Millions and millions of Americans support Obama’s desire to even more massively intervene in the market for medical care than the US state already does. And of course Obama’s moves are just the opening salvo in a desire to eventually end up with fully socialist healthcare, along the lines of Britain’s ghastly National Health Service, which has intermittently tried to kill me over the years.
I have tried pointing Americans at the British example to show them what an appalling idea it is to have the state directing any industry, let alone medical care. But alas it is very hard to overcome that special kind of insular American optimism that does not think what happens in another advanced first world nation can teach them anything, because in the USA things will be different.
Well yes, it will be different… in that the control obsessed Obama’s of this world will find new, innovative and oh so wholesome American ways to end up with a third rate health care system much like Britain has today.
This might be a good time for Americans to invest their money in Swiss medical clinics as I suspect in the coming years expatriated medical care will be a serious growth industry… plus it has the added benefit of getting your money out of the USA and US dollar.
Actually, the Reuters story is somewhat misleading:
CBS(Link), as almost always, the Devil is in the details. Basically 72% of Americans support the health care if it A) doesn’t cost them very much, and B) doesn’t impact their own health care.
From one of those Americans who don’t approve of the current administrations policies toward Euro-style socialism/fascism, there’s another point which rarely gets made. One of the reasons the post-war Euro socialists managed to maintain relatively comfortable lifestyles despite lower growth rates is that the US acted as an engine of world growh, dragging every one else with them. If the US drops that role, there will be no one to replace it. People who think it will be China are in for quite a shock. Their mercantile policies make them utterly dependent on world growth led by the US. I also find the idea that by some magic process they will stimulate domestic demand and cause a population which saved 30% of their income in boom times to start saving less and spending more in the worst major global recession in 30 years, laughable.
The other problem, as has been pointed out by others, is that the US was the place to escape to by oppressed people around the world. If it joins the worlds thugocracies with little respect for rule of law, individuals, independence, etc… people have no place left to go.
I see a very dark future. Even if we manage to throw Obama out in 2012 we will still be saddled with enormous debts and large government programs that will be hard to repeal once they are established (witness Social Security, Medicare, Medicaid or even the Dept of Education and the honey subsidy).
They aren’t being stupid. Other people aren’t stupid en masse, or at least have no greater stupidity than us. It is easy when one has strong convictions on an issue- and are thus certain that one is right- that anyone who disagrees with something obviously right must be stupid. Or ignorant. Or uneducated. Or corrupted. Or evil. And it’s nice to think such things, but doesn’t get one any closer to understanding one’s opponent, and thus to perhaps changing their mind. The rest of the world is stupid is a howl of frustration and despair we all love to emit, but it’s not really true.
For millions of Americans, the promise of free, flawed healthcare is better than no surety of healthcare at all. It is better than becoming ill and finding that one is insufficiently insured. The idea of a nationalised bureaucracy with power of life and death holds little fear for those used to a corporatised “private” bureaucracy with power of life and death. Not very good is not as bad as nothing at all.
Sean Gabb over at the LA recently remarked in his review of Kevin Carson’s new book how little thought libertarians have given to the working class and below- that is, people who have little to gain from the promise of tax cuts, when they pay little tax and probably net gain from the welfare state. Discuss healthcare with americans on the web, ordinary ones, not well-heeled writers and opinion formers, and they cannot be dissuaded from a preference for socialisation of healthcare because of their personal experiences with the current system, and the uncertainty it brings to their lives. When seeking to make our point, it is counterproductive, and just plain wrong, to dismiss such concerns as arising from stupidity.
There are answers in libertarianism to these concerns. But they are answers which will not be- and cannot be- implemented in any current heavily regulated western economy. They would require a “libertarian revolution” and virtual Year Zero in terms of destruction of the regulatory apparatus. If we are honest, we must admit that the experience for millions of Americans of their corporatised healthcare is one of direct rationing by social status and personal wealth. The regulatory apparatus prevents the provision of cheap healthcare. Vast amounts of legal precedent in tort forces up prices. Enormous regulatory requirements on bringing drugs and health interventions to market cause costs to spiral ever upward. And so on.
America does not have anything approaching a free market system. The argument is not between a free market and nationalisation, it is between a corporatised cartel and nationalisation. We may be able to describe to them how healthcare might work in a truly libertarian polity, but they don’t live in one and are not going to get one in the foreseeable future. As such, the choice to fully nationalise, and thus at least ensure healthcare is always available, even if its quality suffers, is not made out of stupidity.
