I'm back, and I think I'm ready to stir things up a bit. So let's talk health care (since Congress is wisely slowing the runaway train of reform down a bit).
It's commonplace to hear how the American health care system is unfair and in need of reform. If you listen to the politicians and major media, you come away convinced that our system is so deeply flawed that we need massive changes, and there is a sense that only government can be trusted to fix it.
From a simplistic economic standpoint, I tend to believe strongly in the efficiency of a free market system, with government involvement only to set fair playing rules for competitors in the market and to deal with what are known as externalities or market failures - situations where for one reason or another the market does not work correctly or efficiently. One of those market failure situations that we all inherently understand is a monopoly - where a single seller controls a market. We instinctively sense that the imbalance of market power causes problems - inefficiency, reduced output, higher prices, "supernormal profits", etc. I'm not sure why we don't have the same instinctive distrust of what is known as a monopsony - a market characterized by a single buyer. The economic arguments for inefficiency are simply the mirror image of a monopoly, yet there is a hue and cry for a monopsony in health care: the "single payer option" with the government as the single payer. In addition to the libertarian distrust of government that I have, I have a further economic problem with such an inefficient solution to a problem that I truly believe is overstated.
Why do I say it is overstated? Consider the following article: http://www.ncpa.org/pub/ba649
I strongly recommend that you read and consider the points being made there before you declare our system irretrievably broken. Some of you have questioned my sources at times - I think the sourcing and documentation of this report are impressive. Don't assume all conservative viewpoints are flawed and incorrect. Read and think for yourselves.
What's the problem with our system? In my opinion the flaws are explainable by my free-market economic approach: for a market to work, consumers and producers must be free to communicate with each other through the market and price mechanism. They aren't, because distortions created by wage controls many years ago and continued by tax laws have led to a system dominated by the insurance companies. In other words, the producer (hospitals, pharmaceutical companies, doctors, etc.) do not deal directly with consumers (patients) because the bulk of payment now is made by the insurance companies. So we have separated the payer from the consumer, a situation which almost always distorts market incentives and responses.
Rather that create a single payer system, we should instead focus on the economic source of the problems, the break created by the insurance companies' dominant role. As for people who are unable to afford or receive adequate healthcare, there are other, less intrusive, less expensive ways to see that they share the benefits identified in the article I linked to above. Let's not throw the baby out with the bath water.
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Impeach President Trump, again
3 years ago
very interesting point of view, im glad someone took time to make sense of the conservative standpoint which i've found so immensely flawed.
ReplyDeleteKC - I think one problem is the way it's been politicized. You're either for the Obama/Democrat plan, or you don't want change. I think a more accurate reality is that both parties, or both conservatives and liberals, think changes need to be made. The difference is whether they believe a statist approach is called for or whether a market oriented approach could work. Thanks for reading and commenting!
ReplyDeleteScarcity of resources is the problem, It's what drives up the price so high that insurance is needed, which creates the problem you highlighted Mr. B. It takes too much money to produce the drugs that are needed for optimum health and living the longest amount of time possible. This is the brutal reality we're faced with... People that have a lot of money are going to be able to pay that price, and people that don't simply aren't. Unless we can find a way to make the cost of producing these drugs less and/or eliminate other sources of cost upon the people producing/handling the drugs, they are going to continue to cost a lot of money... That's economics 101. From an economic standpoint, we need to find a way to make that happen, not have the government beat those producers into submission by controling their prices, because if we do there will be no incentive for them to:
ReplyDelete1. continue doing their job (which is extremely hard and requires a ridiculous amount of knowledge) since their salaries will inevitably be less.
or
2. provide the best care possible, they're not getting paid well, but if they do bad who cares? no one has the choice to go anywhere else because there's no competition.
So, we're either going to have to find a way to accomplish those goals without government control, or deal with the reality that the lower-middle class to upper class can afford health care and the low class cannot.
Corwin - a couple of thoughts. I think in many ways the original intent of insurance has been perverted. Insurance was originally thought of as a way of protecting against catastrophic expense by risk-sharing based on probabilities. As insurance became a nearly ubiquitous corporate benefit, it has morphed into a prepaid medical care system with co-pays on drugs, office visits, etc. So in many ways our medical insurance is no longer what we previously understood as insurance. That's why I think we could improve the system with a combination of medical savings accounts and true catastrophic care insurance.
