and come to an agreement. There is no middle ground between the two.

Violence or contract.

Fair trade or a gun barrel...

So which is it?

moptop (Replying to: Col Sanders) September 2, 2009 9:09 PM

The state has an absolute right to taxation due to their sovereign monopoly of violence. The state that eschews the right to taxation will be supplanted by a neighboring state which has more resources due to its assertion of the right to taxation.

Species have a right to reproduce because species which do not reproduce disappear and so cannot exist.

Col Sanders (Replying to: Col Sanders) September 2, 2009 9:40 PM

@Moptop

"The state has an absolute right to taxation due to their sovereign monopoly of violence."

That's what I said - why repeat it?

They didn't get it the first time I said it.

Justin Blank September 1, 2009 11:15 PM

“So let me turn it around on John Holbo, et. al. Put aside your ideological commitments, and seriously consider the possibility that I might be right.”

“John Holbo, I imagine, gets a great deal of value of knowing that we’re all in this together, getting the same thing at the same time. Unlike left or right, libertarians don’t see great value in feeling like a cell.”

It seems like one side has indeed substituted sarcasm for argument.

The worst part about it is that you spend so much time saying how you shouldn't just take sides in arguments, and discount people's opinions for ideological reasons, etc etc.

You are also being careless. Read the damn post. Holbo didn't say that you "hate" poor people. He only said that there's no philosophical reason to disapprove of reform that isn't indifference to the poor. That's more or less true, and you agree that you're making a kind of practical objection. But he agrees with that, so he's not calling you poor.

Let me give you the jist of Holbo's argument: "Another angle: if your objection is purely practical, you cannot in good intellectual conscience just abstract away from all the actually existing practicalities into a kind of public choice theory Platonic Heaven of ideal tendencies for things to go wrong." This is an extremely simple and natural challenge.

He says you're not talking about the relevant details of a public plan. And you're not.

Ryan W. (Replying to: Justin Blank) September 2, 2009 3:09 AM

He only said that there's no philosophical reason to disapprove of reform that isn't indifference to the poor.

Which is wrong for a number of reasons; 1. medical expenses might not be the most cost effective purchase. 2. Those catagorized as poor may not actually be so, as Megan noted. (The supposed # of citizens who cannot afford insurance is horribly inflated via statistical wrangling. It is not +40 million. ) 3. Medical plans have a tendency to expand. 4. Holbo seems quite careless in conflating the opposition to a public option with any possible conception of reform. I've seen a lot of pundits make exactly this rather obvious mistake and I really don't understand WHY it's become so common.

Megan McArdle (Replying to: Justin Blank) September 2, 2009 7:50 AM

This is wrong for two reasons. First, in fact the poor, as we define them, have health care, unless they are illegal immigrants, in which case they aren't going to anyway. We're worried about people with much more money than the poor.

Second, the poor have duration in time. If a drug is discovered now, they benefit too, both because many of them will get it through Medicaid, and because the natural churn of drug markets will make most (not all) drugs available as cheap generics within ten years of introduction. The main exception is cancer drugs and small lot drugs for rare conditions, which tend to stay expensive because of the manufacturing costs, but even those see dramatic price decreases.

To take an extreme example, the poor might benefit right now if I slaughtered all the millionaires and gave their money to poor people. But in year 2, the poor would be worse off, because the millionaires are often doing things like running companies that make things poor people want. If this is a good way to get killed, no one will do it. So you have gained a temporary benefit by incuring a greater loss, for the poor and everyone else. (We leave aside the justice problem). Today's poor are not some master race in whose name we may do anything, no matter how destructive. The less dramatic and more plausible version of this problem is why even Sweden doesn't try wealth confiscation any more, etc.

Denverflyer (Replying to: Megan McArdle) September 2, 2009 10:14 AM

Even illegal immigrants gets ER care, they just can't get recurring treatments like dialysis, acc. to my State Dept. immigration friends.

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:32 AM

"We're worried about people with much more money than the poor."

This is a great point though I'm not sure it's the one you intended to make. Perhaps pro reform people put too much emphasis on the poor. The ones getting screwed in a lot of cases are people who make too much to qualify for medicaid and too little to afford insurance.

Ryan W. (Replying to: Justin Blank) September 2, 2009 3:09 AM

He only said that there's no philosophical reason to disapprove of reform that isn't indifference to the poor.

Which is wrong for a number of reasons; 1. medical expenses might not be the most cost effective purchase. 2. Those catagorized as poor may not actually be so, as Megan noted. (The supposed # of citizens who cannot afford insurance is horribly inflated via statistical wrangling. It is not +40 million. ) 3. Medical plans have a tendency to expand. 4. Holbo seems quite careless in conflating the opposition to a public option with any possible conception of reform. I've seen a lot of pundits make exactly this rather obvious mistake and I really don't understand WHY it's become so common.

Megan McArdle (Replying to: Justin Blank) September 2, 2009 7:50 AM

This is wrong for two reasons. First, in fact the poor, as we define them, have health care, unless they are illegal immigrants, in which case they aren't going to anyway. We're worried about people with much more money than the poor.

Second, the poor have duration in time. If a drug is discovered now, they benefit too, both because many of them will get it through Medicaid, and because the natural churn of drug markets will make most (not all) drugs available as cheap generics within ten years of introduction. The main exception is cancer drugs and small lot drugs for rare conditions, which tend to stay expensive because of the manufacturing costs, but even those see dramatic price decreases.

To take an extreme example, the poor might benefit right now if I slaughtered all the millionaires and gave their money to poor people. But in year 2, the poor would be worse off, because the millionaires are often doing things like running companies that make things poor people want. If this is a good way to get killed, no one will do it. So you have gained a temporary benefit by incuring a greater loss, for the poor and everyone else. (We leave aside the justice problem). Today's poor are not some master race in whose name we may do anything, no matter how destructive. The less dramatic and more plausible version of this problem is why even Sweden doesn't try wealth confiscation any more, etc.

Denverflyer (Replying to: Megan McArdle) September 2, 2009 10:14 AM

Even illegal immigrants gets ER care, they just can't get recurring treatments like dialysis, acc. to my State Dept. immigration friends.

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:32 AM

"We're worried about people with much more money than the poor."

This is a great point though I'm not sure it's the one you intended to make. Perhaps pro reform people put too much emphasis on the poor. The ones getting screwed in a lot of cases are people who make too much to qualify for medicaid and too little to afford insurance.

Denverflyer (Replying to: Megan McArdle) September 2, 2009 10:14 AM

Even illegal immigrants gets ER care, they just can't get recurring treatments like dialysis, acc. to my State Dept. immigration friends.

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:32 AM

"We're worried about people with much more money than the poor."

This is a great point though I'm not sure it's the one you intended to make. Perhaps pro reform people put too much emphasis on the poor. The ones getting screwed in a lot of cases are people who make too much to qualify for medicaid and too little to afford insurance.

Bill Davis September 1, 2009 11:32 PM

Private health insurance: A select group of people pool their resources, determine what is/isn't covered, who is in/excluded, and how much they have to spend to cover those contingencies. Invariably, someone insists that they have a better approach, and they can manage that resource more efficiently, reducing the amount that individual members have to pay. In return, they're asking for a return on their time/energy/knowledge, and the group agrees. New administration realizes that they can't do what they promised, costs explode, members complain, and in response insists that bringing in outside investors and consultants, who recommend consolidating, reducing benefits, increasing fees, and decreasing cost/salaries, usually all at once, will result in the future bringing promised efficiencies. Now old administration is safely insulated from the problem, collects huge bonuses after transfer/retirement/firing. Promised payoffs never materialize, new administration steps in, repeat cycle.

Public health insurance: A large group of people pool their resources, determine what is/isn't covered, who is ex/included, and how much they have to spend to cover those contingencies. Invariably, someone insists that they have a better approach, and they can manage that resource more efficiently, reducing the amount that individual members have to pay. In return, they're asking for a return on their time/energy/knowledge, and the group agrees. New administration realizes that they can't do what they promised, costs explode, members complain, and in response insists that bringing in outside investors and consultants, who recommend consolidating, reducing benefits, increasing fees, and decreasing cost/salaries, usually all at once, will result in the future bringing promised efficiencies. Now old administration is safely insulated from the problem, collects huge bonuses after transfer/retirement/firing. Promised payoffs never materialize, new administration steps in, repeat cycle.

You tell me, what is the better approach? One is primarily motivated by greed, the other mostly by power, and, as usual, a lot of both.

(Note: I would most surely like to save mostly real, if slightly imaginary thousands of lives now, rather than mostly imaginary, if potentially possible millions of lives later.)

Megan McArdle (Replying to: Bill Davis) September 2, 2009 7:51 AM

They're all equally imaginary, since we don't know who they are.

Can I ask what your position is on global warming?

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:40 PM

You can find real world examples of people that could benefit from actual intervention, in the present moment, whereas hypothetical drugs and treatments has always been the promise of the medical industry that has rarely been delivered, with the impact you suggest.

Are you asking whether I believe in it? (Yes.) If humans directly contribute to global warming. (Yes.) If it's a serious problem? (Yes.) If we need to take equally serious steps to mitigate the impact of global warming. (Yes.) If that will require some sort of government intervention? (Yes.) If, after watching the healthcare debate unfold, do I believe a reasonable compromise can be found? (No.)

In an ideal world, if there was enough time, I would prefer that efficiency (that is, saving money) be the guiding principle behind any attempts to deal with global warming. Unfortunately, I'm not confident that switching lightbulbs will be the answer to reducing, but not eliminating the impact rising, dead seas and a hotter, less hospitable climate will have on our quality of life. Carbon consumption is far too cheap to push people to rapidly change their behavior for the "common good".

I've resigned myself to the fact that by the time we can do something, it may be too late. I think if Obama can push through some sort of political compromise on healthcare, he might have enough momentum and political capital to exert on global warming. I'm not personally rooting for single payer healthcare, or any form of government mandated healthcare (which would negatively impact me), but I do see it as a crucial stepping stone toward moving toward global warming, from a political point of view.

I think a combination of approaches, including cap and trade, a tax on carbon consumption (combined with reduced payroll taxes), rebates, grants, and loans geared toward incentivizing business, government, and consumers to adopt energy efficient technologies, an immediate halt to construction of any more coal fired power plants, and the gradual phasing out of the same, scaling up alternative energy, adding nukes into the mix (still waiting for all the arguments to settle on this one), preserving and planting more trees, and shifting more of our commercial freight transportation to ships and trains could address some of the impact. More radically, I would suggest some sort of technological intervention if none of these ideas take hold, and we're in dire straights (carbon sucking artificial "trees" comes to mind).

All this presupposes that peak oil will come later than sooner, and that we will have enough energy to accomplish the tasks at hand, without the widespread public perception that global warming is a hoax. Hmm.

maudib (Replying to: Bill Davis) September 2, 2009 12:47 PM

Private health insurance is better because there is a referee. And on another level, I'd much rather deal with greed than power-lust because a merely greedy person/institution will leave you alone once there is nothing more to be gained from you. There is, OTOH, no limit to the horrors that might be inflicted on you to demonstrate that a person/institution has "power" over you...particularly when that person/institution is, itself, the referee. I might also add that such demonstrations, in my experience/opinion, must be continually repeated and must grow in severity in order to convince the person/institution of its power and/or to provide the "powerful" with the sensations to sate their power lust.

I might also note that it seems to me that the great atrocities of human civilization have always involved a high degree of centralized control over large numbers of people...and it seems like that control is usually attained just as you point out...by someone promising to make things better for the group as a whole.

In the case at hand, I have to say that I am at a complete loss as to why any program to "save mostly real, if slightly imaginary thousands of lives now" needs to address/control anything other than those very thousands.

Bill Davis (Replying to: maudib) September 2, 2009 5:32 PM

Public healthcare programs have referees (state insurance commissioners, Congressional representatives, etc.), who are also used to intervene into problems with private insurance.

Like all large scale problems, my point is that in the messy intersection of politics, there's no perfect to address the bad.

I prefer to address problems in the here-and-now that will actually help alleviate human suffering, rather than waiting for the promised land of what-could-be. To avoid dealing with healthcare issues because of a perceived future harm is ridiculous.

Megan McArdle (Replying to: Bill Davis) September 2, 2009 7:51 AM

They're all equally imaginary, since we don't know who they are.

Can I ask what your position is on global warming?

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:40 PM

You can find real world examples of people that could benefit from actual intervention, in the present moment, whereas hypothetical drugs and treatments has always been the promise of the medical industry that has rarely been delivered, with the impact you suggest.

Are you asking whether I believe in it? (Yes.) If humans directly contribute to global warming. (Yes.) If it's a serious problem? (Yes.) If we need to take equally serious steps to mitigate the impact of global warming. (Yes.) If that will require some sort of government intervention? (Yes.) If, after watching the healthcare debate unfold, do I believe a reasonable compromise can be found? (No.)

In an ideal world, if there was enough time, I would prefer that efficiency (that is, saving money) be the guiding principle behind any attempts to deal with global warming. Unfortunately, I'm not confident that switching lightbulbs will be the answer to reducing, but not eliminating the impact rising, dead seas and a hotter, less hospitable climate will have on our quality of life. Carbon consumption is far too cheap to push people to rapidly change their behavior for the "common good".

I've resigned myself to the fact that by the time we can do something, it may be too late. I think if Obama can push through some sort of political compromise on healthcare, he might have enough momentum and political capital to exert on global warming. I'm not personally rooting for single payer healthcare, or any form of government mandated healthcare (which would negatively impact me), but I do see it as a crucial stepping stone toward moving toward global warming, from a political point of view.

I think a combination of approaches, including cap and trade, a tax on carbon consumption (combined with reduced payroll taxes), rebates, grants, and loans geared toward incentivizing business, government, and consumers to adopt energy efficient technologies, an immediate halt to construction of any more coal fired power plants, and the gradual phasing out of the same, scaling up alternative energy, adding nukes into the mix (still waiting for all the arguments to settle on this one), preserving and planting more trees, and shifting more of our commercial freight transportation to ships and trains could address some of the impact. More radically, I would suggest some sort of technological intervention if none of these ideas take hold, and we're in dire straights (carbon sucking artificial "trees" comes to mind).

All this presupposes that peak oil will come later than sooner, and that we will have enough energy to accomplish the tasks at hand, without the widespread public perception that global warming is a hoax. Hmm.

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:40 PM

You can find real world examples of people that could benefit from actual intervention, in the present moment, whereas hypothetical drugs and treatments has always been the promise of the medical industry that has rarely been delivered, with the impact you suggest.

Are you asking whether I believe in it? (Yes.) If humans directly contribute to global warming. (Yes.) If it's a serious problem? (Yes.) If we need to take equally serious steps to mitigate the impact of global warming. (Yes.) If that will require some sort of government intervention? (Yes.) If, after watching the healthcare debate unfold, do I believe a reasonable compromise can be found? (No.)

In an ideal world, if there was enough time, I would prefer that efficiency (that is, saving money) be the guiding principle behind any attempts to deal with global warming. Unfortunately, I'm not confident that switching lightbulbs will be the answer to reducing, but not eliminating the impact rising, dead seas and a hotter, less hospitable climate will have on our quality of life. Carbon consumption is far too cheap to push people to rapidly change their behavior for the "common good".

I've resigned myself to the fact that by the time we can do something, it may be too late. I think if Obama can push through some sort of political compromise on healthcare, he might have enough momentum and political capital to exert on global warming. I'm not personally rooting for single payer healthcare, or any form of government mandated healthcare (which would negatively impact me), but I do see it as a crucial stepping stone toward moving toward global warming, from a political point of view.

I think a combination of approaches, including cap and trade, a tax on carbon consumption (combined with reduced payroll taxes), rebates, grants, and loans geared toward incentivizing business, government, and consumers to adopt energy efficient technologies, an immediate halt to construction of any more coal fired power plants, and the gradual phasing out of the same, scaling up alternative energy, adding nukes into the mix (still waiting for all the arguments to settle on this one), preserving and planting more trees, and shifting more of our commercial freight transportation to ships and trains could address some of the impact. More radically, I would suggest some sort of technological intervention if none of these ideas take hold, and we're in dire straights (carbon sucking artificial "trees" comes to mind).

All this presupposes that peak oil will come later than sooner, and that we will have enough energy to accomplish the tasks at hand, without the widespread public perception that global warming is a hoax. Hmm.

maudib (Replying to: Bill Davis) September 2, 2009 12:47 PM

Private health insurance is better because there is a referee. And on another level, I'd much rather deal with greed than power-lust because a merely greedy person/institution will leave you alone once there is nothing more to be gained from you. There is, OTOH, no limit to the horrors that might be inflicted on you to demonstrate that a person/institution has "power" over you...particularly when that person/institution is, itself, the referee. I might also add that such demonstrations, in my experience/opinion, must be continually repeated and must grow in severity in order to convince the person/institution of its power and/or to provide the "powerful" with the sensations to sate their power lust.

I might also note that it seems to me that the great atrocities of human civilization have always involved a high degree of centralized control over large numbers of people...and it seems like that control is usually attained just as you point out...by someone promising to make things better for the group as a whole.

In the case at hand, I have to say that I am at a complete loss as to why any program to "save mostly real, if slightly imaginary thousands of lives now" needs to address/control anything other than those very thousands.

Bill Davis (Replying to: maudib) September 2, 2009 5:32 PM

Public healthcare programs have referees (state insurance commissioners, Congressional representatives, etc.), who are also used to intervene into problems with private insurance.

Like all large scale problems, my point is that in the messy intersection of politics, there's no perfect to address the bad.

I prefer to address problems in the here-and-now that will actually help alleviate human suffering, rather than waiting for the promised land of what-could-be. To avoid dealing with healthcare issues because of a perceived future harm is ridiculous.

Bill Davis (Replying to: maudib) September 2, 2009 5:32 PM

Public healthcare programs have referees (state insurance commissioners, Congressional representatives, etc.), who are also used to intervene into problems with private insurance.

Like all large scale problems, my point is that in the messy intersection of politics, there's no perfect to address the bad.

I prefer to address problems in the here-and-now that will actually help alleviate human suffering, rather than waiting for the promised land of what-could-be. To avoid dealing with healthcare issues because of a perceived future harm is ridiculous.