Maggie’s Farm(Link) has a link to some of the raw data:
Yes but the notion of taking a bad system and making it even worse is bizarre. The US ‘private’ (which actually means massively regulated) healthcare works better than the UK one of shite-for-all. The state imposed (and rent seeking doctor approved) barriers to entry in medical care are enormous… which pushes the price up by hugely limiting competition (i.e. the ability to tell a given “private bureaucracy” to go fuck itself at an acceptable cost). Moreover as study after study after study have shown in the USA, millions of those “millions of uninsured” are young fit healthy people who can afford insurance if they want to and choose not to at that point in their life.
Obama’s changes in the USA will not happen unless millions who do currently benefit from better medical care (compared to the UK) let this happen. And I suspect they will let it happen, and so…
“Even if quality suffers”? This is not cooking or fashion, it is medical care. Fire up google and look at cancer survival numbers for the UK and USA. Millions of people are indeed profoundly shit-for-brains stupid if they let this happen and the only satisfaction I get from that sad fact is the time lag between their choices and the consequences grows shorter by the year.
The problem is, many Americans don’t have any practical ability to tell the private bureaucracy to go fuck itself, because they are locked in via employer provided health packages, etc. They can’t shop around.
Believe me Perry, I’ve tried arguing this one with people, and they will hit you with anecdote after anecdote regarding their experiences with the US system, all as grim as our anecdotes about the NHS. And we at least know we’ll get into hospital, even if we have to then form an escape committee with the rest of the patients just to get out of the hellhole again.
I’m not defending nationalisation. I’m saying you have to take into account the experience of the people considering it in light of their own system. The US system could be vastly improved by de-cartelising it and in particular getting rid of the absurdity of peoples’ employers being their healthcare providers. But this just sounds like more uncertainty to many people and it’s a hard argument to win.
I agree with you that they are wrong. But we need to have a bit more understanding of why they believe what they do.
All of which are irrelevent because as we both know, there is *not* actually a true market in medical care in the USA.
I have lived 1/4 of my life in the USA and I understand the system well. And most who think the UK is preferable after experiencing both is… bat-shit-crazy or lying or… stupid.
I realize I’m wasting my time trying to point out that this story is nothing more than spinning a push poll. The fact of the matter is that the news up until now has not been good for the Obama administration. Like recent Pew Polling (Link)that indicates that support for national health care is softer now than it was when the Clinton’s tried it.
ABC ran a story just three days ago(Link):
From AP, June 18:(Link)
If there genuinely was this level of support, why is ABC broadcasting news from the White House on JUne 24th followed by an hour-long “Special” promoting Obama’s plan? They even refusing paid advertising from opponents of the plan. Link(Link)
Whatever, I’ve said all I have to say, let the chest thumping continue.
But unlike you Perry, most have not experienced both, which makes them ignorant, which is not the same as stupid. Most simply haven’t been lucky enough to run into SI or the few other libertarian sites out there.
The good news is that the Obama Health Service will be financed by a ten cent tax on cans of pop. Why didn’t Aneurin Bevan think of that one?
“As such, the choice to fully nationalise, and thus at least ensure healthcare is always available, even if its quality suffers, is not made out of stupidity.”
Keep in mind that these proposed policies do not deal with “healthcare”, nor with whether “healthcare” is “available”.
You don’t see lepers sitting on the sidewalks in the US. Everyone gets health care when he or she needs it — all you have to do is go to a hospital. Hospitals are mandated to give you health care, whether you can pay for it or not. (Some might argue that this Congressionally-imposed mandate is an unconstitutional “taking”, but that is for another day).
Everyone gets health care today in the US. But not everyone has health insurance.
This whole debate is about insurance.
Except by your own remarks is not nothing of the sort.
That 72% of Americans think more government involvement in medical care could not result in a VAST and hugely expensive bureaucracy and that it will not have a huge negative effect on the quality of care… well in this information age that does not say anything flattering about the credulity and wits of 72% of Americans (or I dare say 90% of Britons).
The fact this is even being tried should cause rioting in the streets but of course it will do nothing of the sort.
Then why does anyone purchase insurance, and why is there concern regarding the uninsured?
Alice beat me to it, and she is absolutely right: the issue is not health care (hospitals cannot turn away the indigent) but rather health insurance. And our health “insurance” system is a bizarre result of historical quirks. It’s not “insurance” in any meaningful sense, but rather “maintenance”. (As, has been said before, like expecting your auto insurance policy to cover routine oil changes.) The whole system needs to be reworked, and that would be a massive job, but nationalizing it will not, has not ever, and cannot, work. Obama and his ilk want it for purposes of power, pure and simple; anyone else supporting the idea is in for a very rude shock should it ever come about.