ReplyDeleteA lot of the cost of pharmaceuticals is the R&D. It's phenomenally expensive to find, test and gain FDA approval of new medicines, and the rate of success for new medicines is very low. So the price of successful medicines must bear the cost of all the investigation and failure. And, given my background, let's not forget the lawyers. How much of the cost of your medicine, how much of the cost of your doctors, and how many medical procedures are defensive in nature, protecting against lawsuits. I submit that aspect of the cost is very high.
There are very few people or politicians calling for the status quo. I think there are ways to provide better health care to the poorer segments of society. I'm not sure Congress is on the right track right now.
I truly think that the democrats will totally screw up the grandiose plan of single-payer insurance. Just like the cap and trade recently introduced it got perverted until it wasn't what it was meant to be. The same will be true of healthcare. There will be partisan compromises until it will indeed fail.
ReplyDeleteThat being said healthcare in America is broken. I know from experience. For those of you who know how my family lives now, it was not always that way (in fact up until the year 2000). I watched Michael Moore's Sicko recently, and minus the ridiculous ultra leftist propaganda, it contains facts. Facts that truly brought me to tears.
The truth is that Big Insurance does not give a damn about their customers. They love money, and will do whatever it takes to maximize profits, a fact highlighted in Moore's documentary.
When people's lives are in the hands of pigs at the trough, everything will turn to slop.
Corey, you state that people will have no incentive to work with free health insurance. I would counter that a healthy workforce leads to more economic prosperity.
My outlook on it is that some things need to be controlled by the hand of the free market. Sometimes there will be ups and sometimes there will be downs. This is normal. Other things though, I just go and look at the postal service, police force, firefighters, teachers, so on and see that these certain things work out when controlled by the government. Health is one thing that must be regulated and, I do in fact believe it must be a monopsony.
That being said I have recently come to the conclusion that american politics will be the ruin of it. It is unsustainable. Just like a car that constantly gets shifted from a lower gear to a higher gear then back to the lower gear, it will wear itself out. A more constant system, where there is more agreement (love) and less partisanship (war) would be more beneficial. I personally love America though (even more so the great state of Texas) but sometimes I think it may not be worth it to live in a society where people truly believe government is out there to hurt its citizens.
But if American politics will be the ruin of it, why do we dare leave it to the government which is made up of and run by those same politicians. I think this is where you and I have our most basic disagreements: you want the world to be different from what it is and believe human nature will change; I want to do the best we can recognizing and allowing for the imperfections of humans. Because my government will be made up of imperfect humans, I want to limit their power over me.
ReplyDeleteWell it comes down to religion i'd have to say. I believe humans can evolve to be better while you believe in the original inherited imperfection (sin). Is that not the case?
ReplyDeleteAgain I think if ideology were more homogenous then it would be better, but with such a large country (larger than all the countries in Europe (at least the ones that matter =])) it is near impossible to progress, or to retain values for that matter.
That's absolutely "not the case", and I think you've now wandered into the absurd while intentionally mischaracterizing my argument. If you want the religious aspect, human imperfection is the reason we need salvation, redemption, adn grace. I also believe humans can become better, but in the meantime and in the real world, our systems and policies need to reflect reality, not the utopia you wish we could "evolve" to.
ReplyDeleteAs to homogeneity, the European countries you refer to in may cases are very different from what you might think they are. The racial and cultural conflicts are even longer established and the religious differences caused by immigration patterns in the past few years are exacerbating their problems. And again, where this post started, the reality of their healthcare compared to ours is not what our system's critics claim it to be.
Wow. Um the only thing intentional was to just try and get down to a more basic disagreement (without ad hominem attacks).
ReplyDeleteAm I wandering into the absurd? I'd have to say that Right Wingers are already there. I don't want this to get ridiculous, so why don't you go ahead and stop before you further "mischaracterize" and hyperbolize my statements.