JohnBoy September 1, 2009 11:36 PM

We need to get over this mindless blaming of insurance companies. 170M Americans are insured under ERISA where the healthcare insurance companies simply act as bill payers and network administrators. Another 90M are covered by Medicare and Medicaid. We can fix the system for the other 40M without "wee-weeing" it up for the the other 260M who are kinda doing OK.

To put it simply, a single payer system will collect all the healthcare dollars in a pool and administer them on some bureaucratic basis, perhaps on some basis like what Rahm's brother came up with. There will be a fixed amount of spending that the govt will deem acceptable and that will be that. The rest of us will have to wait. Doctors will be paid fixed salaries and there will be massive shortages.

This works just fine in Canada and in the UK until you get sick. Check out their survival rates for cancer vs ours. That is the true test of a healthcare system.

Those who call for "single payer" are not really looking for health insurance. They want more welfare.

stonetools (Replying to: JohnBoy) September 2, 2009 9:28 AM

his works just fine in Canada and in the UK until you get sick. Check out their survival rates for cancer vs ours. That is the true test of a healthcare system.

Oh, really? Please cite what medical authority says that this is the only true test. The WHO uses a lot of different metrics and guess that?
The US health system is behind most industrialized countries in most.
All of this is largely irrelevant. Here are the facts: The USA spends twice as much on health care as most countries, while leaving 46 million uninsured. These countries cover everyone, while achieving GOOD outcomes. In some metrics , they are ahead of the USA, and in some they are behind. But they cover everyone at half the cost.

This means that these countries are doing better than the USA, health care wise. Those are are the facts.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 10:02 AM

See my previous post explaining the methodology of the WHO. The WHO measured a weighted average of equality and health care, with equality being given more weight than health care.

We may not have the most equal system, but I see see little evidence our system is behind other countries in quality. If you have any, please provide it.

Your 46 million number is also flawed. It includes 14 million who are eligible for medicaid (but have not signed up) and 27 million making $50k/year who choose not to buy health insurance (most of whom are uninsured for less than 4 months) and an unknown number of illegal immigrants.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:54 AM

It's not a matter of whether we're behind in quality, noone is debating that. The issue seems to me to be whether other countries with socialized medicine are significantly behind us. The answer seems to be no. They're all pretty close. In which case, I think the benefits of equality make the other systems better.

The Ninja Zombie (Replying to: The Ninja Zombie) September 2, 2009 11:10 AM

Criticizing the inequality of our system is legitimate (in the sense that it probably is more unequal than other nations), but I don't see a compelling reason to worry about that inequality.

I see no evidence the inequality has any harmful effect on health, so why should I care about inequality? What are the purported benefits of equality, and how do they outweigh the potential costs of a proposed change to a more equal system?

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 11:40 AM

Basically because many people on the left believe that inequality is part of what's driving up the costs. IE, because we have to pay to cover people with no insurance, prices go up, followed by premiums. Basically I think that cost controls are not the only thing keeping costs down in the other countries.

stonetools (Replying to: JohnBoy) September 2, 2009 9:28 AM

his works just fine in Canada and in the UK until you get sick. Check out their survival rates for cancer vs ours. That is the true test of a healthcare system.

Oh, really? Please cite what medical authority says that this is the only true test. The WHO uses a lot of different metrics and guess that?
The US health system is behind most industrialized countries in most.
All of this is largely irrelevant. Here are the facts: The USA spends twice as much on health care as most countries, while leaving 46 million uninsured. These countries cover everyone, while achieving GOOD outcomes. In some metrics , they are ahead of the USA, and in some they are behind. But they cover everyone at half the cost.

This means that these countries are doing better than the USA, health care wise. Those are are the facts.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 10:02 AM

See my previous post explaining the methodology of the WHO. The WHO measured a weighted average of equality and health care, with equality being given more weight than health care.

We may not have the most equal system, but I see see little evidence our system is behind other countries in quality. If you have any, please provide it.

Your 46 million number is also flawed. It includes 14 million who are eligible for medicaid (but have not signed up) and 27 million making $50k/year who choose not to buy health insurance (most of whom are uninsured for less than 4 months) and an unknown number of illegal immigrants.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:54 AM

It's not a matter of whether we're behind in quality, noone is debating that. The issue seems to me to be whether other countries with socialized medicine are significantly behind us. The answer seems to be no. They're all pretty close. In which case, I think the benefits of equality make the other systems better.

The Ninja Zombie (Replying to: The Ninja Zombie) September 2, 2009 11:10 AM

Criticizing the inequality of our system is legitimate (in the sense that it probably is more unequal than other nations), but I don't see a compelling reason to worry about that inequality.

I see no evidence the inequality has any harmful effect on health, so why should I care about inequality? What are the purported benefits of equality, and how do they outweigh the potential costs of a proposed change to a more equal system?

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 11:40 AM

Basically because many people on the left believe that inequality is part of what's driving up the costs. IE, because we have to pay to cover people with no insurance, prices go up, followed by premiums. Basically I think that cost controls are not the only thing keeping costs down in the other countries.

The Ninja Zombie (Replying to: stonetools) September 2, 2009 10:02 AM

See my previous post explaining the methodology of the WHO. The WHO measured a weighted average of equality and health care, with equality being given more weight than health care.

We may not have the most equal system, but I see see little evidence our system is behind other countries in quality. If you have any, please provide it.

Your 46 million number is also flawed. It includes 14 million who are eligible for medicaid (but have not signed up) and 27 million making $50k/year who choose not to buy health insurance (most of whom are uninsured for less than 4 months) and an unknown number of illegal immigrants.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:54 AM

It's not a matter of whether we're behind in quality, noone is debating that. The issue seems to me to be whether other countries with socialized medicine are significantly behind us. The answer seems to be no. They're all pretty close. In which case, I think the benefits of equality make the other systems better.

The Ninja Zombie (Replying to: The Ninja Zombie) September 2, 2009 11:10 AM

Criticizing the inequality of our system is legitimate (in the sense that it probably is more unequal than other nations), but I don't see a compelling reason to worry about that inequality.

I see no evidence the inequality has any harmful effect on health, so why should I care about inequality? What are the purported benefits of equality, and how do they outweigh the potential costs of a proposed change to a more equal system?

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 11:40 AM

Basically because many people on the left believe that inequality is part of what's driving up the costs. IE, because we have to pay to cover people with no insurance, prices go up, followed by premiums. Basically I think that cost controls are not the only thing keeping costs down in the other countries.

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 10:54 AM

It's not a matter of whether we're behind in quality, noone is debating that. The issue seems to me to be whether other countries with socialized medicine are significantly behind us. The answer seems to be no. They're all pretty close. In which case, I think the benefits of equality make the other systems better.

The Ninja Zombie (Replying to: The Ninja Zombie) September 2, 2009 11:10 AM

Criticizing the inequality of our system is legitimate (in the sense that it probably is more unequal than other nations), but I don't see a compelling reason to worry about that inequality.

I see no evidence the inequality has any harmful effect on health, so why should I care about inequality? What are the purported benefits of equality, and how do they outweigh the potential costs of a proposed change to a more equal system?

Last Years Man (Replying to: The Ninja Zombie) September 2, 2009 11:40 AM

Basically because many people on the left believe that inequality is part of what's driving up the costs. IE, because we have to pay to cover people with no insurance, prices go up, followed by premiums. Basically I think that cost controls are not the only thing keeping costs down in the other countries.

TomB September 1, 2009 11:57 PM

I think the root of this is prices. The price system is the only decent way of allocating goods that man-kind has devised. All other mechanisms have failed in practice. Prices are the result of a fairly complex system of interactions and relations. Like the tin examples shows, prices can rapidly reflect changes in demand, supply, or other conditions resulting in a scarce good being allocated to the use that is the most valuable.

Additionally, prices reflect a variety of information not directly related to current consumption, such as future scarcity or future costs. When you buy a scarce good now, you cannot buy that good in the future. For example, oil prices reflect not only current demand, but also a prediction of what future prices will be. If a barrel of oil is worth $70 today, but in a year it will be worth $100, oil producers may wait and pump that oil in the future. Thus, today's price may rist to $80 to encourage an producer to sell now instead of waiting until the future.

For products such as pharmaceuticals, prices include the cost of research and development. The marginal cost of producing a drug is usually pretty low (which is one reason why it looks like pharma makes a profit in Europe; one of the others is no FDA). It is the enormous cost of research and development that pushes up prices. By charging higher prices today, companies can invest in research and development to create more products in the future. If they charge a lower price today, they cannot invest as much in research, and future products will not be developed. Companies are balancing selling a greater quantity (b/c lower price) of a good now against the availability of new goods in the future. If you have considering investing in a college or graduate school education, you should be familiar with this basic tradeoff.

When government starts tinkering with prices by being the only buyer in town, or by weilding some kind of monopsony power (gov't still has huge market power even if there is some private market for insurance), prices no longer communicate information about the value of resources. When prices are prevented from communicating information about the value of resources, the allocation of goods becomes inefficient - the wrong quantities are produced, the wrong types are produced, people do not invest in areas where there are shortages, people overinvest in areas where there are surpluses, and the allocation over time is skewed.

If the government tries to squeeze prices down, companies will most likely respond by investing less in research and development. This means that there will be fewer new products in the future. If spending less on R&D did not mean fewer products in the future, every company would halve their R&D budget right now. Even though people in the future still have to buy the new product, the new product will not exist without any R&D. So by lowering prices so that "thousands can be saved today," future generations will be deprived of the benefits of current R&D. Finally, government control over prices, even if it is not direct control, will result in overinvestment in some products, i.e., those produced in Barney Frank's district, and underinvestment in others, i.e., geriatiricians.

As much as I would love for everyone to have access to all the very best health care that is out there, the reality is that everyone cannot have the newest cancer treatment or whatever it is. When someone cannot afford a cancer treatment and dies, the system didn't kill him - cancer killed him. People die because they are sick or injured. People who cannot afford the best insurance should be given subsidies or something so that they can pay for some level of care, but they will not have access to the same treatments as a wealthy person. That is just life. It may seem that the newest, expensive cancer treatment is part of the minimum level of care that everyone should have, but it's not. If we try to correct the problem by controling prices, the allocation of resources both across the current population and future populations will be skewed, and someone will be harmed. More often than not, the person that is harmed is unseen.

There is a cost to extending care. The nature of politics means that the system will be designed so that cost is paid in the future. A squeeze on prices will mean less investment in R&D, less investment in education (by aspiring doctors), and a favoring of current consumption over future consumption. Government power over prices will also mean that government will control the winners in the marketplace. Whoever gets the best lobbyists gets the best deal.

Bill Davis (Replying to: TomB) September 2, 2009 5:45 AM

Money doesn't automatically equal good health, but it sure does help.

There's plenty of perverse incentives in the current framework to encourage people to spend money on their health, even if it doesn't work.

Megan McArdle (Replying to: Bill Davis) September 2, 2009 7:53 AM

That is an argument for removing perverse incentives like employer tax deductions for health benefits, not for single payer.

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:03 AM

How so? (not being sarcastic, curious.)

It seems to me that its an argument that doctors have a stake in encouraging treatments that people don't need precisely because they are expensive.

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:55 PM

It's actually an argument to increase research, testing, and even limited regulation to evaluate the efficacy of OTC herbal and vitamin supplements, which, speaking from personal experience, don't work. Considering the amount of money poured down that drain, it's no small change.

I don't really believe that we can come up with any reasonable changes (read: incentives) that the insurance industry hasn't thought of, already, as a means of reducing healthcare expenditures and increasing their profits. They tried the non-smoking, non-BASE jumping thing, no-Big Macs-5-times-a-week strategies, and they always come back to the most reliable indicators of health (and profit), age and income. The system has had over fifty years to work out the kinks, and it just doesn't work.

Who says I'm in favor of single payer, anyway?

Bill Davis (Replying to: Megan McArdle) September 2, 2009 7:08 PM

...And I forgot to add, pre-existing conditions as a reliable indicator of health (and future healthcare expenditures).

stonetools (Replying to: TomB) September 2, 2009 1:44 PM

If the government tries to squeeze prices down, companies will most likely respond by investing less in research and development.

There is the problem of course. You don't know this. Your entire argument is based on this claim, which sounds exactly what like a pharma industry lobbyist would claim. Unless you find support for this claim, I'm afraid I'll have to reject your entire argument.

You may want to read an actual report, which says:

Fortune 500 drug companies devoted 30.8 percent of their revenues to marketing and
administration, compared with the 14.1 percent of revenues spent on R&D.

http://www.citizen.org/documents/Pharma_Report.pdf

It certainly sounds like pharma companies don't HAVE to reduce R &D , if their profits go down- just spend less on marketing.

Whoever gets the best lobbyists gets the best deal.

Given the effectiveness of the pharma lobby, you accurately describe the current situation

Brian 2 (Replying to: stonetools) September 2, 2009 5:32 PM

There is the problem of course. You don't know this.

You're arguing that price ceilings don't affect supply. Theory and historical evidence is rather solidly against you, so you'll need to back that up.

It certainly sounds like pharma companies don't HAVE to reduce R &D , if their profits go down- just spend less on marketing.

If they could increase their profits by cutting marketing, why aren't they doing that now? Marketing isn't a hole that they drop 30% of their revenue into for no good reason, it's part of what produces that revenue in the first place.

Bill Davis (Replying to: TomB) September 2, 2009 5:45 AM

Money doesn't automatically equal good health, but it sure does help.

There's plenty of perverse incentives in the current framework to encourage people to spend money on their health, even if it doesn't work.

Megan McArdle (Replying to: Bill Davis) September 2, 2009 7:53 AM

That is an argument for removing perverse incentives like employer tax deductions for health benefits, not for single payer.

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:03 AM

How so? (not being sarcastic, curious.)

It seems to me that its an argument that doctors have a stake in encouraging treatments that people don't need precisely because they are expensive.

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:55 PM

It's actually an argument to increase research, testing, and even limited regulation to evaluate the efficacy of OTC herbal and vitamin supplements, which, speaking from personal experience, don't work. Considering the amount of money poured down that drain, it's no small change.

I don't really believe that we can come up with any reasonable changes (read: incentives) that the insurance industry hasn't thought of, already, as a means of reducing healthcare expenditures and increasing their profits. They tried the non-smoking, non-BASE jumping thing, no-Big Macs-5-times-a-week strategies, and they always come back to the most reliable indicators of health (and profit), age and income. The system has had over fifty years to work out the kinks, and it just doesn't work.

Who says I'm in favor of single payer, anyway?

Bill Davis (Replying to: Megan McArdle) September 2, 2009 7:08 PM

...And I forgot to add, pre-existing conditions as a reliable indicator of health (and future healthcare expenditures).

Megan McArdle (Replying to: Bill Davis) September 2, 2009 7:53 AM

That is an argument for removing perverse incentives like employer tax deductions for health benefits, not for single payer.

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:03 AM

How so? (not being sarcastic, curious.)

It seems to me that its an argument that doctors have a stake in encouraging treatments that people don't need precisely because they are expensive.

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:55 PM

It's actually an argument to increase research, testing, and even limited regulation to evaluate the efficacy of OTC herbal and vitamin supplements, which, speaking from personal experience, don't work. Considering the amount of money poured down that drain, it's no small change.

I don't really believe that we can come up with any reasonable changes (read: incentives) that the insurance industry hasn't thought of, already, as a means of reducing healthcare expenditures and increasing their profits. They tried the non-smoking, non-BASE jumping thing, no-Big Macs-5-times-a-week strategies, and they always come back to the most reliable indicators of health (and profit), age and income. The system has had over fifty years to work out the kinks, and it just doesn't work.

Who says I'm in favor of single payer, anyway?

Bill Davis (Replying to: Megan McArdle) September 2, 2009 7:08 PM

...And I forgot to add, pre-existing conditions as a reliable indicator of health (and future healthcare expenditures).

Last Years Man (Replying to: Megan McArdle) September 2, 2009 10:03 AM

How so? (not being sarcastic, curious.)

It seems to me that its an argument that doctors have a stake in encouraging treatments that people don't need precisely because they are expensive.

Bill Davis (Replying to: Megan McArdle) September 2, 2009 6:55 PM

It's actually an argument to increase research, testing, and even limited regulation to evaluate the efficacy of OTC herbal and vitamin supplements, which, speaking from personal experience, don't work. Considering the amount of money poured down that drain, it's no small change.

I don't really believe that we can come up with any reasonable changes (read: incentives) that the insurance industry hasn't thought of, already, as a means of reducing healthcare expenditures and increasing their profits. They tried the non-smoking, non-BASE jumping thing, no-Big Macs-5-times-a-week strategies, and they always come back to the most reliable indicators of health (and profit), age and income. The system has had over fifty years to work out the kinks, and it just doesn't work.

Who says I'm in favor of single payer, anyway?

Bill Davis (Replying to: Megan McArdle) September 2, 2009 7:08 PM

...And I forgot to add, pre-existing conditions as a reliable indicator of health (and future healthcare expenditures).

stonetools (Replying to: TomB) September 2, 2009 1:44 PM

If the government tries to squeeze prices down, companies will most likely respond by investing less in research and development.

There is the problem of course. You don't know this. Your entire argument is based on this claim, which sounds exactly what like a pharma industry lobbyist would claim. Unless you find support for this claim, I'm afraid I'll have to reject your entire argument.

You may want to read an actual report, which says:

Fortune 500 drug companies devoted 30.8 percent of their revenues to marketing and
administration, compared with the 14.1 percent of revenues spent on R&D.

http://www.citizen.org/documents/Pharma_Report.pdf

It certainly sounds like pharma companies don't HAVE to reduce R &D , if their profits go down- just spend less on marketing.

Whoever gets the best lobbyists gets the best deal.

Given the effectiveness of the pharma lobby, you accurately describe the current situation

Brian 2 (Replying to: stonetools) September 2, 2009 5:32 PM

There is the problem of course. You don't know this.

You're arguing that price ceilings don't affect supply. Theory and historical evidence is rather solidly against you, so you'll need to back that up.

It certainly sounds like pharma companies don't HAVE to reduce R &D , if their profits go down- just spend less on marketing.

If they could increase their profits by cutting marketing, why aren't they doing that now? Marketing isn't a hole that they drop 30% of their revenue into for no good reason, it's part of what produces that revenue in the first place.

Brian 2 (Replying to: stonetools) September 2, 2009 5:32 PM

There is the problem of course. You don't know this.