As to whether those supporters are truly “stupid”, perhaps “ignorant” is more accurate but I think not. The level of ignorance is extraordinary, true, but it is willful ignorance. Anyone with the least bit of intellectual curiosity (which, to me, is a significant component of “intelligence”) can observe the dismal record of socialized medicine in the UK, in the rest of Europe, or even in our own neighbor Canada. And anyone with the least degree of intellectual honesty knows that it is extremely rare for anyone in this country to be denied care (indeed, when it happens it’s usually news), and that a significant portion of the people without insurance are so voluntarily (they’d rather spend the money on pleasurable consumer goods than boring insurance). So, to me, the adjective “stupid” comes about as close to an accurate description as we’re likely to get.
Laird, I think this whole idea of stupidity misses the mark. We must remember as “libertarians” (or “small governmentists”) or whatever that what we see to be transparently obvious is seen as crazy by the majority of our fellow humans. We have to thus either conclude that everybody else- that is the majority of our species- are “stupid” or “wilfully ignorant” or some other more useful analysis is required. It’s the equivalent of atheists (another minority viewpoint) deciding that all religious people are stupid. That may make them feel better, or superior, but it’s not really much use as an analysis, or more importantly, true.
Alice – Not everyone “gets health care when he or she needs it”. They can get emergency care at any hospital playing by the rules, but a diabetic *needs* care to keep their blood sugar under control, not to get their gangrenous foot amputated, but they’ll only get treatment from the hospital for the latter.
Laird – You present an argument I hadn’t thought of against libertarianism. If favouring a socialized system is an excellent indicator for stupidity, and if you’ll stipulate that favouring a private system just because “it’s the American way” is also a sign of stupidity, then I’d guess that upwards of 90% of people in the US (and by extension, most societies) are stupid, often wilfully so. Clearly 10% of any population will be smarter than the rest, but to have 90% be (wilfully) stupid challenges many of the assumptions I had about libertarianism. Thanks for the prompt to some more reflection.
Perry – I’ve lived under both systems, and on balance I prefer the US system, but it’s awfully close. I currently have BUPA here, and combining that with the NHS is still cheaper than my US insurance, and the combined service loses little to the US. And some of that difference was more to do with the big city facilities I had easier access to in the US.
The US admittedly has an uneven health system. But there are tremendous misunderstandings about it.
One of the biggest is that the uninsured have no choices. Actually the government already has insurance that covers nearly all of them.
To illustrate, here a quote from the Medi-Cal program of California.
“Medi-Cal is California’s Medicaid program. This is a public health insurance program which provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care, pregnant women, and low income people with specific diseases such as tuberculosis, breast cancer or HIV/AIDS. Medi-Cal is financed equally by the State and federal government.”
But you must bother to join. Enrolling is not like mailing a letter. You must find the person who can enroll you. They will be at a clinic or hospital.
Many, many of the very poor simply don’t bother. If you are healthy your main concern may be accidents. And for accidents and other emergency care everyone will be treated at the hospital regardless of status.
And so why fill out the paperwork to get your card in advance? In a serious situation having a card is just going to be a nuisance.
What about other care? Very mixed situation. Free clinics are common but unevenly distributed. Walk in, say you can’t pay and you will receive flu shots and birth control pills and other routine health care without question.
The big problem with the clinic situation is that they are not convenient, not uniform, and are funded by a volatile mix of federal, state, local funds and private initiatives. The workers are often volunteers and staffing is uneven.
The situation for eyeglasses and dentistry is much the same. Free service can be found but it will usually require some travel, waiting, and considerable inconvenience.
I really see three big problems with ObamaCare. The first is that it will be generally worse for those already well insured. And there are many millions of them. They see no reason for the government to bother them. Right or wrong they don’t want it for themselves and they already pay taxes to provide care for others.
Problem two: The US has millions of people, often illegal immigrants, that do not want to be identified or known to the government at all. And they usually are in the young, healthy set that sees little need for health insurance.
But their children are already insured if they have been enrolled. And so have the women, especially those of childbearing age. The father, probably not.
Problem three: The proposed system makes no pretense whatever of offering equal treatment.
Government workers and retirees will continue to have their own, better insurance. So will unionized workers – O isn’t about to offend the UAW, etc. Everyone who bothers to look will see that some pigs are going to be far more equal than others.
This is not a comprehensive look at the insurance situation. They are some good arguments for a national plan. Some sets of people will be better off. But those sets are much smaller than commonly believed.