Done
As far as the original post goes I find the cancer survival rates in America being higher shocking. I have no rebuttal to such facts, and it makes people like me think more. But the more left you get the more the ends do justify the means. THAT is a fact.
Fact No. 7 I think is insanely biased and cannot be taken seriously.
No. 8 just deals with the American condition: 'nothing is wrong with us; we are the best.'
No. 9 is no surprise. When your incentive is cash rather than healing an individual of course you will get better at the latter (ends justifying the means).
It is no surprise that The Hoover Institution is a libertarian think tank.
JS-Why do you think those certain things work when run by the government? What is your basis for that conclusion? Just because they are currently being conducted by government institutions does not mean they should be.
ReplyDeleteWhy shouldn't the postal service be carried out by private industry such as FedEx, UPS, etc. competing for routes? The cost of the federal government to provide for those non profitable rural areas would likely be far less than the current annual post office deficit.
Why shouldn't education be more voucher funded so that parents/students/social welfare workers can determine which environment is best for the student? There are many educational studies which show that a system that competes for students benefits the students.
You are probably too young to have had much experience with government bureaucrats. Why should someone who doesn't know me and isn't as smart or educated as me or my doctor be a gatekeeper to my healthcare decisions? With a government run system you are only replacing insurance restrictions with even more onerous, less flexible government restrictions. At least now I have alternatives. Government's role should be to maximize the opportunities for all citizens.
You should keep in mind two things, whenever you are talking about the government should do this or the government should do that. First, when you say the government should pay for something, consider that you are the government, the one paying. That is sometimes appropriate. When you say the government should run something, the government is the guy who slept through class all the time and can't get a competitive job. He'll be the one telling you what you can do. That is rarely appropriate.
I agree with you that providing for the common defense with our military and FBI are appropriate federal activities under our Constitution. But police and fire, similar roles, are provided by state and local governments, with far more local accountability.
I really enjoyed the breakdown of the situation. A lot more informative than what I normally get through media etc..
ReplyDeleteI have a few questions to ask about this but not sure how to form them yet. Ill get back to you!
Well my only experience with bureaucrats is the DMV and, while it is a HUGE hassle, think how efficient it is. Millions of people go through it and it all works. I for one believe a free market alternative to post, education, emergency services, education, would collapse under the volume. I know for a fact that The USPS handles more post every day than FedEX and UPS combined handle in a whole year.
ReplyDeleteThe right, without fail, always brings up lack of incentive. I say it all depends. What if your incentive was to make each of your students as smart as possible, instead of getting a paycheck. I think if your goal is to better the human race, that is a far better incentive than any number with a '$' in front of it.
What is defense? Is that word limited to that of a militaristic nature? I think defense could very well be extrapolated to the defense of intellectualism and progressivism.
As far as me being the government that is MY POINT! If we as a nation understand that when you pay taxes it leads to better highways (and soon to be better healthcare) then the government suddenly stops taking and is now giving. When education is good enough to keep 'the guy who slept' awake, then that is when the goal has been accomplished.
I feel I'm the only one on this blog who is left.
Devin - whenever! I would like for this to be a multiparty dialog. Thanks for reading.
ReplyDeleteHahaha yes Jay, our religion does state that we are fundamentally flawed as humans, as we are by its standards,i seeing as we all do things that are against the text within the book. But that doesn't mean that we can't strive to be better...? I don't know where the even comes from... "Faith without works is dead" clear as day the bible says that it's not okay to be complacent with the status quo, but after we come to christ we must continually be striving to better ourselves. If that's the basis of your argument... that conservatives don't believe people can evolve into better people... you're sorely mistaken, it's actually quite the contrary, our religion's entire purpose is to draw closer to God and his ways aka "evolve to be better." Besides the acumulation of churchs tithes do more distribution of wealth than any other organization or government on earth. It's written in the New Testament that we are to give 10% of our income to the church so that they can spend it on missions i.e. running food drives, helping out the homeless, helping out hurting families in the church, etc.