You're arguing that price ceilings don't affect supply. Theory and historical evidence is rather solidly against you, so you'll need to back that up.

It certainly sounds like pharma companies don't HAVE to reduce R &D , if their profits go down- just spend less on marketing.

If they could increase their profits by cutting marketing, why aren't they doing that now? Marketing isn't a hole that they drop 30% of their revenue into for no good reason, it's part of what produces that revenue in the first place.

derek September 2, 2009 12:26 AM

>if you don't have any money, you shouldn't be entitled to any medicine.

Moral preening.

I live in a jurisdiction with universal medical care. We face the reality of these asinine fairy tails where money can't get you timely medical care, because some stupid Marxist twit decided that there were too many doctors, so we should stop training them. And right now all the jurisdictions in Canada are cutting back on medical expenses due to the economic downturn. How many people does that kill? And by the way, how does making someone wait months or years for medical procedures save money? Spontaneous remission?

I may have to face a 6 month wait for an angiogram. I know of one man who died waiting.

This reminds me of a story. Gorbachev and aides were visiting Canada on some agricultural technology exchange thingy. They were shown a bunch of agricultural stuff, and asked to see a grocery store. They were taken to some store somewhere, and looked in amazement at the choice, full shelves and evident abundance. They insisted that this was a setup. No way could there be grocery stores like this unless there was a setup. (another reason to jeer those who want to control food to cure obesity). No, go anywhere, even small towns, and you will see the same thing.

That evening Gorbachev and an aide were seen walking and having animated conversations. They realized that their system was fundamentally broken.

There are problems with the US system, no question. If there are people who aren't getting cared for, fix that. But the solutions always end up being socialized and more government control. It doesn't work, and you don't know how good you have it.

Derek

Bill Davis (Replying to: derek) September 2, 2009 5:34 AM

That's the thing...I don't have it. No matter the good, it's still bad.

By my own admission, it's quite voluntary. I got tired of paying for all the sick old people like, well, you. No sense in investing my money in a very socialistic system, here down South (of your border). The amount of money that they wanted me to pay, non-smoker, non-drinker, non-cliff jumping, non-sick in general, just to have the privilege of having substantial coverage, was too much.

BTW, I know of lots of people that just simply died...Insurance company's fault? Government's fault? God's fault? Who knows...

Apples and oranges. We aren't going for Canada's system, so the only fairy tale here is the one swimming inside your head. Think...Switzerland. Much closer to reality. Better now?

You say fix that, and then blabber on that the fix is always socialism. Which is it then? Fix it, or forget it?

The say the grass is always greener on the other side of the fence, right? Grass has always left a bitter taste in my mouth. Yours?

derek (Replying to: Bill Davis) September 2, 2009 10:02 AM

So you want someone else to pay for your insurance?

The situations I've described are people who are insured. We have a fee we have to pay here. If you want to compare the Canadian insured people to US non insured, then you may have an argument.

Derek

Bill Davis (Replying to: derek) September 2, 2009 6:00 PM

Do you seriously think it's better here?

Be grateful for what you have, and quit complaining. This isn't your fight.

Bill Davis (Replying to: derek) September 2, 2009 5:34 AM

That's the thing...I don't have it. No matter the good, it's still bad.

By my own admission, it's quite voluntary. I got tired of paying for all the sick old people like, well, you. No sense in investing my money in a very socialistic system, here down South (of your border). The amount of money that they wanted me to pay, non-smoker, non-drinker, non-cliff jumping, non-sick in general, just to have the privilege of having substantial coverage, was too much.

BTW, I know of lots of people that just simply died...Insurance company's fault? Government's fault? God's fault? Who knows...

Apples and oranges. We aren't going for Canada's system, so the only fairy tale here is the one swimming inside your head. Think...Switzerland. Much closer to reality. Better now?

You say fix that, and then blabber on that the fix is always socialism. Which is it then? Fix it, or forget it?

The say the grass is always greener on the other side of the fence, right? Grass has always left a bitter taste in my mouth. Yours?

derek (Replying to: Bill Davis) September 2, 2009 10:02 AM

So you want someone else to pay for your insurance?

The situations I've described are people who are insured. We have a fee we have to pay here. If you want to compare the Canadian insured people to US non insured, then you may have an argument.

Derek

Bill Davis (Replying to: derek) September 2, 2009 6:00 PM

Do you seriously think it's better here?

Be grateful for what you have, and quit complaining. This isn't your fight.

derek (Replying to: Bill Davis) September 2, 2009 10:02 AM

So you want someone else to pay for your insurance?

The situations I've described are people who are insured. We have a fee we have to pay here. If you want to compare the Canadian insured people to US non insured, then you may have an argument.

Derek

Bill Davis (Replying to: derek) September 2, 2009 6:00 PM

Do you seriously think it's better here?

Be grateful for what you have, and quit complaining. This isn't your fight.

Bill Davis (Replying to: derek) September 2, 2009 6:00 PM

Do you seriously think it's better here?

Be grateful for what you have, and quit complaining. This isn't your fight.

derek September 2, 2009 12:40 AM

An example of how screwed up government can be with regard to provision of medical goods is the radioactive substances used in therapy and diagnostics. In Canada the production of these things was done at Chalk River, and ancient reactor that finally failed this year. To build such a thing requires a decade at least, and probably very huge fight from the NIMBY crowd. So no one did it, and now there is a crisis.

Is there not a profitable market to serve here? I guess not. So we don't have what we need.

I know. All we need to do is chant 'no one should die for lack of health care' and magic fairies will make it all happen.

I honestly don't know how any sane person could justify handing control of one of the most complex and necessary industries to government.

Derek

Bill Davis (Replying to: derek) September 2, 2009 5:50 AM

I'm glad that you volunteered to have it in your back yard. Need a shovel?

We've handed it over to the corporations, here, and they've done such a splendid job.

I sometimes wonder if anyone here actually has worked for either a government agency or a corporation? I have (both)...They're three parts bad mixed with two parts terrible. Sometimes you can't tell the two apart.

Bill Davis (Replying to: derek) September 2, 2009 5:50 AM

I'm glad that you volunteered to have it in your back yard. Need a shovel?

We've handed it over to the corporations, here, and they've done such a splendid job.

I sometimes wonder if anyone here actually has worked for either a government agency or a corporation? I have (both)...They're three parts bad mixed with two parts terrible. Sometimes you can't tell the two apart.

ElectronHayek September 2, 2009 1:23 AM

Basically Megan has been targeted for character assassination by the left-wing loonies. Don't think for a second this is about anything less.

Alsadius (Replying to: ElectronHayek) September 2, 2009 2:00 AM

"Targeted" is generous. This is pretty much just how the Internet works.

Bill Davis (Replying to: ElectronHayek) September 2, 2009 6:00 AM

The unstoppable force of her practical philosophy has finally met up with immovable object of actual reality.

movertyperguy (Replying to: ElectronHayek) September 2, 2009 8:04 AM

"Basically Megan has been targeted for character assassination by the left-wing loonies. Don't think for a second this is about anything less."

This comment is the most intelligent comment in this thread. They're out to get her fired from The Atlantic. They're isolating her. Ridiculing her. Watching everything she does waiting to pounce on any "mistake."

She's being excommunicated.

stonetools (Replying to: movertyperguy) September 2, 2009 9:44 AM

She is being targeted for analysis, not excommunication. Actually, Megan has made a long, thoughtful post, and I commend her for it. She seems to actually trying to think in the real world, not like most libertarians, who are busy discussing such non issues as whether the state should tax its citizens at all.
As a result of making such a post, respected commentators are discussing her post and people are showing up to discuss it. Many of those who are showing up are liberals, so of course they disagree with her on many points (and agree on others) Its a debate , not a mutual admiration society, where you get banned for disagreeing. ( see Ta-Na-Hesi Coates).

ElectronHayek (Replying to: stonetools) September 2, 2009 3:07 PM

Indeed I've seen people's comments deleted on Coates' blog. That guy is a fascist, pure and simple.

Alsadius (Replying to: ElectronHayek) September 2, 2009 2:00 AM

"Targeted" is generous. This is pretty much just how the Internet works.

Bill Davis (Replying to: ElectronHayek) September 2, 2009 6:00 AM

The unstoppable force of her practical philosophy has finally met up with immovable object of actual reality.

movertyperguy (Replying to: ElectronHayek) September 2, 2009 8:04 AM

"Basically Megan has been targeted for character assassination by the left-wing loonies. Don't think for a second this is about anything less."

This comment is the most intelligent comment in this thread. They're out to get her fired from The Atlantic. They're isolating her. Ridiculing her. Watching everything she does waiting to pounce on any "mistake."

She's being excommunicated.

stonetools (Replying to: movertyperguy) September 2, 2009 9:44 AM

She is being targeted for analysis, not excommunication. Actually, Megan has made a long, thoughtful post, and I commend her for it. She seems to actually trying to think in the real world, not like most libertarians, who are busy discussing such non issues as whether the state should tax its citizens at all.
As a result of making such a post, respected commentators are discussing her post and people are showing up to discuss it. Many of those who are showing up are liberals, so of course they disagree with her on many points (and agree on others) Its a debate , not a mutual admiration society, where you get banned for disagreeing. ( see Ta-Na-Hesi Coates).

ElectronHayek (Replying to: stonetools) September 2, 2009 3:07 PM

Indeed I've seen people's comments deleted on Coates' blog. That guy is a fascist, pure and simple.

stonetools (Replying to: movertyperguy) September 2, 2009 9:44 AM

She is being targeted for analysis, not excommunication. Actually, Megan has made a long, thoughtful post, and I commend her for it. She seems to actually trying to think in the real world, not like most libertarians, who are busy discussing such non issues as whether the state should tax its citizens at all.
As a result of making such a post, respected commentators are discussing her post and people are showing up to discuss it. Many of those who are showing up are liberals, so of course they disagree with her on many points (and agree on others) Its a debate , not a mutual admiration society, where you get banned for disagreeing. ( see Ta-Na-Hesi Coates).

ElectronHayek (Replying to: stonetools) September 2, 2009 3:07 PM

Indeed I've seen people's comments deleted on Coates' blog. That guy is a fascist, pure and simple.

ElectronHayek (Replying to: stonetools) September 2, 2009 3:07 PM

Indeed I've seen people's comments deleted on Coates' blog. That guy is a fascist, pure and simple.

Matt Steinglass September 2, 2009 1:25 AM

Megan, your prior:

People have no obligation to perform labor for others

...leads pretty directly to Holbo's "if you don't have any money, you shouldn't be entitled to any medicine."

The only reason poor people don't currently die on the street in America (not much, anyway) is because doctors are obliged by law to provide emergency care regardless of the ability to pay. You sound like you're advocating removing that obligation.

This isn't a quibble, it's a central point. The idea that poor people are entitled to basic health care is an elaboration of the idea that if you know the Heimlich maneuver and are standing next to someone who is choking, you have a moral obligation to perform the Heimlich maneuver on them.

Basically, if you don't believe that people have an obligation to perform some labor for others -- that people are obligated, at some basic level, to do a little work to make sure others have what you call their "basic needs" -- then you can't get to "people are entitled to some medicine even if they don't have any money." So Holbo is right. Furthermore, you don't really believe your own point; it would mean you think that a military draft would be morally illegitimate, that a child doesn't have a right to an education, etc.

Bearded Spock (Replying to: Matt Steinglass) September 2, 2009 2:37 AM

Megan's not advocating the removal of that obligation, but I am. Should farmers have an obligation to grow food for the hungry? All transactions should be voluntary. Anything else is coercion. The shortage of hospitals is directly a result of the obligation to treat everyone. If you care so much about the uninsured, then give to a charity that helps them. You have no right to be charitable with my money.

Matt Steinglass (Replying to: Bearded Spock) September 2, 2009 5:41 AM

Yeah, but you also believe we should abolish the armed forces of the US, eliminate taxes, privatize all the public roads in the country, and so on. That's a philosophically consistent position ("all transactions should be voluntary"), but also a completely crazy one that basically nobody else in the country agrees with, fortunately.

The Ninja Zombie (Replying to: Matt Steinglass) September 2, 2009 8:51 AM

A distinction can be made between taxation to fund public goods (roads, military) and private goods (food, health care).

Matt Steinglass (Replying to: Bearded Spock) September 2, 2009 5:44 AM

Oh, and yes, incidentally, if there were a famine in the US, farmers would be obligated to grow food for the hungry. That's both a moral necessity and a fact of practical politics. Under the current system, too, farmers are paid by the government to grow food for the poor, via both subsidies and the food stamps program, which effectively means people are being obliged to work in order to feed the hungry. You may advocate eliminating the safeguards we have to ensure nobody goes hungry in the US, but again, virtually nobody else agrees with you.

Megan McArdle (Replying to: Matt Steinglass) September 2, 2009 7:57 AM

There is a difference between charging people taxes as the price for participating in society, and forcing them to do something. The government may tax me, but I have no moral obligation to take the highest paid possible job in order to maximize my taxes, nor can the government make me do so. I am not obliged to work at all, if I can support myself.

If you think there is such a moral obligation, why have you chosen your profession?

If you really think that the state has a right to force people to farm, or perform surgery, at gunpoint, then yes, we have a fundamental philosophical difference. But this sounds more like Pol Pot than social democracy.

silentbeep (Replying to: Matt Steinglass) September 2, 2009 12:24 PM

Megan: I have no idea how you got to the "government forcing people to do things by gunpoint" and Pol Pot, just from what matt said above. He is talking about "effectively" being obligated by the government to work in order to feed the hungry and the poor, right now "under the current system", not in the future where the government is holding guns against people's heads and where this is a Pol Pot. A moral obligation is one thing, and having the government 'make' that moral obligation a law is another. I don't see where Matt said that guns would need to be used and pol pot style government would have to be enacted.

Would you consider WW II rationhing a form of "pol pot" type forcing? After all, such rationing was a direct invective by the government to 'force' somebody to do something.

Matt Steinglass (Replying to: Matt Steinglass) September 2, 2009 2:33 PM

Those comments were made in response to Bearded Spock, not Megan, and operated at a lower degree of seriousness and coherence. But I do stand by the observation that if hunger were a serious problem in the US, the government would ensure that enough food were being grown and given to the hungry, by requisitioning food if necessary.

Denverflyer (Replying to: Matt Steinglass) September 2, 2009 9:56 AM

"The idea that poor people are entitled to basic health care is an elaboration of the idea that if you know the Heimlich maneuver and are standing next to someone who is choking, you have a moral obligation to perform the Heimlich maneuver on them."

It's more like knowing the Heimlich and therefore being forced to hang out at restaurants every Saturday night for the rest of your life without pay b/c you "owe it" to others. It's not a one time thing.

derek (Replying to: Matt Steinglass) September 2, 2009 10:06 AM

http://www.freerepublic.com/focus/news/723068/posts

This is what happens. Doctors forced to do things they are not willing to do. Like work longer hours. Due to stupid decisions made by government.

What has happened as a result of this policy is doctors have left practice or left the province. I saw one the other day, a doctor from Quebec. Left for better pastures.

Actually, they say that half the doctors trained in Canada end up practicing in the US.

Maybe we should force them to stay here.

This is so simple to understand. You should stop trying to twist your mind around unreality. Megan is right.

Derek

Joshua Lyle (Replying to: Matt Steinglass) September 2, 2009 10:54 AM

Let's say I concede that people have an imperfect duty to contribute to the common good and the welfare of others. That means the others have a moral claim on that contribution, but they don't have a right to it, that is, they don't have a legitimately enforceable moral claim on any particular contribution. Since it is illegitimate for them to use force to secure that contribution, it is still illegitimate to have the government act as their agent in securing it.

So, whether this "obligation" constitutes a perfect or imperfect duty determines whether it leads to an "entitlement", if an entitlement is something you have a right to. But what's so objectionable about the notion that people have a moral claim on getting medicine, but not an unlimited one? Especially when, in the real world, an entitlement is not a metaphysical guarantee: it is still possible for people to fail to have what they are entitled to, so the non-ideal question of whether they are better served by possible implementations of a regimented government enforcement of perfect duty or a civil-society-based voluntary manifestation of imperfect duty matters quite a bit.

Matt Steinglass (Replying to: Joshua Lyle) September 2, 2009 2:36 PM

"But what's so objectionable about the notion that people have a moral claim on getting medicine, but not an unlimited one?"

Nothing at all. Sounds like a perfectly reasonable position that would lead one to support a universal health insurance plan like the one currently in Congress.

Joshua Lyle (Replying to: Matt Steinglass) September 2, 2009 3:56 PM

So your response to my position that the moral claim to medicine does not constitute an entitlement legitimately securable by force is to suggest that it binds me to support making it an entitlement secured by force? Surely you jest.

TallDave (Replying to: Matt Steinglass) September 2, 2009 2:07 PM

People have no obligation to perform labor for others
...leads pretty directly to Holbo's "if you don't have any money, you shouldn't be entitled to any medicine."

Megan already addressed that a couple points down with her point that societies have a right to redistribute income.

The idea that poor people are entitled to basic health care is an elaboration of the idea that if you know the Heimlich maneuver and are standing next to someone who is choking, you have a moral obligation to perform the Heimlich maneuver on them.

Actually, this is saying "if you know the Heimlich maneuver, you have a moral obligation to spend 10% of your time running around finding people who are choking and saving them." This mainly serves to disincentivize people from learning the Heimlich maneuver.

The only reason poor people don't currently die on the street in America (not much, anyway) is because doctors are obliged by law to provide emergency care regardless of the ability to pay.

But the only reason those doctors and hospitals exist in the first place is because of the other people who do pay. If you started rounding up doctors at gunpoint and forcing them to treat the poor for free ("it's your moral duty!") who would want to be a doctor?

Matt Steinglass (Replying to: TallDave) September 2, 2009 2:46 PM

"Actually, this is saying "if you know the Heimlich maneuver, you have a moral obligation to spend 10% of your time running around finding people who are choking and saving them." This mainly serves to disincentivize people from learning the Heimlich maneuver."

No. If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver. Similarly, a guarantee of universal health insurance incentivizes people to become doctors. The recognition that we have an obligation to provide everyone with basic health care leads to guaranteed payment for basic health care, which leads to increased capacity to provide health care. We have more health care capacity today because of Medicare, not less.

mischief (Replying to: Matt Steinglass) September 2, 2009 3:52 PM

Depends on how big the payment is.