Ian B, you are probably correct that calling such people “stupid” is not particularly helpful to an analysis of how to fix the system, but it is helpful in analyzing why we’re in this predicament. (And it has the benefit of being true. 50% of the electorate is of below-average intelligence; do the math.) It might also be useful to keep in mind when formulating a strategy for garnering popular support for an alternative to nationalizing health care.
Paul, wherever did you come up with the notion that I support private health care merely because “it’s the American Way”? I support it because it’s the superior method of allocating a scarce resource. Socialized systems are not only theoretically and philosophically inferior, they are demonstrably so in practice.
K’s analysis is pretty good.
I don’ understand what people’s relative intelligence has to do with any of this. There are plenty of highly intelligent people who are hard-core collectivists, and plenty of average and above who are stubborn individualists, and just as many on all levels of intelligence who don’t really care either way.
Ignorance is not the same as stupidity. Some of you might find it hard to believe, but most ordinary folks cannot afford spending even small part of their day reading SI and the like, or even reading anything for that matter. People struggle to find time to make a living and to tend to their loved ones even in the best of times. I didn’t run into SI because I am oh so clever, but because at the time I was lucky enough to have some extra time on my hands. If not for that, I’d now be as ignorant as the rest of them. If you want to change things, you need to change people’s views, and you don’t do that by dismissing them as stupid. You do that by bringing the relevant information to them, and make it interesting, and appealing, and as easy to understand as possible.
I meant average and below there.
The problem is the Republicans are all about cartels and fascism. They have no problem with the AMA cartel driving up prices. Yet again, they have problem themselves in this area to be a big government party, supporting small moves toward socialism which make things worse, and since the lying fucks claim to support free markets, the free market is blamed for their failures.
The stupidity in this case is stupidity on the part of Republicans, who think they can regulate the system enough to make their friends rich without destroying it. How’s that working out for you?
*** That came out as gibberish ***
The problem is the Republicans are all about cartels and fascism. They have no problem with the AMA cartel driving up prices. Yet again, they have proven themselves in this area to be a big government party, supporting small moves toward socialism which make things worse, and since the lying fucks claim to support free markets, the free market is blamed for their failures.
The stupidity in this case is stupidity on the part of Republicans, who think they can regulate the system enough to make their friends rich without destroying it. How’s that working out for you?
For sure. In a very real sense Obama is a Republican creation. Nothing The One is doing now would have been possible without GWB laying the groundwork in oh so many ways.
One of the biggest problems is that I am forced to buy insurance approved by the the state I live in. If I as a single male want to buy insurance and the state mandates that the insurer provide gynecological care in that policy, this drives up the price of the insurance. Republican congresscritter Shadegg sponsored a bill a few years ago that would let me buy a policy of my own choosing in any state.
You see the statists perch themselves on the the regulatory bodies and slowly crank up their control.
Router- does any Congresscritter promise to let you not pay to an insurance scheme? Or is Healthcare one of those assumed ‘rights’ that Judges keep finding in the Con?
I was going to wax on about how a working Federalism would leave this to the states to make laws about, and economic reality would show that it is better to leave this to private concerns, but I see that even states want to get into the act! Couldn’t you start up a Federalist Party, and at least keep Washington out of such matters?
On the subject of “stupidity”, one need look no further than the stupidity of the pollsters, a subset of the media (no doubts about stupidity there), and totally in bed with the Political Class (the very definition of stupidity).
Ordinary people with whom I have talked realize that the issue of paying for health care involves a whole lot of difficult moral (for want of a better word) decisions. but those questions don’t get asked by pollsters.
Since we are happy to practice something very close to infanticide, then why should we also spend vasts sums of someone’s money keeping premature babies alive?
Since about half the money spent on health care for an individual over his or her life is spent in the last 6 months, then do we need to become more realistic about when to deny care (other than palliative)?
Since we pay for health treatment for uninsured individuals whose health problems are strictly lifestyle-related, should those individuals be forbidden from suing doctors & hospitals?
Those kinds of “moral” questions never made it into HillaryCare, and they are not making it into ObamaCare either. The health insurance debate is just another example of the failure of the Political Class — and of the even greater failure of Libertarians to take advantage of the honking great targets those failing politicians create.
There! Have I managed to offend everybody?
Alice:
This is in fact the core of the problem. There has never been such thing as “health insurance,” and the whole concept is a giant misnomer and generator of confusion.