ReplyDeleteThe kind of Government and Nation you want... ya, it's like a giant church. Rich people help out the poor people because of vested interest, while the pastor (instructed by the words written in the Bible) controls what's going on and teaches all the members the correct way to live. Problem is... if Government is the Pastor, what is his Bible? It can't be the ACTUAL Bible because of separation of church and state. This is why Socialism has, and will continue to, fall apart at the seams. The people don't believe the same thing their Government does and therefore revolt against it.
Irony at it's finest.
Sorry Balthrop, I know you didn't want this to go to a religious component, but that was just something I found interesting that I do think Jay got correct. If we were all on board for Socialism, rich people and poor people alike, it would work and we would be the most profitable, healthiest, most prosperous nation in the world. It would be the closest to coming to a Utopia we could possibly see. But seeing as there is no incentive for a rich person to support a Socialist system other than "it's the right thing to do because God tells me to" it can never, and will never work... they simply wont get on board. For socialism to work the rich people have to not care that they're not making as much money as they deserve for their work, and that wont happen without some outside stimuli.
ReplyDeleteDebates over the applicability of socialism to universal health care is both misinformed and overstated. The amount of coverage will still be uneven, and most will still be fee based. I strongly believe that the most efficient way to boost healthcare is to provide universal primary care with large centers with lots of nurses , physicians assistants and a few limited specialists and primary care doctors working together. Pay for it through letting these doctors run a primary care practice without having to pay taxes on company profits. Set up minimum pay and subsidize primary care, give zero-interest loans to start these practices and give better grants to doctors pursuing a primary care specialty.
ReplyDeleteI know quite a few people going to medical school who laugh at being a family physician or general medical doctor, and think of it as a role for the embarassing bottom half of the class. Lets prop up the first step in the primary care system, give better access to dermatologists, dentists, and nutritionists and any other doctors would have to take care of only extreme situations, accidents, and genetic disorders.
If the first doctor you see can help you quickly and efficiently you'll never need to see another. The problem is that noone wants to be paid the least in their field that can escape it. Mr. Baltrop I bet this is the reason you were a corporate lawyer for Alcon and not a pro bono defense lawyer. Keep the system capitalist, but just change up who gets paid the most. This could be easily accomplished with a few small government interventions and standardization of insurance.
Obama Explains How His Health Care Plan Will ‘Eliminate’ Private Insurance: http://www.breitbart.tv/uncovered-video-obama-explains-how-his-health-care-plan-will-eliminate-private-insurance/
ReplyDeleteWell you guys lose. Healthcare will get passed. It is what a large majority of the nation wants. Most of you us suburbanites jsut do not know what it's like for lower class people who don't have health care.
ReplyDeletehttp://www.cbsnews.com/stories/2007/03/01/opinion/polls/main2528357.shtml
I'm so glad about your post corwin. We agree. And I agree with you. It simply cannot happen. As some of you may have saw I said on facebook Communism is a delusion of granduer, one for the human race, because we simply are not good enough organisms to carry out the grandiose theory.
You say the government would be like a big church, corey. Or is it more that churches are socialist communes? I'd have to say that the smaller the population the better a utopian socialist society works. Has anyone sen Defiance with Daniel Craig? It is about a socialist commune of Jews hiding in WW2. It does point out at one point that the leader must be totalitarian, and he one time shoots some slackers. The ends justify the means.
I guess I'm misguided here as well. I don't assume our economy, our healthcare system, and politics are or must be either/or, win/lose situations. If you are correct about your beliefs, economic theory, and these issues, we all win. Or do I lose because we are better off but my preferences and beliefs weren't followed? Similarly, if your theories and beliefs hold sway and the economy is damaged along with our healthcare system, we all lose.
ReplyDeleteLower class people don't have healthcare? No, what we are discussing is who and how it is paid for. People who claim to not have healthcare are generally complaining about the cost of treatments or the cost of insurance. There are a number of government funded, government provided, or charitably supported healthcare opportunities out there. Are they as great as what the rich could afford? Of course not, but that's true of any product that exists.
I just wanted to chime in that I really enjoyed this discussion and the entire dynamic, including the thoughts on how religion can impact thoughts on this. Anything else I would have to contribute has already been said (disclosure: I am a socialist and a lot of my friends are libertarians).
ReplyDelete