If it's low enough, you can decrease the chances of people learning it over free. For instance, giving blood for nothing makes you feel good for doing something good; giving blood for a small fee makes it a nasty way to earn some money. As a consequence, people are more likely to give blood for nothing than for a fee.

TallDave (Replying to: Matt Steinglass) September 2, 2009 7:38 PM

Your original analogy suggested something easy to do that was of lifesaving benefit to someone else was a moral obligation. Now the people paying for it are the ones with the obligation, not the person performing it -- but we already agreed society can redistribute income. What they can't do is force you to perform labor for other people, moral obligation or not.

If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver

Not necessarily. That would depend how much it paid, and whether you were forced to do it whether you thought the payment was worth the service or not. If the payment was say, only a dollar, most people would avoid the training to escape the obligation.

(There would also no doubt be various people pretending to choke 5 times a day for kickbacks, but I digress.)

Now, if there was already a functioning private network of highly-trained, well-paid expert Heimlich performers, and the government came in and said "Well, from now we're going to exercise monopsony pricing to lower your compensation" talented people would abandon the field.

We have more health care capacity today because of Medicare, not less.

Probably. And maybe food stamps have increased food supply (without monopsony pricing). I'm not against Medicare, or food stamps. But I don't think everyone should be on either.

Bearded Spock (Replying to: Matt Steinglass) September 2, 2009 2:37 AM

Megan's not advocating the removal of that obligation, but I am. Should farmers have an obligation to grow food for the hungry? All transactions should be voluntary. Anything else is coercion. The shortage of hospitals is directly a result of the obligation to treat everyone. If you care so much about the uninsured, then give to a charity that helps them. You have no right to be charitable with my money.

Matt Steinglass (Replying to: Bearded Spock) September 2, 2009 5:41 AM

Yeah, but you also believe we should abolish the armed forces of the US, eliminate taxes, privatize all the public roads in the country, and so on. That's a philosophically consistent position ("all transactions should be voluntary"), but also a completely crazy one that basically nobody else in the country agrees with, fortunately.

The Ninja Zombie (Replying to: Matt Steinglass) September 2, 2009 8:51 AM

A distinction can be made between taxation to fund public goods (roads, military) and private goods (food, health care).

Matt Steinglass (Replying to: Bearded Spock) September 2, 2009 5:44 AM

Oh, and yes, incidentally, if there were a famine in the US, farmers would be obligated to grow food for the hungry. That's both a moral necessity and a fact of practical politics. Under the current system, too, farmers are paid by the government to grow food for the poor, via both subsidies and the food stamps program, which effectively means people are being obliged to work in order to feed the hungry. You may advocate eliminating the safeguards we have to ensure nobody goes hungry in the US, but again, virtually nobody else agrees with you.

Megan McArdle (Replying to: Matt Steinglass) September 2, 2009 7:57 AM

There is a difference between charging people taxes as the price for participating in society, and forcing them to do something. The government may tax me, but I have no moral obligation to take the highest paid possible job in order to maximize my taxes, nor can the government make me do so. I am not obliged to work at all, if I can support myself.

If you think there is such a moral obligation, why have you chosen your profession?

If you really think that the state has a right to force people to farm, or perform surgery, at gunpoint, then yes, we have a fundamental philosophical difference. But this sounds more like Pol Pot than social democracy.

silentbeep (Replying to: Matt Steinglass) September 2, 2009 12:24 PM

Megan: I have no idea how you got to the "government forcing people to do things by gunpoint" and Pol Pot, just from what matt said above. He is talking about "effectively" being obligated by the government to work in order to feed the hungry and the poor, right now "under the current system", not in the future where the government is holding guns against people's heads and where this is a Pol Pot. A moral obligation is one thing, and having the government 'make' that moral obligation a law is another. I don't see where Matt said that guns would need to be used and pol pot style government would have to be enacted.

Would you consider WW II rationhing a form of "pol pot" type forcing? After all, such rationing was a direct invective by the government to 'force' somebody to do something.

Matt Steinglass (Replying to: Matt Steinglass) September 2, 2009 2:33 PM

Those comments were made in response to Bearded Spock, not Megan, and operated at a lower degree of seriousness and coherence. But I do stand by the observation that if hunger were a serious problem in the US, the government would ensure that enough food were being grown and given to the hungry, by requisitioning food if necessary.

Matt Steinglass (Replying to: Bearded Spock) September 2, 2009 5:41 AM

Yeah, but you also believe we should abolish the armed forces of the US, eliminate taxes, privatize all the public roads in the country, and so on. That's a philosophically consistent position ("all transactions should be voluntary"), but also a completely crazy one that basically nobody else in the country agrees with, fortunately.

The Ninja Zombie (Replying to: Matt Steinglass) September 2, 2009 8:51 AM

A distinction can be made between taxation to fund public goods (roads, military) and private goods (food, health care).

The Ninja Zombie (Replying to: Matt Steinglass) September 2, 2009 8:51 AM

A distinction can be made between taxation to fund public goods (roads, military) and private goods (food, health care).

Matt Steinglass (Replying to: Bearded Spock) September 2, 2009 5:44 AM

Oh, and yes, incidentally, if there were a famine in the US, farmers would be obligated to grow food for the hungry. That's both a moral necessity and a fact of practical politics. Under the current system, too, farmers are paid by the government to grow food for the poor, via both subsidies and the food stamps program, which effectively means people are being obliged to work in order to feed the hungry. You may advocate eliminating the safeguards we have to ensure nobody goes hungry in the US, but again, virtually nobody else agrees with you.

Megan McArdle (Replying to: Matt Steinglass) September 2, 2009 7:57 AM

There is a difference between charging people taxes as the price for participating in society, and forcing them to do something. The government may tax me, but I have no moral obligation to take the highest paid possible job in order to maximize my taxes, nor can the government make me do so. I am not obliged to work at all, if I can support myself.

If you think there is such a moral obligation, why have you chosen your profession?

If you really think that the state has a right to force people to farm, or perform surgery, at gunpoint, then yes, we have a fundamental philosophical difference. But this sounds more like Pol Pot than social democracy.

silentbeep (Replying to: Matt Steinglass) September 2, 2009 12:24 PM

Megan: I have no idea how you got to the "government forcing people to do things by gunpoint" and Pol Pot, just from what matt said above. He is talking about "effectively" being obligated by the government to work in order to feed the hungry and the poor, right now "under the current system", not in the future where the government is holding guns against people's heads and where this is a Pol Pot. A moral obligation is one thing, and having the government 'make' that moral obligation a law is another. I don't see where Matt said that guns would need to be used and pol pot style government would have to be enacted.

Would you consider WW II rationhing a form of "pol pot" type forcing? After all, such rationing was a direct invective by the government to 'force' somebody to do something.

Matt Steinglass (Replying to: Matt Steinglass) September 2, 2009 2:33 PM

Those comments were made in response to Bearded Spock, not Megan, and operated at a lower degree of seriousness and coherence. But I do stand by the observation that if hunger were a serious problem in the US, the government would ensure that enough food were being grown and given to the hungry, by requisitioning food if necessary.

Megan McArdle (Replying to: Matt Steinglass) September 2, 2009 7:57 AM

There is a difference between charging people taxes as the price for participating in society, and forcing them to do something. The government may tax me, but I have no moral obligation to take the highest paid possible job in order to maximize my taxes, nor can the government make me do so. I am not obliged to work at all, if I can support myself.

If you think there is such a moral obligation, why have you chosen your profession?

If you really think that the state has a right to force people to farm, or perform surgery, at gunpoint, then yes, we have a fundamental philosophical difference. But this sounds more like Pol Pot than social democracy.

silentbeep (Replying to: Matt Steinglass) September 2, 2009 12:24 PM

Megan: I have no idea how you got to the "government forcing people to do things by gunpoint" and Pol Pot, just from what matt said above. He is talking about "effectively" being obligated by the government to work in order to feed the hungry and the poor, right now "under the current system", not in the future where the government is holding guns against people's heads and where this is a Pol Pot. A moral obligation is one thing, and having the government 'make' that moral obligation a law is another. I don't see where Matt said that guns would need to be used and pol pot style government would have to be enacted.

Would you consider WW II rationhing a form of "pol pot" type forcing? After all, such rationing was a direct invective by the government to 'force' somebody to do something.

Matt Steinglass (Replying to: Matt Steinglass) September 2, 2009 2:33 PM

Those comments were made in response to Bearded Spock, not Megan, and operated at a lower degree of seriousness and coherence. But I do stand by the observation that if hunger were a serious problem in the US, the government would ensure that enough food were being grown and given to the hungry, by requisitioning food if necessary.

Denverflyer (Replying to: Matt Steinglass) September 2, 2009 9:56 AM

"The idea that poor people are entitled to basic health care is an elaboration of the idea that if you know the Heimlich maneuver and are standing next to someone who is choking, you have a moral obligation to perform the Heimlich maneuver on them."

It's more like knowing the Heimlich and therefore being forced to hang out at restaurants every Saturday night for the rest of your life without pay b/c you "owe it" to others. It's not a one time thing.

derek (Replying to: Matt Steinglass) September 2, 2009 10:06 AM

http://www.freerepublic.com/focus/news/723068/posts

This is what happens. Doctors forced to do things they are not willing to do. Like work longer hours. Due to stupid decisions made by government.

What has happened as a result of this policy is doctors have left practice or left the province. I saw one the other day, a doctor from Quebec. Left for better pastures.

Actually, they say that half the doctors trained in Canada end up practicing in the US.

Maybe we should force them to stay here.

This is so simple to understand. You should stop trying to twist your mind around unreality. Megan is right.

Derek

Joshua Lyle (Replying to: Matt Steinglass) September 2, 2009 10:54 AM

Let's say I concede that people have an imperfect duty to contribute to the common good and the welfare of others. That means the others have a moral claim on that contribution, but they don't have a right to it, that is, they don't have a legitimately enforceable moral claim on any particular contribution. Since it is illegitimate for them to use force to secure that contribution, it is still illegitimate to have the government act as their agent in securing it.

So, whether this "obligation" constitutes a perfect or imperfect duty determines whether it leads to an "entitlement", if an entitlement is something you have a right to. But what's so objectionable about the notion that people have a moral claim on getting medicine, but not an unlimited one? Especially when, in the real world, an entitlement is not a metaphysical guarantee: it is still possible for people to fail to have what they are entitled to, so the non-ideal question of whether they are better served by possible implementations of a regimented government enforcement of perfect duty or a civil-society-based voluntary manifestation of imperfect duty matters quite a bit.

Matt Steinglass (Replying to: Joshua Lyle) September 2, 2009 2:36 PM

"But what's so objectionable about the notion that people have a moral claim on getting medicine, but not an unlimited one?"

Nothing at all. Sounds like a perfectly reasonable position that would lead one to support a universal health insurance plan like the one currently in Congress.

Joshua Lyle (Replying to: Matt Steinglass) September 2, 2009 3:56 PM

So your response to my position that the moral claim to medicine does not constitute an entitlement legitimately securable by force is to suggest that it binds me to support making it an entitlement secured by force? Surely you jest.

Matt Steinglass (Replying to: Joshua Lyle) September 2, 2009 2:36 PM

"But what's so objectionable about the notion that people have a moral claim on getting medicine, but not an unlimited one?"

Nothing at all. Sounds like a perfectly reasonable position that would lead one to support a universal health insurance plan like the one currently in Congress.

Joshua Lyle (Replying to: Matt Steinglass) September 2, 2009 3:56 PM

So your response to my position that the moral claim to medicine does not constitute an entitlement legitimately securable by force is to suggest that it binds me to support making it an entitlement secured by force? Surely you jest.

Joshua Lyle (Replying to: Matt Steinglass) September 2, 2009 3:56 PM

So your response to my position that the moral claim to medicine does not constitute an entitlement legitimately securable by force is to suggest that it binds me to support making it an entitlement secured by force? Surely you jest.

TallDave (Replying to: Matt Steinglass) September 2, 2009 2:07 PM

People have no obligation to perform labor for others
...leads pretty directly to Holbo's "if you don't have any money, you shouldn't be entitled to any medicine."

Megan already addressed that a couple points down with her point that societies have a right to redistribute income.

The idea that poor people are entitled to basic health care is an elaboration of the idea that if you know the Heimlich maneuver and are standing next to someone who is choking, you have a moral obligation to perform the Heimlich maneuver on them.

Actually, this is saying "if you know the Heimlich maneuver, you have a moral obligation to spend 10% of your time running around finding people who are choking and saving them." This mainly serves to disincentivize people from learning the Heimlich maneuver.

The only reason poor people don't currently die on the street in America (not much, anyway) is because doctors are obliged by law to provide emergency care regardless of the ability to pay.

But the only reason those doctors and hospitals exist in the first place is because of the other people who do pay. If you started rounding up doctors at gunpoint and forcing them to treat the poor for free ("it's your moral duty!") who would want to be a doctor?

Matt Steinglass (Replying to: TallDave) September 2, 2009 2:46 PM

"Actually, this is saying "if you know the Heimlich maneuver, you have a moral obligation to spend 10% of your time running around finding people who are choking and saving them." This mainly serves to disincentivize people from learning the Heimlich maneuver."

No. If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver. Similarly, a guarantee of universal health insurance incentivizes people to become doctors. The recognition that we have an obligation to provide everyone with basic health care leads to guaranteed payment for basic health care, which leads to increased capacity to provide health care. We have more health care capacity today because of Medicare, not less.

mischief (Replying to: Matt Steinglass) September 2, 2009 3:52 PM

Depends on how big the payment is.

If it's low enough, you can decrease the chances of people learning it over free. For instance, giving blood for nothing makes you feel good for doing something good; giving blood for a small fee makes it a nasty way to earn some money. As a consequence, people are more likely to give blood for nothing than for a fee.

TallDave (Replying to: Matt Steinglass) September 2, 2009 7:38 PM

Your original analogy suggested something easy to do that was of lifesaving benefit to someone else was a moral obligation. Now the people paying for it are the ones with the obligation, not the person performing it -- but we already agreed society can redistribute income. What they can't do is force you to perform labor for other people, moral obligation or not.

If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver

Not necessarily. That would depend how much it paid, and whether you were forced to do it whether you thought the payment was worth the service or not. If the payment was say, only a dollar, most people would avoid the training to escape the obligation.

(There would also no doubt be various people pretending to choke 5 times a day for kickbacks, but I digress.)

Now, if there was already a functioning private network of highly-trained, well-paid expert Heimlich performers, and the government came in and said "Well, from now we're going to exercise monopsony pricing to lower your compensation" talented people would abandon the field.

We have more health care capacity today because of Medicare, not less.

Probably. And maybe food stamps have increased food supply (without monopsony pricing). I'm not against Medicare, or food stamps. But I don't think everyone should be on either.

Matt Steinglass (Replying to: TallDave) September 2, 2009 2:46 PM

"Actually, this is saying "if you know the Heimlich maneuver, you have a moral obligation to spend 10% of your time running around finding people who are choking and saving them." This mainly serves to disincentivize people from learning the Heimlich maneuver."

No. If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver. Similarly, a guarantee of universal health insurance incentivizes people to become doctors. The recognition that we have an obligation to provide everyone with basic health care leads to guaranteed payment for basic health care, which leads to increased capacity to provide health care. We have more health care capacity today because of Medicare, not less.

mischief (Replying to: Matt Steinglass) September 2, 2009 3:52 PM

Depends on how big the payment is.

If it's low enough, you can decrease the chances of people learning it over free. For instance, giving blood for nothing makes you feel good for doing something good; giving blood for a small fee makes it a nasty way to earn some money. As a consequence, people are more likely to give blood for nothing than for a fee.

TallDave (Replying to: Matt Steinglass) September 2, 2009 7:38 PM

Your original analogy suggested something easy to do that was of lifesaving benefit to someone else was a moral obligation. Now the people paying for it are the ones with the obligation, not the person performing it -- but we already agreed society can redistribute income. What they can't do is force you to perform labor for other people, moral obligation or not.

If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver

Not necessarily. That would depend how much it paid, and whether you were forced to do it whether you thought the payment was worth the service or not. If the payment was say, only a dollar, most people would avoid the training to escape the obligation.

(There would also no doubt be various people pretending to choke 5 times a day for kickbacks, but I digress.)

Now, if there was already a functioning private network of highly-trained, well-paid expert Heimlich performers, and the government came in and said "Well, from now we're going to exercise monopsony pricing to lower your compensation" talented people would abandon the field.

We have more health care capacity today because of Medicare, not less.

Probably. And maybe food stamps have increased food supply (without monopsony pricing). I'm not against Medicare, or food stamps. But I don't think everyone should be on either.

mischief (Replying to: Matt Steinglass) September 2, 2009 3:52 PM

Depends on how big the payment is.

If it's low enough, you can decrease the chances of people learning it over free. For instance, giving blood for nothing makes you feel good for doing something good; giving blood for a small fee makes it a nasty way to earn some money. As a consequence, people are more likely to give blood for nothing than for a fee.

TallDave (Replying to: Matt Steinglass) September 2, 2009 7:38 PM

Your original analogy suggested something easy to do that was of lifesaving benefit to someone else was a moral obligation. Now the people paying for it are the ones with the obligation, not the person performing it -- but we already agreed society can redistribute income. What they can't do is force you to perform labor for other people, moral obligation or not.

If the federal government guaranteed payment to anyone who performed the Heimlich maneuver on a choking person, that would incentivize people to learn the Heimlich maneuver

Not necessarily. That would depend how much it paid, and whether you were forced to do it whether you thought the payment was worth the service or not. If the payment was say, only a dollar, most people would avoid the training to escape the obligation.

(There would also no doubt be various people pretending to choke 5 times a day for kickbacks, but I digress.)

Now, if there was already a functioning private network of highly-trained, well-paid expert Heimlich performers, and the government came in and said "Well, from now we're going to exercise monopsony pricing to lower your compensation" talented people would abandon the field.

We have more health care capacity today because of Medicare, not less.

Probably. And maybe food stamps have increased food supply (without monopsony pricing). I'm not against Medicare, or food stamps. But I don't think everyone should be on either.