An example of real insurance is fire insurance. There’s a small probability that your house will burn down as a consequence of a totally random event, so you pay a small amount for the right to be compensated in case of this unlikely disaster, and the insurer can stay profitable while charging each client only a small fee because only a small percentage of the clients will ever need to be paid.
In reality, only a small part of health care could ever work like this. Young and healthy people could indeed insure themselves against the costs of treating accidents and unforeseeable diseases. However, the enormous bulk of health care consists of entirely foreseeable expenses. First, there are relatively minor expenses that nearly everyone incurs regularly, such as periodic general medical checks, childbirth and postnatal care, etc. Second, there are disabled and chronically ill persons who are guaranteed to incur large costs at a more or less constant rate for the rest of their lives. Third and most important, nearly all people age to the point where they become permanent patients on whom practically infinite resources could always be spent to achieve some yet further improvement in life quality and expectancy.
None of these costs are amenable to “insurance” in any meaningful sense of the word. They don’t represent an insurable risk, because they are not subject to risk, but high certainty. Any scheme devised to finance them, whether public or private, cannot be other than a savings program or a transfer in disguise. All the existing schemes, including the present American mixed corporatist/socialist model, represent a transfer from the young and healthy to the old and chronically sick (and to the medical cartel, of course). The way it’s used in practice, the phrase “having health insurance” means having the right to place oneself on the receiving end of these transfers. No honest discussion of the situation is possible until the entirely false and misleading concept of “health insurance” is dropped.
Laird – I didn’t come up with such a notion at all. I’m merely saying that someone who thinks that private health care is better than socialized medicine for the wrong reason (e.g. ‘it’s the American Way’) is just as stupid as a supporter of socialized medicine, they just happen to have guessed right. Take those two groups together, and it would appear most people are stupid.
Perry,
What makes you think that, “… Obama’s moves are just the opening salvo in a desire to eventually end up with fully socialist healthcare, along the lines of Britain’s ghastly National Health Service …” ? As far as I know nowhere has copied the NHS. There are dozens of other socialized/subsidized medicine models – including the one that the US already has.
In the US things will inevitably be different. They are different in different places everywhere else, because other things are not equal. I am inclined to believe that the primary reason US medicine has become so expensive in modern times compared with that in other industrialised states is more to do with its unique legal culture. The probability that a president and congress of the party of tort lawyers will mitigate that problem seems to me pretty small.
There are so many institutional and cultural differences that comparisons don’t help in making specific changes to policy. Can anyone explain to me why the US has such apparently entrenched, standardised state schooling systems? British families usually try to escape state schools before state medicine.
Didn’t B. Franklin coma up with the idea of State schools, publicly funded? Maybe Americans feel a patriotic duty to support anything started by a Founding Fat-head? (He was also the one who felt that a single House of government would be alright- no checks or balances needed! You could trust in human bebevolence. Honest!)
Ivan wins the thread.
Ivan does indeed win the thread.
But, that is only part of the picture – granted, a very big one. And, at least for me, is the relatively easy one to understand, the other part being the whole tort issue: what is the root of the problem there – before we even get to how to solve it? Is it something inherent in the US legal system, or the political one, or both?
Sorry, guys, Ivan doesn’t win the thread, although I’ll give him honorable mention. He’s right in that health care is not truly an insurance risk, however.
Guy Herbert comes closest. It’s truly not the cost of the health care, it’s the cost of the defensive medicine that all doctors must practice. Remove all the truly unnecessary testing that physicians call for simply to maintain their defenses against the howling, ravenous wolves of the American legal system, and you would see the cost of health care drop dramatically.
If there was meaningful tort reform and doctors knew the cost of a mistake wouldn’t be their license to practice and their life savings, they wouldn’t do many of the things they do that add to the ever-rising bill.
The problem with that, however, is that it runs afoul of the Democrats’ most powerful funding/lobbying group. Google what the Trial Lawyers Association gives every year and who they give it to and you’ll understand why there’s not a hope of tort reform happening.
Yes, we in America do have a unique legal culture and while it has some real advantages, it has all but killed our business culture. No business in America does ANYTHING without first thinking what liability risk it incurs. Doctors are at the head of that list.
I would like to think there is a chance it will get better but I believe it will take things getting considerably worse to have people motivated enough to demand the necessary changes. Maybe two terms of Obama and the impoverishment of most middle-class Americans might do it.
Hard times tend to make people cut to the chase. One of the things that Milton Friedman used to say often was that you could have a welfare state or unlimited education–but not both. California is finding that out as I write this. Will they learn from their impending bankruptcy? I guess we’ll know in two months.
Thomas Sowell is fond of saying “there are no solutions, only tradeoffs.” If Americans decide that the lawyers need to take a serious haircut and have the medical malpractice business taken away from them, it will be tough on the lawyers but the cost of insurance would come way down.
If they fully enforced both the legal hiring laws and the immigration laws, it would be tough on the illegals (and their employers, who receive a hidden subsidy)but it would greatly benefit the legal citizens of the country as their social costs to support said illegals would decrease dramatically.
Somebody’s ox is going to get gored because we can’t continue on the way we have been–the money is no longer available to support that model. The only question now is who’s ox it’s going to be.
PIMF. Friedman said “you can have a welfare state or unlimited IMMIGRATION, but not both.” I had just read a news report about how Cal’s education regime is coming crashing down around them due to lack of money. It highlighted how many children they have to teach who are “special needs” and who don’t speak English.
Sorry about the mental lapse.
Guy, you need to re-read what I wrote then.
Stupid?
I guess it should be defined. Are they stupid because they believe they are looking out for their best interest? No. Are they stupid because they have plenty of examples of government run programs and how costly they are, how inefficient they are, and how they are ultimately used to feed the bureaucrats who flesh them out first and foremost? Yes. Are they to be blamed squarely for being so stupid? Not entirely, they are the product of the socialist education system, and are they own case in point as to the efficacy of government run programs.
People are trained from 4-year-old kindergarten on to be afraid and to rely on the State. Until a libertarian revolution occurs on how people acquire their philosophies of life every other argument or attempt to persuade will be for naught. I’m even willing to compromise and have collective training on the common symbologies that make for literacy. A solid “three R’s” but leave the acquisition of truly efficacious philosophies to the free market.
The vast cost of socialist healthcare lies in illnesses which derive from behavior. Until people are conditioned to believe that they are their own first defense against illnesses that cause short lifespans and costly deteriorating deaths, then they will engage in whatever behaviors they please. They will have a gnawing fear that they are soon doomed to die and look to the State for mitigation. As long as this is how people are conditioned by socialist education, these are the answers that will be called for in all walks of life.
OK, so what’s to be done about tort reform?
I mean, isn’t the ability to freely sue a free-market form of “competition”? If the state should not mandate a company act a certain way, the private model for redirecting errant corporate policy is to sue them, isn’t it? (I’m asking honestly)
Do we make the penalties for frivolous lawsuits more onerous? Do we make the losers pay all? If so, how do we address the fact that in many cases, the side with the better lawyers wins, not necessarily the side that is most right?
What exactly is tort reform, and how can it be addressed in a libertarian manner?
Exactly the questions I had in mind, MichaelV.
Of course another factor that drives the healthcare prices up is the MD’s guild that is AMA, but that is not specific to the US.
mac,
When I pointed out the confusion generated by the “insurance” misnomer, I didn’t mean to imply that this is the whole problem. You are of course correct that the modern American litigation culture spinning out of control is a huge part of the problem. Still, even that is far from being the whole story. Among all fields of human endeavor, medicine is plagued by a unique set of inherent problems, and they’re all somewhat responsible for the present mess.
The first huge problem is epistemology (don’t laugh, and read on!). Out of all practical sciences, in medicine, it’s by far the hardest to come to rational conclusions about what works and what doesn’t. This holds both for ordinary people and medical experts, and it’s due to a nasty combination of the sheer complexity of the problems and wishful thinking, which may easily affect even otherwise very rational minds when human lives and health are in question. For this reason, medical quackery will always be rampant, and in fact it’s only in fairly recent times that any real medical knowledge was distilled at all; historically, medicine was always pure quackery even in periods when other sciences were making real advances. Also, even in our scientific age, most people still subconsciously look at medicine as supernatural magic.
An important consequence is that physicians find it extremely easy politically to form a privileged guild. People easily buy the argument that there has to bee an official medicine to fence off the quacks, which powerfully combines with the physicians’ special, quasi-magical status in people’s minds. This worked even a century ago, when the Western world was unimaginably libertarian by today’s standards. The result, of course, is a complete cartelization and distortion of the market, even without any further government measures.