Arjun September 2, 2009 3:11 AM

I liked Dr. Chevlen's article in First Things. It seems to me that Dr. Chevlen is doing good work in his role as a private health insurance company health care rationer. I agree with Dr. Chevlen that reserving health care for the wealthiest only runs contrary to many Americans' belief in and conception of human dignity and equality. However, when he states that there are only two alternatives to this (private health insurance and government health insurance) I disagree slightly.

The advantage of cost as a means of rationing is that the individual has the power to prioritize spending according to her own values and interests. The disadvantage of cost is that those with less money can afford less health care. I do not want to solve this problem completely, but I do want to address the problem so that all Americans can afford at least a basic level of health care. Given my prejudice in favor of "spread[ing] the wealth around", I propose that one way to do this might be to set up a system of government-subsidized health savings accounts (in conjunction with some sort of universal insurance coverage, I don't care whether private or government, for catastrophic costs).

I am familiar with the high costs of cost-"free" medical care because I am personally complicit in the wasteful excesses. For example, I write a lot of prescriptions for inexpensive over-the-counter medications, which are thereby "free" to patients on Medicaid. It is easy to be "generous" with other people's money.

stonetools (Replying to: Arjun) September 2, 2009 10:07 AM

Actually, you are helping a poor person receive medical care. What's wrong with that? Maybe its your view that the poor should be entitled to only life saving meds and should do without say, effective pain meds because they should be willing to endure discomfort that us "good" folk should be able to alleviate. If you feel that way , fine: write your representative, vote, participate in the political process. If you are persuasive, then Medicaid will be limited only to the drugs that you believe the poor should have. That's democracy .

You should understand that your proposed system is much too coercive for the libertarians here, who think that the poor should simply die if they can't afford health care. They don't put it so bluntly, but that's what they in effect believe.

Col Sanders (Replying to: stonetools) September 2, 2009 10:23 AM

[quote]"Actually, you are helping a poor person receive medical care. What's wrong with that?"[/quote]

One thing makes it wrong: Your gun in my back forcing me to "help".

Arjun (Replying to: stonetools) September 2, 2009 11:13 AM

Thanks for your reply. I guess I kind of lost focus drifted off subject with my personal confession about wasting taxpayer money. My main point is that people who say that imposing cost is the best way to ration health care (I think George Will said something like this, for example) are right, but according to my prejudices, it isn't fair that some people can't afford any health care, so some wealth should be redistributed (via coercion) so that all Americans can shop around for better health care at lower prices.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:54 AM

*sigh* Are we really going to play this game? Okay, here goes:

That's democracy.

So you think that anyone, poor or not, should simply die if the electorate expresses the opinion that they should? Democrats (small 'd') don't put it so bluntly, but that's what they in effect believe.

stonetools (Replying to: Arjun) September 2, 2009 10:07 AM

Actually, you are helping a poor person receive medical care. What's wrong with that? Maybe its your view that the poor should be entitled to only life saving meds and should do without say, effective pain meds because they should be willing to endure discomfort that us "good" folk should be able to alleviate. If you feel that way , fine: write your representative, vote, participate in the political process. If you are persuasive, then Medicaid will be limited only to the drugs that you believe the poor should have. That's democracy .

You should understand that your proposed system is much too coercive for the libertarians here, who think that the poor should simply die if they can't afford health care. They don't put it so bluntly, but that's what they in effect believe.

Col Sanders (Replying to: stonetools) September 2, 2009 10:23 AM

[quote]"Actually, you are helping a poor person receive medical care. What's wrong with that?"[/quote]

One thing makes it wrong: Your gun in my back forcing me to "help".

Arjun (Replying to: stonetools) September 2, 2009 11:13 AM

Thanks for your reply. I guess I kind of lost focus drifted off subject with my personal confession about wasting taxpayer money. My main point is that people who say that imposing cost is the best way to ration health care (I think George Will said something like this, for example) are right, but according to my prejudices, it isn't fair that some people can't afford any health care, so some wealth should be redistributed (via coercion) so that all Americans can shop around for better health care at lower prices.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:54 AM

*sigh* Are we really going to play this game? Okay, here goes:

That's democracy.

So you think that anyone, poor or not, should simply die if the electorate expresses the opinion that they should? Democrats (small 'd') don't put it so bluntly, but that's what they in effect believe.

Col Sanders (Replying to: stonetools) September 2, 2009 10:23 AM

[quote]"Actually, you are helping a poor person receive medical care. What's wrong with that?"[/quote]

One thing makes it wrong: Your gun in my back forcing me to "help".

Arjun (Replying to: stonetools) September 2, 2009 11:13 AM

Thanks for your reply. I guess I kind of lost focus drifted off subject with my personal confession about wasting taxpayer money. My main point is that people who say that imposing cost is the best way to ration health care (I think George Will said something like this, for example) are right, but according to my prejudices, it isn't fair that some people can't afford any health care, so some wealth should be redistributed (via coercion) so that all Americans can shop around for better health care at lower prices.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:54 AM

*sigh* Are we really going to play this game? Okay, here goes:

That's democracy.

So you think that anyone, poor or not, should simply die if the electorate expresses the opinion that they should? Democrats (small 'd') don't put it so bluntly, but that's what they in effect believe.

PeteL September 2, 2009 3:13 AM

The Buffett-redistribution argument is a pretty good one. Sort of at the core of what's wrong with National Health Care schemes.

Consider: Wikipedia says that Canada spent $5,000/person on health care in 2008. 66% of Canadians have private supplemental insurance to cover what the universal system doesn't; my impression based on Canadian relatives' testimonials is that this supplemental insurance might be around $3,000/yr for a family of three.

$3,000/yr is a swag. Work with me. If $3,000/yr for a family of three, that's $1,000/person, multiplied by .66 means that about 15% or so of the Canadian health care delivery cost is borne privately through insurance contracts, beyond the high gas taxes, GST, and income taxes that pay for the rest.

Even in Canada, with the national song of harmony for the beauty of universal coverage, you end up with a public/private system, the main difference with ours being that more care is reimbursed via public means than in the US.

Nevertheless, as cost pressures increase due to more sophisticated life-saving care, which Canadian payor group, the public or private, do you anticipate eating the increased cost? Here's a hint: while the average Canadian has a greater social conscience than the average American, the average Canadian politician is just as opportunistic as the average American politician.

In summary, I think Megan should turn around the "I hate random poor people" objection from Balko. Its quite alright to worry about the public/private scheme by claiming that you are just fine with poor people, you just don't like strangers enough to place yourself permanently at their mercy.

Oh, and, for people who object to national health care because they won't be able to buy more care: you aren't really seeing the big picture. *Of course* you'll be able to buy more care in our national health care scheme!

Yours...and everyone elses, as circumstances warrant.

yZrs (Replying to: PeteL) September 2, 2009 12:24 PM

My company's (pretty good) supplemental insurance is closer to $1300/year per family (Alberta). It mostly covers optical, dental and drug costs and odds and ends like massages and chiropractic work. Strictly medical coverage is limited to things like private room upgrades and travel medical insurance.

yZrs (Replying to: PeteL) September 2, 2009 12:24 PM

My company's (pretty good) supplemental insurance is closer to $1300/year per family (Alberta). It mostly covers optical, dental and drug costs and odds and ends like massages and chiropractic work. Strictly medical coverage is limited to things like private room upgrades and travel medical insurance.

Bearded Spock September 2, 2009 3:46 AM

Nobody is entitled to health care! Not rich people. not poor people. nobody. Health care is no different than any other good or service. it is given or it is bought. You cannot steal it through coercive laws without unintended consequences.

stonetools (Replying to: Bearded Spock) September 2, 2009 10:11 AM

According to you, no one is entitled to national defense either . Its easy for you to say-you live under the protection of the most powerful military and most expensive military in history- paid for by those filthy coercive taxes that you are always banging on about.

Rick Caird (Replying to: stonetools) September 2, 2009 10:42 AM

That is a very dumb attempt at an argument. National defense is a benefit shared by everyone (assuming you don't want to be invaded). That, in fact, is one of the fundamental functions of government i.e to protect the people from outside aggression. Health care is an entirely different matter. It is neither a necessary function of government nor is it a shared benefit. If I have adequate health care now, it is not to my advantage to reduce my care in order to enhance someone else.

On a second note, I looked at the report "Care Without Coverage: Too Little, Too Late" you referenced and found it wanting. In the first place, it o\in no way attempted to address the costs involved. You cannot evaluate changes to a system without assessing the costs of providing those changes. Second, it made no attempt to compare its conclusions with any other method of providing health care. The US provides a much higher percentage of the population with screening such as colonoscopies, mammograms, and prostate exams than single payer systems such as Canada and England. Unless we posit, as the report seems to do, an unlimited ability to provide health care, the obvious question is whether any other plan would reduce the total screenings negating not only the perceived advantage, but actually making things much worse.

Rick

stonetools (Replying to: Bearded Spock) September 2, 2009 10:11 AM

According to you, no one is entitled to national defense either . Its easy for you to say-you live under the protection of the most powerful military and most expensive military in history- paid for by those filthy coercive taxes that you are always banging on about.

Rick Caird (Replying to: stonetools) September 2, 2009 10:42 AM

That is a very dumb attempt at an argument. National defense is a benefit shared by everyone (assuming you don't want to be invaded). That, in fact, is one of the fundamental functions of government i.e to protect the people from outside aggression. Health care is an entirely different matter. It is neither a necessary function of government nor is it a shared benefit. If I have adequate health care now, it is not to my advantage to reduce my care in order to enhance someone else.

On a second note, I looked at the report "Care Without Coverage: Too Little, Too Late" you referenced and found it wanting. In the first place, it o\in no way attempted to address the costs involved. You cannot evaluate changes to a system without assessing the costs of providing those changes. Second, it made no attempt to compare its conclusions with any other method of providing health care. The US provides a much higher percentage of the population with screening such as colonoscopies, mammograms, and prostate exams than single payer systems such as Canada and England. Unless we posit, as the report seems to do, an unlimited ability to provide health care, the obvious question is whether any other plan would reduce the total screenings negating not only the perceived advantage, but actually making things much worse.

Rick

Rick Caird (Replying to: stonetools) September 2, 2009 10:42 AM

That is a very dumb attempt at an argument. National defense is a benefit shared by everyone (assuming you don't want to be invaded). That, in fact, is one of the fundamental functions of government i.e to protect the people from outside aggression. Health care is an entirely different matter. It is neither a necessary function of government nor is it a shared benefit. If I have adequate health care now, it is not to my advantage to reduce my care in order to enhance someone else.

On a second note, I looked at the report "Care Without Coverage: Too Little, Too Late" you referenced and found it wanting. In the first place, it o\in no way attempted to address the costs involved. You cannot evaluate changes to a system without assessing the costs of providing those changes. Second, it made no attempt to compare its conclusions with any other method of providing health care. The US provides a much higher percentage of the population with screening such as colonoscopies, mammograms, and prostate exams than single payer systems such as Canada and England. Unless we posit, as the report seems to do, an unlimited ability to provide health care, the obvious question is whether any other plan would reduce the total screenings negating not only the perceived advantage, but actually making things much worse.

Rick

TexasJew September 2, 2009 8:38 AM

"Poverty" is polygenetic.
Many poor people are poor due to their own personal decisions, many of which center upon the expectations that others will always take care of them.
There is no bottom to that money hole.
As we have seen with Welfare Reform, and what could have been predicted decades earlier, saving millions of wasted lives and many trillions of wasted dollars. rewarding "poverty" in a random fashion only encourages it and allows it to grow.

Troy September 2, 2009 9:51 AM

If the government crowds out private health insurance for many people--a result that a number of analysts on both right and left think (hope) is likely

Megan, would you be willing to explain, or point me to someone who explains, how exactly these analysts anticipate this will happen? I've seen this asserted from the beginning of the debate, more often by people against the legislation than by people for it, but I've never seen a detailed, persuasive explanation of exactly how this is supposed to happen.

Is the argument that businesses would rather pay the fine than provide the healthcare so millions of currently insured will pour into the government system? Or it that the government says it won't cheat and run the program at a huge loss but these analysts think they will anyway? Or what?

Skullberg (Replying to: Troy) September 2, 2009 1:20 PM

I don't have links handy but I know off the top of my head Obama, Schakowsky and Barney Frank have all said as much on video.

MBP (Replying to: Troy) September 2, 2009 1:40 PM

i'm a wall st analyst and i'll pass along the way that many investors view it. A strong public plan will undercut private insurers and take most of their market share. A weak public plan that competes on a level playing field at the start will be too tempting and Congress will eventually turn it into a strong public plan, in an attempt to save $$, which will have the same end result.

In more detail, wall st doesn't trust that gov't will run a public plan at break even (and certainly not at a profit). It will run at a loss. It will eventually use Medicare's power to set prices, which will undercut private insurers. If the public plan is cheaper than private options, employers will drop coverage and force their employees into a public plan.

Reform without a public plan will lower margins for private insurers but will not likely drive them out of business.

Troy (Replying to: Troy) September 2, 2009 2:31 PM

MBP, just so I understand: the wall st. view is that a "weak" public plan is one that breaks even, and a "strong" public plan is one that operates at a loss. And it is a strong public plan that competes unfairly with private insurers.

Which is being proposed in the actual legislation, and not in some Ezra Klein (pro) or NRO (con) fever dream: a strong public plan, i.e. one that loses money, or a weak public plan, i.e. one that breaks even?

I was hoping that the answer would be that there some kind of government buying power economics that make it compete unfairly or something. But it sounds like Wall St., and many other Americans, are not really engaging this legislation on its own terms, but rather assuming that it will lead to subsequent legislation that they don't like. Is that right? In other words, I don't have an opinion on the merits of legislation A; instead, I'd like to talk about how legislation A puts us on a "slippery slope" toward some future legislation D, and we really don't want D therefore we can't we can't pass A.

Skullberg (Replying to: Troy) September 2, 2009 1:20 PM

I don't have links handy but I know off the top of my head Obama, Schakowsky and Barney Frank have all said as much on video.

MBP (Replying to: Troy) September 2, 2009 1:40 PM

i'm a wall st analyst and i'll pass along the way that many investors view it. A strong public plan will undercut private insurers and take most of their market share. A weak public plan that competes on a level playing field at the start will be too tempting and Congress will eventually turn it into a strong public plan, in an attempt to save $$, which will have the same end result.

In more detail, wall st doesn't trust that gov't will run a public plan at break even (and certainly not at a profit). It will run at a loss. It will eventually use Medicare's power to set prices, which will undercut private insurers. If the public plan is cheaper than private options, employers will drop coverage and force their employees into a public plan.

Reform without a public plan will lower margins for private insurers but will not likely drive them out of business.

Troy (Replying to: Troy) September 2, 2009 2:31 PM

MBP, just so I understand: the wall st. view is that a "weak" public plan is one that breaks even, and a "strong" public plan is one that operates at a loss. And it is a strong public plan that competes unfairly with private insurers.

Which is being proposed in the actual legislation, and not in some Ezra Klein (pro) or NRO (con) fever dream: a strong public plan, i.e. one that loses money, or a weak public plan, i.e. one that breaks even?

I was hoping that the answer would be that there some kind of government buying power economics that make it compete unfairly or something. But it sounds like Wall St., and many other Americans, are not really engaging this legislation on its own terms, but rather assuming that it will lead to subsequent legislation that they don't like. Is that right? In other words, I don't have an opinion on the merits of legislation A; instead, I'd like to talk about how legislation A puts us on a "slippery slope" toward some future legislation D, and we really don't want D therefore we can't we can't pass A.

Joshua Lyle September 2, 2009 10:00 AM

Imagine a universe consisting entirely of two identical blue spheres. Is there a right to national health care in that universe? Please show your work.

I think I got this one: 1. The stipulated universe has no nations. 2. There can be no national health care in the absence of nations. 3. There can be no right to something that is impossible. 4. By 1 & 2: National health care is impossible in the stipulated universe. 5. By 3 & 4: There is no right to national health care in a universe consisting entirely of two identical blue spheres.

Alfred Centauri September 2, 2009 10:23 AM

Matt Steinglass wrote:

Oh, and yes, incidentally, if there were a famine in the US, farmers would be obligated to grow food for the hungry. That's both a moral necessity and a fact of practical politics

That practical political fact you refer to is The Sanction of the Victim.

---

Nobody is entitled to health care! Not rich people. not poor people. nobody.

Bearded Spock 'gets' it.

A question: are we entitled to medicine if we have money? Of course not.

The practice of medicine is the product of individuals living their own lives.

None of us are entitled to the products of others no matter how much or how little money we may have.

stonetools (Replying to: Alfred Centauri) September 2, 2009 10:46 AM

I do hope that you never, ever, drive on the interstate highway system ( paid for by mine and other's money). I hope that you are not drinking any water from the public water system, borrowing any books from the public library, or going to any public parks. That's all theft.
The Californians whose lives and property are being saved by the National Guard and the state fire fighting services-they are all thieves too.
BS doesn't get a damned thing. If someone sets fire to his house, he will call 911 and get the (government) fire department to put out the fire. He will then insist that the (government) police department to find the arsonist. If he is injured, he he will go to the emergency room, where he will receive health care without being required to pay for it first ( another evil "gumint" intervention).
By the way , you need to get off the (government created) Internet. That's theft too.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:13 AM

By the way , you need to get off the (government created) Internet. That's theft too.

Sorry, man, try catching someone that is 'fer intellectual property trumping rights to real property on that one.

As to the interstate highway system: lets say I steal a bunch of money from you and several other people, and use to build something, say, a road. Since I don't have the money, you can't reclaim what you have a particular right to (that is, the money itself), but you're still entitled to be made as close to whole as is feasible, say, by getting one equal ownership share in the property I do have that can be seized, to wit, one road. You can probably see where this is going.

Also, how do you know that Bearded Spock lives in an area dominated by a fire-protection cartel? The last county I lived in had privately contracted fire-putter-outters. Not to mention the fact that many of us live on privately owned roads, use private or co-op utilities, prefer arbitration to court, etc. All we ask is the opportunity: we'll embrace alternatives whenever the state deems to allow it.

Alfred Centauri (Replying to: stonetools) September 2, 2009 11:16 AM

stonetools, your silly childish rant entirely misses the quite obvious point of my post:

we are not entitled to the products of others as a matter of principle.

Do you disagree with this?

That is, do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Matt Steinglass (Replying to: Alfred Centauri) September 2, 2009 2:58 PM

Yes. If you have a heart attack in front of me, and I know CPR, I am morally obliged to perform CPR on you. You have a claim on my labor. You have that claim on my labor because you are a fellow human being. Unfortunately the CPR course I took for my lifeguard certificate was 23 years ago and I'd probably screw it up, so better hope you don't have a heart attack in front of me.

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors? If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Col Sanders (Replying to: Alfred Centauri) September 2, 2009 3:31 PM

@Matt Steinglass

You may personally believe, as do I, that you are morally bound to assist if you know how and are capable.

However, neither you nor the person in trouble are allowed to use your morals and a gun to make anyone else help.

Alfred Centauri (Replying to: Alfred Centauri) September 2, 2009 4:23 PM

Matt, you've evaded the question. Do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Your hypothetical is a transparent attempt to evade answering this simple question.

Given that you brought it up but against my better judgment to engage in pointless "life boat" scenarios, allow me to ask you the question in a different manner.

Considering your scenario, you maintain that I have a claim on your labor (your words) because I am a fellow human being.

Don't forget, since I have a claim on your labor, this claim can be enforced.

Suppose that in your independent rational judgement, providing me with CPR is simply the wrong thing to do for whatever reason.

According to your view that I have claim on your labor as a fellow human being, you owe me CPR and you ought to be forced to provide CPR to me against your own rational judgement.

Do you really, truthfully, honestly, hold that you should be forced to act against your rational judgement simply because I'm a fellow human being - simply because I exist?

TallDave (Replying to: Alfred Centauri) September 2, 2009 7:48 PM

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors?

That's for him to decide, not us.

If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Well, this is the government we're talking about, so what you're really asking is this:

Would it be acceptable for, say, Locke to put a gun to Jack's head and demand he perform care on the marshal?

stonetools (Replying to: Alfred Centauri) September 2, 2009 10:46 AM

I do hope that you never, ever, drive on the interstate highway system ( paid for by mine and other's money). I hope that you are not drinking any water from the public water system, borrowing any books from the public library, or going to any public parks. That's all theft.
The Californians whose lives and property are being saved by the National Guard and the state fire fighting services-they are all thieves too.
BS doesn't get a damned thing. If someone sets fire to his house, he will call 911 and get the (government) fire department to put out the fire. He will then insist that the (government) police department to find the arsonist. If he is injured, he he will go to the emergency room, where he will receive health care without being required to pay for it first ( another evil "gumint" intervention).
By the way , you need to get off the (government created) Internet. That's theft too.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:13 AM

By the way , you need to get off the (government created) Internet. That's theft too.

Sorry, man, try catching someone that is 'fer intellectual property trumping rights to real property on that one.

As to the interstate highway system: lets say I steal a bunch of money from you and several other people, and use to build something, say, a road. Since I don't have the money, you can't reclaim what you have a particular right to (that is, the money itself), but you're still entitled to be made as close to whole as is feasible, say, by getting one equal ownership share in the property I do have that can be seized, to wit, one road. You can probably see where this is going.

Also, how do you know that Bearded Spock lives in an area dominated by a fire-protection cartel? The last county I lived in had privately contracted fire-putter-outters. Not to mention the fact that many of us live on privately owned roads, use private or co-op utilities, prefer arbitration to court, etc. All we ask is the opportunity: we'll embrace alternatives whenever the state deems to allow it.

Alfred Centauri (Replying to: stonetools) September 2, 2009 11:16 AM

stonetools, your silly childish rant entirely misses the quite obvious point of my post:

we are not entitled to the products of others as a matter of principle.

Do you disagree with this?

That is, do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Matt Steinglass (Replying to: Alfred Centauri) September 2, 2009 2:58 PM

Yes. If you have a heart attack in front of me, and I know CPR, I am morally obliged to perform CPR on you. You have a claim on my labor. You have that claim on my labor because you are a fellow human being. Unfortunately the CPR course I took for my lifeguard certificate was 23 years ago and I'd probably screw it up, so better hope you don't have a heart attack in front of me.

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors? If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Col Sanders (Replying to: Alfred Centauri) September 2, 2009 3:31 PM

@Matt Steinglass

You may personally believe, as do I, that you are morally bound to assist if you know how and are capable.

However, neither you nor the person in trouble are allowed to use your morals and a gun to make anyone else help.

Alfred Centauri (Replying to: Alfred Centauri) September 2, 2009 4:23 PM

Matt, you've evaded the question. Do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Your hypothetical is a transparent attempt to evade answering this simple question.

Given that you brought it up but against my better judgment to engage in pointless "life boat" scenarios, allow me to ask you the question in a different manner.

Considering your scenario, you maintain that I have a claim on your labor (your words) because I am a fellow human being.

Don't forget, since I have a claim on your labor, this claim can be enforced.

Suppose that in your independent rational judgement, providing me with CPR is simply the wrong thing to do for whatever reason.

According to your view that I have claim on your labor as a fellow human being, you owe me CPR and you ought to be forced to provide CPR to me against your own rational judgement.

Do you really, truthfully, honestly, hold that you should be forced to act against your rational judgement simply because I'm a fellow human being - simply because I exist?

TallDave (Replying to: Alfred Centauri) September 2, 2009 7:48 PM

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors?

That's for him to decide, not us.

If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Well, this is the government we're talking about, so what you're really asking is this:

Would it be acceptable for, say, Locke to put a gun to Jack's head and demand he perform care on the marshal?

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:13 AM

By the way , you need to get off the (government created) Internet. That's theft too.

Sorry, man, try catching someone that is 'fer intellectual property trumping rights to real property on that one.

As to the interstate highway system: lets say I steal a bunch of money from you and several other people, and use to build something, say, a road. Since I don't have the money, you can't reclaim what you have a particular right to (that is, the money itself), but you're still entitled to be made as close to whole as is feasible, say, by getting one equal ownership share in the property I do have that can be seized, to wit, one road. You can probably see where this is going.

Also, how do you know that Bearded Spock lives in an area dominated by a fire-protection cartel? The last county I lived in had privately contracted fire-putter-outters. Not to mention the fact that many of us live on privately owned roads, use private or co-op utilities, prefer arbitration to court, etc. All we ask is the opportunity: we'll embrace alternatives whenever the state deems to allow it.

Alfred Centauri (Replying to: stonetools) September 2, 2009 11:16 AM

stonetools, your silly childish rant entirely misses the quite obvious point of my post:

we are not entitled to the products of others as a matter of principle.

Do you disagree with this?

That is, do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Matt Steinglass (Replying to: Alfred Centauri) September 2, 2009 2:58 PM

Yes. If you have a heart attack in front of me, and I know CPR, I am morally obliged to perform CPR on you. You have a claim on my labor. You have that claim on my labor because you are a fellow human being. Unfortunately the CPR course I took for my lifeguard certificate was 23 years ago and I'd probably screw it up, so better hope you don't have a heart attack in front of me.

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors? If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Col Sanders (Replying to: Alfred Centauri) September 2, 2009 3:31 PM

@Matt Steinglass

You may personally believe, as do I, that you are morally bound to assist if you know how and are capable.

However, neither you nor the person in trouble are allowed to use your morals and a gun to make anyone else help.

Alfred Centauri (Replying to: Alfred Centauri) September 2, 2009 4:23 PM

Matt, you've evaded the question. Do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Your hypothetical is a transparent attempt to evade answering this simple question.

Given that you brought it up but against my better judgment to engage in pointless "life boat" scenarios, allow me to ask you the question in a different manner.

Considering your scenario, you maintain that I have a claim on your labor (your words) because I am a fellow human being.

Don't forget, since I have a claim on your labor, this claim can be enforced.

Suppose that in your independent rational judgement, providing me with CPR is simply the wrong thing to do for whatever reason.

According to your view that I have claim on your labor as a fellow human being, you owe me CPR and you ought to be forced to provide CPR to me against your own rational judgement.

Do you really, truthfully, honestly, hold that you should be forced to act against your rational judgement simply because I'm a fellow human being - simply because I exist?

TallDave (Replying to: Alfred Centauri) September 2, 2009 7:48 PM

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors?

That's for him to decide, not us.

If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Well, this is the government we're talking about, so what you're really asking is this:

Would it be acceptable for, say, Locke to put a gun to Jack's head and demand he perform care on the marshal?

Matt Steinglass (Replying to: Alfred Centauri) September 2, 2009 2:58 PM

Yes. If you have a heart attack in front of me, and I know CPR, I am morally obliged to perform CPR on you. You have a claim on my labor. You have that claim on my labor because you are a fellow human being. Unfortunately the CPR course I took for my lifeguard certificate was 23 years ago and I'd probably screw it up, so better hope you don't have a heart attack in front of me.

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors? If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Col Sanders (Replying to: Alfred Centauri) September 2, 2009 3:31 PM

@Matt Steinglass

You may personally believe, as do I, that you are morally bound to assist if you know how and are capable.

However, neither you nor the person in trouble are allowed to use your morals and a gun to make anyone else help.

Alfred Centauri (Replying to: Alfred Centauri) September 2, 2009 4:23 PM

Matt, you've evaded the question. Do you hold that one has, for no other reason than that one exists, a claim on the property and labor of others?

Your hypothetical is a transparent attempt to evade answering this simple question.

Given that you brought it up but against my better judgment to engage in pointless "life boat" scenarios, allow me to ask you the question in a different manner.

Considering your scenario, you maintain that I have a claim on your labor (your words) because I am a fellow human being.

Don't forget, since I have a claim on your labor, this claim can be enforced.

Suppose that in your independent rational judgement, providing me with CPR is simply the wrong thing to do for whatever reason.

According to your view that I have claim on your labor as a fellow human being, you owe me CPR and you ought to be forced to provide CPR to me against your own rational judgement.

Do you really, truthfully, honestly, hold that you should be forced to act against your rational judgement simply because I'm a fellow human being - simply because I exist?

TallDave (Replying to: Alfred Centauri) September 2, 2009 7:48 PM

How about this: on "Lost", does Jack have an obligation to provide medical care to the other crash survivors?

That's for him to decide, not us.

If he knows how to treat the marshal in the first episode with the shrapnel sticking out of his chest, is he obliged to do so? Or is he perfectly within his rights to skip it and go for a stroll on the beach instead?

Well, this is the government we're talking about, so what you're really asking is this:

Would it be acceptable for, say, Locke to put a gun to Jack's head and demand he perform care on the marshal?

moptop September 2, 2009 10:36 AM

"Megan, would you be willing to explain, or point me to someone who explains, how exactly these analysts anticipate this [crowding out of private plans] will happen?"

A There is in the plan a provision whereby companies can dump their expensive health plans by simply paying an 8% payroll tax, and dump the headaches too.

B The govt plan is subsidized by the taxpayer, and has, for all practical purposes, unlimited credit, short term anyway. At the same time, 3200 caps premiums for private plans, forcing them to cut service.

C Private plans will be so extensively regulated as to be different animals from the private plans that currently exist.

D Govt programs grow. Social Security used to be supplemental income for the elderly, it has been steadily expanded over the years to the point where it is verging on broke as we speak.

stonetools (Replying to: moptop) September 2, 2009 11:00 AM

Universal health insurance has been instituted in many Countries. In none of these countries has private health insurance died out. NONE.
In the USA, there is Medicare ( universal, single payer health insurance for seniors). Yet some seniors still buy supplemental health insurance.

Look at the facts, , don't confuse yourself with right wing theories.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:21 AM

Right, so long as you assume that what people mean by "private health insurance" is "private supplemental health insurance", there is no problem. So let me be explicit: I have a problem with the fact that single-payer health care will drive out private primary health insurance. Whether entrenched corporate interests are still going to have a chance to profit on the supplemental market is of merely instrumental concern.

Rick Caird (Replying to: stonetools) September 2, 2009 11:29 AM

It is you who is confused. In Canada it is illegal to provide medical services outside the government program. So where would the private health insurance fit in?

In Britain, if you go outside the national system, you can be eliminated from the system for the treatment of that disease. Private insurance is a very minor part of the English system and covers only a subset of procedures. The statistic I saw says that only 8% of the population have private health insurance.

Your claim that private health insurance has not died out is misleading at best.

Rick

stonetools (Replying to: Rick Caird) September 2, 2009 12:28 PM

The Canadian claim has been dealt with above. It is not illegal.
Search "New England journal of Medicine" on this page.The claim is right wing propaganda, as one (anti reform) commenter puts it.
In Britain, you in fact can have private health insurance. The famous Boyle case is misconstrued by the right wing as showing that the NHS bans private health insurance, whereas in fact Ms. Boyle received most of her cancer treatment from the NHS, and wanted to continue receiving NHS treatment, while paying for an experimental private treatment.
Whatever the merits of either system we do not have to adopt either the British or Canadian system. Indeed,none of the current reform bills propose that we adopt either system. What they propose is something like the Swiss system -highly regulated private health insurance, with a possible public option. Its time for us to stop beating the "government will abolish private health insurance" strawman. That not what is being proposed.

Megan McArdle (Replying to: Rick Caird) September 2, 2009 10:07 PM

It's not right wing propaganda--it's just outdated. Quebec did indeed forbid private care. The Canadian Supreme Court struck it down a few years back. I'm not sure that other provinces didn't as well.

moptop (Replying to: stonetools) September 2, 2009 12:04 PM

"don't confuse yourself with right wing theories"

Devastating comeback Stony. I have no plans to school you again on debate, since knowledge obviously rolls off your head like water off a duck's back. Keep pushing that Canadian system. It is really working for you.

90% of Stony's responses can be summarized as follows: "reject first, ask rhetorical questions later"

Lefty arguments can mostly be classified as appeals to common beliefs and imagined shared emotions, rather than to evidence and logic. That is what a rhetorical question is, almost every time.

What really frosts me about lefties is that in their own blindness, they are unable to perceive that most on the right want the greatest good for the greatest number too. It's just that we think that the simplistic and coercive theories of the left work against human nature to the detriment of the majority.

stonetools (Replying to: moptop) September 2, 2009 12:33 PM

Well, whether I am pushing the Canadian system or not ( and I'm not) the reform bills do not espouse the Canadian system, so discussion of it is a red herring.
But then, moptop specializes in red herrings.
I

moptop (Replying to: moptop) September 2, 2009 8:34 PM

Stony,
You are like the blind man arguing that there is no color blue.

Troy (Replying to: moptop) September 2, 2009 3:33 PM

Moptop, thanks for replying. Some follow ups:

A: Not sure that necessarily means companies dump their healthcare plans. If I can spend 10% of payroll on healthcare and that 2% marginal cost helps me compete for talent, it may be worth the 2% and the administration of the plan. Any sense of the ranges think tanks are projecting for how many people companies will dump into the public plan at 8%?

B: Why in the world would we be capping premiums in addition to offering a public plan? Seems like a bad idea. The credit argument is one I've heard, though most of the objections I hear have to do with permanently running the program at a loss, not stopgap, short-term measures. How important is short-term credit for health insurers?

C: Any sense of how much this is supposed to add (or, I suppose, detract) to the cost of doing business for insurers? On a percent of revenue basis?

D: True, but healthcare used to be a much smaller percentage of the household budget too. Not saying you're wrong, but isn't that the equivalent of saying, "Don't get on board the Lusitania, stay here on the Titanic?"

Nice to have someone answer substantively. The public debate moved so quickly into "sales" mode -- along with all the attending lies, strawmen, etc. -- that I have had a lot of trouble cutting through and understanding what is actually being proposed.

moptop (Replying to: Troy) September 2, 2009 8:20 PM

A) Right now, we are in a deflationary era, and companies are cutting pay, not raising it, unless you work for the govt of course. Competition for employees is not at an all time high right now. And because of point B, the fact that, according to Charlie Rangle on TV anyway, private plan premiums will be capped, it will be difficult for employers to offer private plans that are substantially better than the public plan.

B) They are talking about capping premiums as a selling point. I didn't make it up. When I talk about short term credit, I am talking about how long the US govt can go on borrowing trillions a year before our credit rating goes to hell. Leaving a broke govt in charge of supplying health care.

C) I have no idea, I just know that insurance plans as they exist today will no longer exist.

D) The market will control the cost of medical care. I know that lefties don't believe in supply and demand, but at some point, people will say that that improvements in medical care are not worth the cost, and will stop paying it. Our economy consists of people who make a living doing stuff for each other that the society needs. Why isn't health care part of that? What if we were spending 18% of our GDP on mass transportation, but everybody agreed that it was nice to be able to take trains everywhere? Or Entertainment? Would the govt say that we have to bring down the cost of entertainment and take over the movie industry, cutting quality, then everybody is supposed to be happy because ticket prices are cheaper... Maybe we don't want to spend 10% of our GDP and wait months to see a specialist.

Troy (Replying to: moptop) September 3, 2009 11:56 AM

A) The first two sentences are a weak argument -- legislation of this scale should have a much longer time horizon than the current economic cycle. The premiums cap problem, though, is a very strong argument. I just can't wrap my mind around that one. Seems like EITHER a public plan OR premium caps, but not both.

B) I understood your point about short-term credit, I just don't know how important it is to large insurers. Is this a key for their business model, and consequently the govt's ability to borrow in the short-term will be a huge advantage? Or is it a relatively minor advantage? Long-term debt, essentially the ability to operate at a loss for long periods of time, is another matter, and any legislation that allows the public option to operate at a loss as a matter of course would immediately lose my support.

D) I know a lot of lefties who believe in supply and demand, but think that it fails in the case of healthcare. There are some good arguments for this: if someone shows up to the auto dealership and can't afford a car, we feel no moral obligation to provide them with one, but if they show up at the hospital bleeding, we feel obligated to provide them with healthcare whether they can afford it or not. Surely you would agree that this is distorts the usual market dynamics. And that's just one way in which healthcare doesn't operate like a normal market -- I saw a list weeks ago with about 5 more, but have tried to find it and can't. But my point is that I see no contradiction in believing in general in the power of supply and demand but also thinking healthcare may be different.

What I'd like to understand, though, is how much those effects distort the usual workings of the market. I honestly don't know. I wish I could find that article again so I could propose those ideas and talk about if they're a big deal or a little deal.

stonetools (Replying to: moptop) September 2, 2009 11:00 AM

Universal health insurance has been instituted in many Countries. In none of these countries has private health insurance died out. NONE.
In the USA, there is Medicare ( universal, single payer health insurance for seniors). Yet some seniors still buy supplemental health insurance.