The second huge problem is the bottomless pit of diminishing returns that can’t be rationally evaluated. Regardless of what health care system is in place, it is always possible to achieve some further gains in life expectancy and elimination of suffering by spending even more resources. This is true both statistically and individually. A terminally sick multimillionaire can easily spend his whole fortune to prolong his life somewhat and lessen his suffering. All medical treatments, even the most routine, carry some risks of dangerous complications that can be reduced by taking ever more precautions and employing ever more advanced techniques. However small these diminishing returns are, people attach great value even to very small gains and events with very low probabilities when it comes to the health of themselves and their family members. In a system that’s funded by transfers, they’ll have every incentive to demand more and more medicine until the costs reach exorbitant amounts, unless of course the rationing authorities cut them off. The above mentioned U.S. litigation culture is just another factor pushing the envelope towards ever more extravagantly expensive marginal gains.
In reality, the marginal gains from medicine diminish very quickly. As soon as the living standards increase to the point where people eat well and maintain basic hygiene, a few basic medical treatments and procedures (antibiotics, accident surgery, obstetrics, etc.) are enough to push life expectancy up to ripe old age. (I suppose some further significant improvements could be made with a few standardized treatments for diseases that often kill in middle age.) These services could be produced with a tiny fraction of today’s health care costs, even with cartelized medicine. The rest of the present costs goes towards avoiding low probability marginal cases of complications, towards helping the disabled victims of accidents and genetic bad luck, who are relatively few in number but consume a lot — and most important, towards spending exorbitant amounts on small marginal gains in life quality and expectancy for the elderly. Of course, all that a man hath will he give for his life — and even more if he can find a way to make others pay for it.
Basically, the truth is too ugly to be openly discussed in public by any side in the political debate. Physicians will find a way to cartelize easier than any other trade, but even without that, the basic economics of health care makes only the following options possible: (1) everyone gets only as much medicine as he can pay out of his own pocket, (2) a European-style socialist system that pretends to serve everyone, but in fact employs disguised forms of rationing such as queues, and (3) a corporatist system funded by transfers such as Medicare and similar U.S. programs, where the beneficiaries will push up the costs all until it bankrupts the country. In its long-term consequences, (3) might well be worse than (2).
You seriously think (2) will not do exactly the same? with option (2) you get a bankrupt country *and* crap medical care.
But, maybe even tort reform is a red herring. The reason that doctors are a target for lawsuits is that they are seen to have deep pockets. And they are seen to have deep pockets because they do have deep pockets.
Doctors can (though not all do) make large amounts of money because of restricted access to the profession. Simply put, it’s far too hard to become a doctor, even for stuff that would require a much lesser degree of study and competence (though believe me, from what I saw of student doctors, there’s plenty less competent getting through anyway).
So the lawsuits are just the free market correcting itself. Unfortunately in an aberrant way that enriches lawyers and insurance companies (medical practice insurance, not healthcare) and pushes up costs for the common man. Bring some sanity to qualifying for medical practice and the problem will become much less significant.
Another thing is Perry, if you look around other places where this argument is being waged, there are plenty of British, Canadians etc. who are practically chomping at the bit to blather on about how amazing their health care is.
Presumably these are Brits who have never been near the chaotic cesspool that is Northampton General Hospital.
That’s a very perceptive comment, and I don’t think (2) will necessarily lead to the same place as (3). The key is Ivan’s phrase “disguised forms of rationing”. A government can effectively ration health care by limiting its total expenditures on it. In a free market the price system serves to allocate resources, but absent that system something else will take its place. Explicit rationing won’t be politically palatable, but lengthy queues aren’t as unacceptable (after all, the apply to everybody, right?). In the US we’re on the road to (3) right now, so distasteful as it is (2) might be preferable.
I shall have to ponder this some more.
Perry de Havilland:
The full-blown socialist system (2) results in crappier medical care, I certainly don’t dispute that. However, under the system (2), the medical establishment decides about the rationing, and they typically implement it surreptitiously via indirect guidelines and policies, in a way that requires some understanding of economics to see for what it is. Whereas under the transfer/corporatist system (3), the beneficiaries of transfers are directly aware of what they get, and they will incessantly lobby for further increases in transfers, which can cause the costs to spin out of control completely in the medium to long run, as is happening with Medicare and similar programs in the U.S. Of course, under option (2), the medical establishment will also constantly lobby for more money, but this will cause a much slower growth of spending, since the medical guild has the power to ration the total amount of medicine produced without endangering their own interests. Empirically, this seems to be the case — the costs of U.S. Medicare are indeed booming much faster than those of the Canadian universal socialist system.
So, yes, it’s an ugly trade-off between crappier health care with high but hopefully sustainable costs on one hand, and better health care with costs climbing rapidly out of control. Needless to say, I’m not a partisan of either option, but I think it’s fair to point out that the latter one, objectively speaking, has the potential to wreak greater destruction in the long run.