Look at the facts, , don't confuse yourself with right wing theories.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:21 AM

Right, so long as you assume that what people mean by "private health insurance" is "private supplemental health insurance", there is no problem. So let me be explicit: I have a problem with the fact that single-payer health care will drive out private primary health insurance. Whether entrenched corporate interests are still going to have a chance to profit on the supplemental market is of merely instrumental concern.

Rick Caird (Replying to: stonetools) September 2, 2009 11:29 AM

It is you who is confused. In Canada it is illegal to provide medical services outside the government program. So where would the private health insurance fit in?

In Britain, if you go outside the national system, you can be eliminated from the system for the treatment of that disease. Private insurance is a very minor part of the English system and covers only a subset of procedures. The statistic I saw says that only 8% of the population have private health insurance.

Your claim that private health insurance has not died out is misleading at best.

Rick

stonetools (Replying to: Rick Caird) September 2, 2009 12:28 PM

The Canadian claim has been dealt with above. It is not illegal.
Search "New England journal of Medicine" on this page.The claim is right wing propaganda, as one (anti reform) commenter puts it.
In Britain, you in fact can have private health insurance. The famous Boyle case is misconstrued by the right wing as showing that the NHS bans private health insurance, whereas in fact Ms. Boyle received most of her cancer treatment from the NHS, and wanted to continue receiving NHS treatment, while paying for an experimental private treatment.
Whatever the merits of either system we do not have to adopt either the British or Canadian system. Indeed,none of the current reform bills propose that we adopt either system. What they propose is something like the Swiss system -highly regulated private health insurance, with a possible public option. Its time for us to stop beating the "government will abolish private health insurance" strawman. That not what is being proposed.

Megan McArdle (Replying to: Rick Caird) September 2, 2009 10:07 PM

It's not right wing propaganda--it's just outdated. Quebec did indeed forbid private care. The Canadian Supreme Court struck it down a few years back. I'm not sure that other provinces didn't as well.

moptop (Replying to: stonetools) September 2, 2009 12:04 PM

"don't confuse yourself with right wing theories"

Devastating comeback Stony. I have no plans to school you again on debate, since knowledge obviously rolls off your head like water off a duck's back. Keep pushing that Canadian system. It is really working for you.

90% of Stony's responses can be summarized as follows: "reject first, ask rhetorical questions later"

Lefty arguments can mostly be classified as appeals to common beliefs and imagined shared emotions, rather than to evidence and logic. That is what a rhetorical question is, almost every time.

What really frosts me about lefties is that in their own blindness, they are unable to perceive that most on the right want the greatest good for the greatest number too. It's just that we think that the simplistic and coercive theories of the left work against human nature to the detriment of the majority.

stonetools (Replying to: moptop) September 2, 2009 12:33 PM

Well, whether I am pushing the Canadian system or not ( and I'm not) the reform bills do not espouse the Canadian system, so discussion of it is a red herring.
But then, moptop specializes in red herrings.
I

moptop (Replying to: moptop) September 2, 2009 8:34 PM

Stony,
You are like the blind man arguing that there is no color blue.

Joshua Lyle (Replying to: stonetools) September 2, 2009 11:21 AM

Right, so long as you assume that what people mean by "private health insurance" is "private supplemental health insurance", there is no problem. So let me be explicit: I have a problem with the fact that single-payer health care will drive out private primary health insurance. Whether entrenched corporate interests are still going to have a chance to profit on the supplemental market is of merely instrumental concern.

Rick Caird (Replying to: stonetools) September 2, 2009 11:29 AM

It is you who is confused. In Canada it is illegal to provide medical services outside the government program. So where would the private health insurance fit in?

In Britain, if you go outside the national system, you can be eliminated from the system for the treatment of that disease. Private insurance is a very minor part of the English system and covers only a subset of procedures. The statistic I saw says that only 8% of the population have private health insurance.

Your claim that private health insurance has not died out is misleading at best.

Rick

stonetools (Replying to: Rick Caird) September 2, 2009 12:28 PM

The Canadian claim has been dealt with above. It is not illegal.
Search "New England journal of Medicine" on this page.The claim is right wing propaganda, as one (anti reform) commenter puts it.
In Britain, you in fact can have private health insurance. The famous Boyle case is misconstrued by the right wing as showing that the NHS bans private health insurance, whereas in fact Ms. Boyle received most of her cancer treatment from the NHS, and wanted to continue receiving NHS treatment, while paying for an experimental private treatment.
Whatever the merits of either system we do not have to adopt either the British or Canadian system. Indeed,none of the current reform bills propose that we adopt either system. What they propose is something like the Swiss system -highly regulated private health insurance, with a possible public option. Its time for us to stop beating the "government will abolish private health insurance" strawman. That not what is being proposed.

Megan McArdle (Replying to: Rick Caird) September 2, 2009 10:07 PM

It's not right wing propaganda--it's just outdated. Quebec did indeed forbid private care. The Canadian Supreme Court struck it down a few years back. I'm not sure that other provinces didn't as well.

stonetools (Replying to: Rick Caird) September 2, 2009 12:28 PM

The Canadian claim has been dealt with above. It is not illegal.
Search "New England journal of Medicine" on this page.The claim is right wing propaganda, as one (anti reform) commenter puts it.
In Britain, you in fact can have private health insurance. The famous Boyle case is misconstrued by the right wing as showing that the NHS bans private health insurance, whereas in fact Ms. Boyle received most of her cancer treatment from the NHS, and wanted to continue receiving NHS treatment, while paying for an experimental private treatment.
Whatever the merits of either system we do not have to adopt either the British or Canadian system. Indeed,none of the current reform bills propose that we adopt either system. What they propose is something like the Swiss system -highly regulated private health insurance, with a possible public option. Its time for us to stop beating the "government will abolish private health insurance" strawman. That not what is being proposed.

Megan McArdle (Replying to: Rick Caird) September 2, 2009 10:07 PM

It's not right wing propaganda--it's just outdated. Quebec did indeed forbid private care. The Canadian Supreme Court struck it down a few years back. I'm not sure that other provinces didn't as well.

moptop (Replying to: stonetools) September 2, 2009 12:04 PM

"don't confuse yourself with right wing theories"

Devastating comeback Stony. I have no plans to school you again on debate, since knowledge obviously rolls off your head like water off a duck's back. Keep pushing that Canadian system. It is really working for you.

90% of Stony's responses can be summarized as follows: "reject first, ask rhetorical questions later"

Lefty arguments can mostly be classified as appeals to common beliefs and imagined shared emotions, rather than to evidence and logic. That is what a rhetorical question is, almost every time.

What really frosts me about lefties is that in their own blindness, they are unable to perceive that most on the right want the greatest good for the greatest number too. It's just that we think that the simplistic and coercive theories of the left work against human nature to the detriment of the majority.

stonetools (Replying to: moptop) September 2, 2009 12:33 PM

Well, whether I am pushing the Canadian system or not ( and I'm not) the reform bills do not espouse the Canadian system, so discussion of it is a red herring.
But then, moptop specializes in red herrings.
I

moptop (Replying to: moptop) September 2, 2009 8:34 PM

Stony,
You are like the blind man arguing that there is no color blue.

stonetools (Replying to: moptop) September 2, 2009 12:33 PM

Well, whether I am pushing the Canadian system or not ( and I'm not) the reform bills do not espouse the Canadian system, so discussion of it is a red herring.
But then, moptop specializes in red herrings.
I

moptop (Replying to: moptop) September 2, 2009 8:34 PM

Stony,
You are like the blind man arguing that there is no color blue.

Troy (Replying to: moptop) September 2, 2009 3:33 PM

Moptop, thanks for replying. Some follow ups:

A: Not sure that necessarily means companies dump their healthcare plans. If I can spend 10% of payroll on healthcare and that 2% marginal cost helps me compete for talent, it may be worth the 2% and the administration of the plan. Any sense of the ranges think tanks are projecting for how many people companies will dump into the public plan at 8%?

B: Why in the world would we be capping premiums in addition to offering a public plan? Seems like a bad idea. The credit argument is one I've heard, though most of the objections I hear have to do with permanently running the program at a loss, not stopgap, short-term measures. How important is short-term credit for health insurers?

C: Any sense of how much this is supposed to add (or, I suppose, detract) to the cost of doing business for insurers? On a percent of revenue basis?

D: True, but healthcare used to be a much smaller percentage of the household budget too. Not saying you're wrong, but isn't that the equivalent of saying, "Don't get on board the Lusitania, stay here on the Titanic?"

Nice to have someone answer substantively. The public debate moved so quickly into "sales" mode -- along with all the attending lies, strawmen, etc. -- that I have had a lot of trouble cutting through and understanding what is actually being proposed.

moptop (Replying to: Troy) September 2, 2009 8:20 PM

A) Right now, we are in a deflationary era, and companies are cutting pay, not raising it, unless you work for the govt of course. Competition for employees is not at an all time high right now. And because of point B, the fact that, according to Charlie Rangle on TV anyway, private plan premiums will be capped, it will be difficult for employers to offer private plans that are substantially better than the public plan.

B) They are talking about capping premiums as a selling point. I didn't make it up. When I talk about short term credit, I am talking about how long the US govt can go on borrowing trillions a year before our credit rating goes to hell. Leaving a broke govt in charge of supplying health care.

C) I have no idea, I just know that insurance plans as they exist today will no longer exist.

D) The market will control the cost of medical care. I know that lefties don't believe in supply and demand, but at some point, people will say that that improvements in medical care are not worth the cost, and will stop paying it. Our economy consists of people who make a living doing stuff for each other that the society needs. Why isn't health care part of that? What if we were spending 18% of our GDP on mass transportation, but everybody agreed that it was nice to be able to take trains everywhere? Or Entertainment? Would the govt say that we have to bring down the cost of entertainment and take over the movie industry, cutting quality, then everybody is supposed to be happy because ticket prices are cheaper... Maybe we don't want to spend 10% of our GDP and wait months to see a specialist.

Troy (Replying to: moptop) September 3, 2009 11:56 AM

A) The first two sentences are a weak argument -- legislation of this scale should have a much longer time horizon than the current economic cycle. The premiums cap problem, though, is a very strong argument. I just can't wrap my mind around that one. Seems like EITHER a public plan OR premium caps, but not both.

B) I understood your point about short-term credit, I just don't know how important it is to large insurers. Is this a key for their business model, and consequently the govt's ability to borrow in the short-term will be a huge advantage? Or is it a relatively minor advantage? Long-term debt, essentially the ability to operate at a loss for long periods of time, is another matter, and any legislation that allows the public option to operate at a loss as a matter of course would immediately lose my support.

D) I know a lot of lefties who believe in supply and demand, but think that it fails in the case of healthcare. There are some good arguments for this: if someone shows up to the auto dealership and can't afford a car, we feel no moral obligation to provide them with one, but if they show up at the hospital bleeding, we feel obligated to provide them with healthcare whether they can afford it or not. Surely you would agree that this is distorts the usual market dynamics. And that's just one way in which healthcare doesn't operate like a normal market -- I saw a list weeks ago with about 5 more, but have tried to find it and can't. But my point is that I see no contradiction in believing in general in the power of supply and demand but also thinking healthcare may be different.

What I'd like to understand, though, is how much those effects distort the usual workings of the market. I honestly don't know. I wish I could find that article again so I could propose those ideas and talk about if they're a big deal or a little deal.

moptop (Replying to: Troy) September 2, 2009 8:20 PM

A) Right now, we are in a deflationary era, and companies are cutting pay, not raising it, unless you work for the govt of course. Competition for employees is not at an all time high right now. And because of point B, the fact that, according to Charlie Rangle on TV anyway, private plan premiums will be capped, it will be difficult for employers to offer private plans that are substantially better than the public plan.

B) They are talking about capping premiums as a selling point. I didn't make it up. When I talk about short term credit, I am talking about how long the US govt can go on borrowing trillions a year before our credit rating goes to hell. Leaving a broke govt in charge of supplying health care.

C) I have no idea, I just know that insurance plans as they exist today will no longer exist.

D) The market will control the cost of medical care. I know that lefties don't believe in supply and demand, but at some point, people will say that that improvements in medical care are not worth the cost, and will stop paying it. Our economy consists of people who make a living doing stuff for each other that the society needs. Why isn't health care part of that? What if we were spending 18% of our GDP on mass transportation, but everybody agreed that it was nice to be able to take trains everywhere? Or Entertainment? Would the govt say that we have to bring down the cost of entertainment and take over the movie industry, cutting quality, then everybody is supposed to be happy because ticket prices are cheaper... Maybe we don't want to spend 10% of our GDP and wait months to see a specialist.

Troy (Replying to: moptop) September 3, 2009 11:56 AM

A) The first two sentences are a weak argument -- legislation of this scale should have a much longer time horizon than the current economic cycle. The premiums cap problem, though, is a very strong argument. I just can't wrap my mind around that one. Seems like EITHER a public plan OR premium caps, but not both.

B) I understood your point about short-term credit, I just don't know how important it is to large insurers. Is this a key for their business model, and consequently the govt's ability to borrow in the short-term will be a huge advantage? Or is it a relatively minor advantage? Long-term debt, essentially the ability to operate at a loss for long periods of time, is another matter, and any legislation that allows the public option to operate at a loss as a matter of course would immediately lose my support.

D) I know a lot of lefties who believe in supply and demand, but think that it fails in the case of healthcare. There are some good arguments for this: if someone shows up to the auto dealership and can't afford a car, we feel no moral obligation to provide them with one, but if they show up at the hospital bleeding, we feel obligated to provide them with healthcare whether they can afford it or not. Surely you would agree that this is distorts the usual market dynamics. And that's just one way in which healthcare doesn't operate like a normal market -- I saw a list weeks ago with about 5 more, but have tried to find it and can't. But my point is that I see no contradiction in believing in general in the power of supply and demand but also thinking healthcare may be different.

What I'd like to understand, though, is how much those effects distort the usual workings of the market. I honestly don't know. I wish I could find that article again so I could propose those ideas and talk about if they're a big deal or a little deal.

Troy (Replying to: moptop) September 3, 2009 11:56 AM

A) The first two sentences are a weak argument -- legislation of this scale should have a much longer time horizon than the current economic cycle. The premiums cap problem, though, is a very strong argument. I just can't wrap my mind around that one. Seems like EITHER a public plan OR premium caps, but not both.

B) I understood your point about short-term credit, I just don't know how important it is to large insurers. Is this a key for their business model, and consequently the govt's ability to borrow in the short-term will be a huge advantage? Or is it a relatively minor advantage? Long-term debt, essentially the ability to operate at a loss for long periods of time, is another matter, and any legislation that allows the public option to operate at a loss as a matter of course would immediately lose my support.

D) I know a lot of lefties who believe in supply and demand, but think that it fails in the case of healthcare. There are some good arguments for this: if someone shows up to the auto dealership and can't afford a car, we feel no moral obligation to provide them with one, but if they show up at the hospital bleeding, we feel obligated to provide them with healthcare whether they can afford it or not. Surely you would agree that this is distorts the usual market dynamics. And that's just one way in which healthcare doesn't operate like a normal market -- I saw a list weeks ago with about 5 more, but have tried to find it and can't. But my point is that I see no contradiction in believing in general in the power of supply and demand but also thinking healthcare may be different.

What I'd like to understand, though, is how much those effects distort the usual workings of the market. I honestly don't know. I wish I could find that article again so I could propose those ideas and talk about if they're a big deal or a little deal.

Michael Couvillion September 2, 2009 10:57 AM

This may have been said before, but if what we really want is more health care for everyone, and I think it is, we need to work on increasing productivity in the health care industry. No amount of redistributing a set of services that scarcity has made too dear is going to magically make it plentiful and cheap, and as Megan has pointed out many times, it's really easy to mess things up in trying, so that there's even less of the service (relatively speaking) available tomorrow. Increasing productivity in the health care industry is a very difficult proposition already. Personnel costs are high (and most of that cost is unavoidable, given the high levels of education, regulation, etc., in that field), and new equipment/treatments are increasingly expensive. New pharma is arguably the easiest way to increase health care productivity, and that's what we put the most at risk with if we implement some of the more extreme proposals out there. We need to focus on increasing competition in the health care industry. We need more pharmacutical companies, more health care delivery companies, more health care workers, more innovation, etc., if we want more health care services per dollar, which is what we need. We should be looking at how we impede entry into these industries, or how we increase the cost of operating therein, rather than trying to rearrange the deck chairs on the health care Titanic.

Arjun (Replying to: Michael Couvillion) September 2, 2009 12:25 PM

It is highly doubtful that I can improve upon this comment but I wanted to try to add a little bit. It seems to me that shielding health care consumers from the costs of their health care, though it may result from an understandable impulse, allows individuals and institutions providing the health care to increase costs excessively. The providers may do so, for example, by raising prices with relative impunity, or by recommending more services than are necessary for or even beneficial to the patient.

When I was a medical student I overheard a physician angrily denounce Americans' acceptance of managed care (which had cut his income nearly in half for the same amount of work). "You know what? You get what you pay for!" Maybe yes and no. Look at the health care centers in the U.S. where care is provided at relatively lower cost. These are not bare bones facilities -- patients come from all around the world (including from developed countries with better health care financing systems!) to receive care at some of these centers. Surely there must be a way to enable health care consumers to make good choices so that health care providers are forced to compete for health care consumers by increasing health care quality and decreasing health care costs.

stonetools (Replying to: Arjun) September 2, 2009 12:52 PM

Well, one propsal often made in these comment threads is that we can increase the supply of medical services and cut costs if we repeal the occupational licensing laws and all allow nondoctors to offer the services currently reserved to doctors.
Are you OK with that :-).

This article is considered a must read on cost control:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

You should read the whole thing, but this is the conclusion:

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

He wants something like the Mayo Clinic for all, whether paid for by the government or by private health insurance. Of course, it would take major government intervention in the current system to achieve this.

Arjun (Replying to: stonetools) September 2, 2009 2:01 PM

In my experience, non-physician providers such as physician assistants and nurse practitioners can be excellent colleagues and team members. I've met many who provide excellent health care. They also provide less expensive health care. So I would support reducing some of the anti-competitive restrictions on licensed midlevel providers. However, I would not support repeal of all licensing laws.

I loved Dr. Gawande's article, and of course I accept that Dr. Gawande is smarter than I am, but I think I disagree with some of Dr. Gawande's conclusions. I think "major government intervention" to promote high quality, low cost, and accountability for the totality of care is a great idea. But I also think that maybe it does matter who writes the checks. If the consumer writes the checks then she has the power to choose her provider and she has an incentive to seek lower costs. If she has good information about costs and quality (e.g. outcomes), perhaps she will choose a good provider. Perhaps the providers will compete with each other to do a better job at a lower cost.

If I recall correctly, Dr. Gawande gives the example of a woman who is told she needs a coronary artery bypass graft in order to stay alive. He says she is not going to haggle over the price "like buying a rug in a souk." Therefore, Dr. Gawande suggests, consumer-directed health care can't work.

But wait a minute! This coronary patient doesn't have to negotiate a lower price. She doesn't even have to shop around for a lower price. The hospital will know that other patients are shopping around for a lower price. I don't know anything about economics, but maybe the fear of competitors will exert downward pressure on the price the hospital charges?

Arjun (Replying to: Michael Couvillion) September 2, 2009 12:25 PM

It is highly doubtful that I can improve upon this comment but I wanted to try to add a little bit. It seems to me that shielding health care consumers from the costs of their health care, though it may result from an understandable impulse, allows individuals and institutions providing the health care to increase costs excessively. The providers may do so, for example, by raising prices with relative impunity, or by recommending more services than are necessary for or even beneficial to the patient.

When I was a medical student I overheard a physician angrily denounce Americans' acceptance of managed care (which had cut his income nearly in half for the same amount of work). "You know what? You get what you pay for!" Maybe yes and no. Look at the health care centers in the U.S. where care is provided at relatively lower cost. These are not bare bones facilities -- patients come from all around the world (including from developed countries with better health care financing systems!) to receive care at some of these centers. Surely there must be a way to enable health care consumers to make good choices so that health care providers are forced to compete for health care consumers by increasing health care quality and decreasing health care costs.

stonetools (Replying to: Arjun) September 2, 2009 12:52 PM

Well, one propsal often made in these comment threads is that we can increase the supply of medical services and cut costs if we repeal the occupational licensing laws and all allow nondoctors to offer the services currently reserved to doctors.
Are you OK with that :-).

This article is considered a must read on cost control:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

You should read the whole thing, but this is the conclusion:

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

He wants something like the Mayo Clinic for all, whether paid for by the government or by private health insurance. Of course, it would take major government intervention in the current system to achieve this.

Arjun (Replying to: stonetools) September 2, 2009 2:01 PM

In my experience, non-physician providers such as physician assistants and nurse practitioners can be excellent colleagues and team members. I've met many who provide excellent health care. They also provide less expensive health care. So I would support reducing some of the anti-competitive restrictions on licensed midlevel providers. However, I would not support repeal of all licensing laws.

I loved Dr. Gawande's article, and of course I accept that Dr. Gawande is smarter than I am, but I think I disagree with some of Dr. Gawande's conclusions. I think "major government intervention" to promote high quality, low cost, and accountability for the totality of care is a great idea. But I also think that maybe it does matter who writes the checks. If the consumer writes the checks then she has the power to choose her provider and she has an incentive to seek lower costs. If she has good information about costs and quality (e.g. outcomes), perhaps she will choose a good provider. Perhaps the providers will compete with each other to do a better job at a lower cost.

If I recall correctly, Dr. Gawande gives the example of a woman who is told she needs a coronary artery bypass graft in order to stay alive. He says she is not going to haggle over the price "like buying a rug in a souk." Therefore, Dr. Gawande suggests, consumer-directed health care can't work.

But wait a minute! This coronary patient doesn't have to negotiate a lower price. She doesn't even have to shop around for a lower price. The hospital will know that other patients are shopping around for a lower price. I don't know anything about economics, but maybe the fear of competitors will exert downward pressure on the price the hospital charges?

stonetools (Replying to: Arjun) September 2, 2009 12:52 PM

Well, one propsal often made in these comment threads is that we can increase the supply of medical services and cut costs if we repeal the occupational licensing laws and all allow nondoctors to offer the services currently reserved to doctors.
Are you OK with that :-).

This article is considered a must read on cost control:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

You should read the whole thing, but this is the conclusion:

This last point is vital. Activists and policymakers spend an inordinate amount of time arguing about whether the solution to high medical costs is to have government or private insurance companies write the checks. Here’s how this whole debate goes. Advocates of a public option say government financing would save the most money by having leaner administrative costs and forcing doctors and hospitals to take lower payments than they get from private insurance. Opponents say doctors would skimp, quit, or game the system, and make us wait in line for our care; they maintain that private insurers are better at policing doctors. No, the skeptics say: all insurance companies do is reject applicants who need health care and stall on paying their bills. Then we have the economists who say that the people who should pay the doctors are the ones who use them. Have consumers pay with their own dollars, make sure that they have some “skin in the game,” and then they’ll get the care they deserve. These arguments miss the main issue. When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care. Otherwise, you get a system that has no brakes. You get McAllen.

He wants something like the Mayo Clinic for all, whether paid for by the government or by private health insurance. Of course, it would take major government intervention in the current system to achieve this.

Arjun (Replying to: stonetools) September 2, 2009 2:01 PM

In my experience, non-physician providers such as physician assistants and nurse practitioners can be excellent colleagues and team members. I've met many who provide excellent health care. They also provide less expensive health care. So I would support reducing some of the anti-competitive restrictions on licensed midlevel providers. However, I would not support repeal of all licensing laws.

I loved Dr. Gawande's article, and of course I accept that Dr. Gawande is smarter than I am, but I think I disagree with some of Dr. Gawande's conclusions. I think "major government intervention" to promote high quality, low cost, and accountability for the totality of care is a great idea. But I also think that maybe it does matter who writes the checks. If the consumer writes the checks then she has the power to choose her provider and she has an incentive to seek lower costs. If she has good information about costs and quality (e.g. outcomes), perhaps she will choose a good provider. Perhaps the providers will compete with each other to do a better job at a lower cost.

If I recall correctly, Dr. Gawande gives the example of a woman who is told she needs a coronary artery bypass graft in order to stay alive. He says she is not going to haggle over the price "like buying a rug in a souk." Therefore, Dr. Gawande suggests, consumer-directed health care can't work.

But wait a minute! This coronary patient doesn't have to negotiate a lower price. She doesn't even have to shop around for a lower price. The hospital will know that other patients are shopping around for a lower price. I don't know anything about economics, but maybe the fear of competitors will exert downward pressure on the price the hospital charges?

Arjun (Replying to: stonetools) September 2, 2009 2:01 PM

In my experience, non-physician providers such as physician assistants and nurse practitioners can be excellent colleagues and team members. I've met many who provide excellent health care. They also provide less expensive health care. So I would support reducing some of the anti-competitive restrictions on licensed midlevel providers. However, I would not support repeal of all licensing laws.

I loved Dr. Gawande's article, and of course I accept that Dr. Gawande is smarter than I am, but I think I disagree with some of Dr. Gawande's conclusions. I think "major government intervention" to promote high quality, low cost, and accountability for the totality of care is a great idea. But I also think that maybe it does matter who writes the checks. If the consumer writes the checks then she has the power to choose her provider and she has an incentive to seek lower costs. If she has good information about costs and quality (e.g. outcomes), perhaps she will choose a good provider. Perhaps the providers will compete with each other to do a better job at a lower cost.

If I recall correctly, Dr. Gawande gives the example of a woman who is told she needs a coronary artery bypass graft in order to stay alive. He says she is not going to haggle over the price "like buying a rug in a souk." Therefore, Dr. Gawande suggests, consumer-directed health care can't work.

But wait a minute! This coronary patient doesn't have to negotiate a lower price. She doesn't even have to shop around for a lower price. The hospital will know that other patients are shopping around for a lower price. I don't know anything about economics, but maybe the fear of competitors will exert downward pressure on the price the hospital charges?

Earnest Iconoclast September 2, 2009 11:01 AM

One thing that keeps getting left out of the so-called "price rationing" versus government rationing argument is that markets and prices allow for the allocation of resources to and from an industry. In other words, if prices go up because demand goes up, then resources from completely different industries can be allocated to meet the demand.

In the case of medicine, perhaps manufacturers start making more medical equipment and less of another kind of equipment that is in lower demand. Or more people go into medicine (as doctors, nurses, etc...). Or investors are willing to build more hospitals.

Once the government starts rationing, there is no signal to other markets to jump in and meet the demand as the government sets the resource allocation.

We may not be able to consume ALL of the health care that we want, but we can certainly consume MORE if we are willing to pay for it under a more market-based system.

For example, how much do Americans spend on cosmetic surgery compared to other nations where health care costs are lower?

MikeR September 2, 2009 11:55 AM

Great post, and food for thought. Thanks.

TallDave September 2, 2009 1:47 PM

Great essay, Megan. Fair-minded and well thought-out.

Some of your best work. Really a pleasure to read.

Lee A. Arnold September 2, 2009 4:19 PM

Megan, you quote Hayek on the functions of the price mechanism, but this argument applies to supply and demand over an ENTIRE system, and does not invalidate the making of one portion of it into some other sort of rationing mechanism. So even with a totally nationalized healthcare system, outside of it the private suppliers of goods to it would still exist, and be innovating according to its demand.

Indeed there would be MORE demand, because more people would be in the system.

Of course in the U.S. reform debate, a national healthcare system is not on the table: merely a public insurance choice for consumers in the market. Here, your argument appears to jump to the position that this would crowd-out, and put an end to, private insurance. But in the Congressional bills being offered it would not, and you offer no theoretical or empirical particulars that it would.

This makes it difficult to accept your implication that one’s own philosophical opinion on a policy issue should make reference to particulars. In fact, you appear to be making the general “slippery slope to communism” argument again, vacillating as libertarians often do between the liberty and efficiency aspects of that old chestnut.

As to particulars, The Road to Serfdom never came true in a democracy -- and by the way, Hayek argued in favor of national health insurance:

"Where, as in the case of sickness and accident, neither the desire to avoid such calamities nor the efforts to overcome their consequences are as a rule weakened by the provision of assistance -- where, in short, we deal with genuinely insurable risks -- the case for the state's helping to organize a comprehensive system of social insurance is very strong." -- Hayek, Road to Serfdom (1944) pp. 120-121.

TallDave September 2, 2009 7:41 PM

Indeed there would be MORE demand, because more people would be in the system.

Monopsony pricing.

Repeat after me: price controls always lead to...

Lee A. Arnold (Replying to: TallDave) September 3, 2009 1:34 AM

TallDave: "Indeed there would be MORE demand, because more people would be in the system.
Monopsony pricing.
Repeat after me: price controls always lead to..."

No, they don't. First I should follow Megan's example and say what I would accept, in in fact would like to see: which is a public insurance option for a rudimentary healthcare package, plus additional private coverage available for your own lifestyle. This is a two-tier system and sounds like the Australian system, if I read it correctly. Private insurers will do quite well with the high-end market.

But even if it were a complete monopsony, this isn't your textbook monopsony. In this particular monopsony, the sellers aren't perfect substitutes by any means: they are either dominant in a local geography (such as hospitals) or they are actually monopolistic competitors (such as pharma.) They aren't interchangeable and so they don't suffer a big demand restriction. In reality Big Pharm does well in socialized medicine countries. (So it would not be a monopsony, actually it's more like a bilateral monopoly. Evening up the sides, as it were.)

That's on the supply side. On the demand side, because the buyer is Everybody, we can't even conclude that there is a deadweight loss to social welfare in this monopsony. Here is the quote from Hayek again:

"Where, as in the case of sickness and accident, NEITHER THE DESIRE TO AVOID such calamities NOR THE EFFORTS TO OVERCOME their consequences ARE as a rule WEAKENED by the provision of assistance -- where, in short, we deal with genuinely insurable risks -- the case for the state's helping to organize a comprehensive system of social insurance is very strong." [my caps]

In other words, the will of the individual is not weakened in these types of cases and the intentions do not change. Now, to make a monopsony, these intentionalities aggregate into the one big buyer. Therefore in this particular monopsony the demand is constant -- it's not a curve, it's a horizontal line. In reality that demand exists right now -- the problem is that some of it is just not being filled.

So we have a monopsony in which demand is a straight line, and the supply cannot be done without! Hardly a situation where price controls always lead to...

Lee A. Arnold (Replying to: Lee A. Arnold) September 3, 2009 1:38 AM

Actually in a traditional supply and demand graph a constant demand would be a vertical line, not a horizontal one. The point still stands.

Lee A. Arnold (Replying to: TallDave) September 3, 2009 1:34 AM

TallDave: "Indeed there would be MORE demand, because more people would be in the system.
Monopsony pricing.
Repeat after me: price controls always lead to..."

No, they don't. First I should follow Megan's example and say what I would accept, in in fact would like to see: which is a public insurance option for a rudimentary healthcare package, plus additional private coverage available for your own lifestyle. This is a two-tier system and sounds like the Australian system, if I read it correctly. Private insurers will do quite well with the high-end market.

But even if it were a complete monopsony, this isn't your textbook monopsony. In this particular monopsony, the sellers aren't perfect substitutes by any means: they are either dominant in a local geography (such as hospitals) or they are actually monopolistic competitors (such as pharma.) They aren't interchangeable and so they don't suffer a big demand restriction. In reality Big Pharm does well in socialized medicine countries. (So it would not be a monopsony, actually it's more like a bilateral monopoly. Evening up the sides, as it were.)

That's on the supply side. On the demand side, because the buyer is Everybody, we can't even conclude that there is a deadweight loss to social welfare in this monopsony. Here is the quote from Hayek again:

"Where, as in the case of sickness and accident, NEITHER THE DESIRE TO AVOID such calamities NOR THE EFFORTS TO OVERCOME their consequences ARE as a rule WEAKENED by the provision of assistance -- where, in short, we deal with genuinely insurable risks -- the case for the state's helping to organize a comprehensive system of social insurance is very strong." [my caps]

In other words, the will of the individual is not weakened in these types of cases and the intentions do not change. Now, to make a monopsony, these intentionalities aggregate into the one big buyer. Therefore in this particular monopsony the demand is constant -- it's not a curve, it's a horizontal line. In reality that demand exists right now -- the problem is that some of it is just not being filled.

So we have a monopsony in which demand is a straight line, and the supply cannot be done without! Hardly a situation where price controls always lead to...

Lee A. Arnold (Replying to: Lee A. Arnold) September 3, 2009 1:38 AM

Actually in a traditional supply and demand graph a constant demand would be a vertical line, not a horizontal one. The point still stands.

Lee A. Arnold (Replying to: Lee A. Arnold) September 3, 2009 1:38 AM

Actually in a traditional supply and demand graph a constant demand would be a vertical line, not a horizontal one. The point still stands.

zosima September 2, 2009 8:40 PM

Holbo seems to be engaging in the proverbial smack-down. Rocking your socks around the blocks, philosophically speaking.

M. Report September 2, 2009 10:04 PM

MM: Mental Health Break

http://www.poetryloverspage.com/poets
/kipling/imperial_rescript.html

My own 2000 mils:
The economic emergency justifies
delaying action on this issue
until said EE is resolved.

The medical engineering advances
over the next 10 years, 20 tops,
will render the point moot, even
allowing for reduction in size
of the medical community.

Justin Blank September 2, 2009 11:37 PM

Mea culpa: the use of 'poor' there was a lapse. I was following the couple of uses of the word by you and Holbo and didn't stop to think. You're right that healthcare reform will have its effects elsewhere. I'm not sure it matters since:

The entire point of the 'poor' quote was that you're not make a principled argument against healthcare, you're making a practical argument. Which was half of Holbo's point, and which you've never really contested. Practical arguments are of course a great type of argument.

But Holbo's charge was that you're not making a good practical argument, because you're not giving details, just general reasons why public policies are often bad. Good arguments, and ones that I worry about! But not ones that deal with questions about whether a specific plan is a good idea. That's Holbo's charge, and I don't see a response.

And of course I was also noting that you were being incredibly snide and dismissive, while loudly saying that Holbo was an ideological hack.

zosima September 3, 2009 4:52 AM

Megan,
You fall back to the generic argument, "prices signals make markets more efficient than government."

For like the third time, you miss holbo's argument which is: "Yes, given, price signals make markets more efficient in general, but in the specific case of medical R&D, price signals are not important or significant, thus we can conclude the performance of private and public should be comparable."

You need to explain why the medical R&D market is the same as the market for Tin in some substantive way. At this point you haven't, holbo's argument subsumes your claim entirely.

TomB (Replying to: zosima) September 3, 2009 10:08 AM

I think you or Holbo need to explain why the medical R&D market would be any different than that for tin. His argument is pure speculation.

Government provides most of the R&D money for defense-related innovation. Investment decisions are made based on keeping jobs in a district. Why does Murtha's district, 3 hours outside of DC in the middle of nowhere Pennsylvania, have so much defense work? Because Murtha allocates money to his district. Politicians do not make the same cost-benefit determination that businessmen make.

Lee A. Arnold (Replying to: TomB) September 3, 2009 10:24 AM

Because it would be a sort of bilateral monopoly with a monopsony on one side, and monopolistic competition on the other side. So the demand is constant, and the supply cannot be done without.

TomB (Replying to: zosima) September 3, 2009 10:08 AM

I think you or Holbo need to explain why the medical R&D market would be any different than that for tin. His argument is pure speculation.

Government provides most of the R&D money for defense-related innovation. Investment decisions are made based on keeping jobs in a district. Why does Murtha's district, 3 hours outside of DC in the middle of nowhere Pennsylvania, have so much defense work? Because Murtha allocates money to his district. Politicians do not make the same cost-benefit determination that businessmen make.

Lee A. Arnold (Replying to: TomB) September 3, 2009 10:24 AM

Because it would be a sort of bilateral monopoly with a monopsony on one side, and monopolistic competition on the other side. So the demand is constant, and the supply cannot be done without.

Lee A. Arnold (Replying to: TomB) September 3, 2009 10:24 AM

Because it would be a sort of bilateral monopoly with a monopsony on one side, and monopolistic competition on the other side. So the demand is constant, and the supply cannot be done without.