I suppose there is a general lesson somewhere here that largely, but not fully statist solutions can sometimes be even worse than completely socialist ones. Mind you, I don’t know enough about the present U.S. situation to be able to accurately estimate the net consequences of further health care nationalization, and my analysis in this post might be wrong, but I think it would only be fair to consider the possibility that the present American semi-socialist corporatist system is even worse than an out-and-out socialist system would be.
Swiss? Nah, I’mna thinking Indian. Likely cheaper and I expect that they’ll at least pretend to give a $h#%.
Pondering Ivan’s idea some more, it occurs to me that moving to a European-style socialized medical system might have the indirect benefit of reining in the tort bar. If all physicians are de facto state employees, (a) they will not need to carry private malpractice insurance, since the state will in effect provide it (probably via self-insurance), and (b) at some point the state will severely limit malpractice damage awards, and especially the portion the lawyers can take (if not barring them outright through some version of sovereign immunity and managing them through some sort of administrative procedure which looks like workmen’s compensation claims). What has been the experience in the UK with medical malpractice claims?
About half of American health care is already taxpayer financed (and these subsidies have the same effect in increasing prices as the subsidies for higher education do in increasing tuition costs) – and the rest of American health care is insanely twisted by regulations that vastly increase costs.
And the plan is – yet more programs and regulations.
Comrade President Barack Obama calls the idea that his plan is a Trojan horse for total government control of health care (“single payer” ism) a “scare tactic”.
But who is up tape (from 2003) openly boasting of having “single payer” ism as his objective – and planning to get there by stealth.
Barack Obama.
Oh yes the tape has been played (by Glenn Beck and others) – but the mainstream media ignore the truth about their false God.
Very few people I know and count as any sort of friend have any plans whatsoever to cooperate with some sort of nationalized health care scheme, or to comply with requirements to carry health coverage.
Enough is enough; we’re tired of paying money into ponzi schemes that we’ll never benefit from. People are starting to talk of not ballots, but molotovs and bricks.
I agree. These things are just strategies for extracting more money from the public, for corruption to ensue and on bigger and bigger levels. We never benefit from it – those who benefit from it are mostly those who cook up this plan.
I agree. These things are just strategies for extracting more money from the public, for corruption to ensue and on bigger and bigger levels. We never benefit from it – those who benefit from it are mostly those who cook up this plan.
As always with opinion polls – it depends how you frame the question.
Ask people “do you support Barack Obama on health care” and you get the reply “yes” (because Barack is “cool” and so on – hence Perry’s frustation with the stupidy of voters).
But ask them “do you support total government control of health care” (the actual objective of Barack Obama – as the government, the taxpayers, already funds half of American health care and controls the rest via endless regulations) and the reply is “no”.
“What about an unbiased question”.
There can be no such thing – but let us call the Congressional Budget Office “unbiased”.
According them the plan will cost one and half TRILLION Dollars (of course it will be much more than that – as entitlement programs always cost more and more) and will NOT cover most of the uninsured.
So an “unbiased” question would be ………
“Do you want to spend one and half trillion Dollars more for a plan that will not cover most of the uninsured”.
I suggest that people would have to be very “stupid” indeed to say “yes” to such an unbiased question.
The WSJ points out the flaws in the CBO’s current analysis here: http://online.wsj.com/article/SB124580516633344953.html
That doesn’t mean that the final plan will be better or cheaper than the CBO’s current projection, just that it’s projection is unavoidably flawed at the moment.
Quite so Paul.
No matter how expensive and damaging the Congressional Budget Office says the Obama plan will be, in reality it will be far more expensive and damaging.
That has been the case with all previous entitlement programs.
However, the very expense and harm is what Barack Obama is looking for.
Like the Cap and Trade Bill the Health plan is not supported in spite of the harm it will do – but BECAUSE of the harm it will do.
The point is to undermine the economy and civil society generally – and thereby create ever more people dependent on the government.
Loyal voting fodder for the left – who will be told their poverty is due to evil rich people and corporations.
And the “evil rich people and corporations” – they will support Obama as well (many of them already do).
Partly out of fear (of “the masses” who are being taught to hate them – by the very regime that also says “you need us to protect you from the masses”) and partly because the rich people and corporate managers have also been to school (and many of the private schools teach the same horrors that the state schools do) and university.
I.E. they have been taught to hate themselves – and to support the left as a gesture of self abasement.
And of course (for a few) there is the added matter of government contracts and other favours.
I am sure General Electric loves the health plan, just as it (and a few others) love the Cap and Trade Bill.