patrick.net

But the free market fails very badly in many cases. Take roads. Would you want toll roads everywhere?

Agree with your point. Roads are an example of a "natural monopoly." It's most cost-effective to just have one road network rather than multiple competing road networks. Same can be said for water/sewer systems, electrical transmission lines, etc. Maybe health services are a natural monopoly?

Critical health care is kind of like that. Everyone really needs it, and our "free market" cartel has completely failed to provide it at a reasonable cost, because there is no real ability to shop or walk away.

That's a compelling point, I think. That was one of the flaws in my "is health service like food?" question.

It's true...in an emergency, you just need to get to the nearest hospital. The hospital, in a sense, has a "captive market". They can charge $50 for a piece of toast just like a sports stadium can charge $10 for a hot dog.

I was recently in the hospital for a sudden bout of uncontrollable shivering and chills. It was probably just a virus, they said. But because the symptoms were so strange, they did test after test. And those tests were really expensive. I have a high-deductible insurance plan with an HSA, and the bills cleaned out my HSA completely and then some. Ouch. No chance to "shop around" obviously.

1. You cannot shop for critical health care, and you cannot walk away. You MUST have treatment for your heart attack NOW. If you shop or walk away, you die. Even for long-term critical care like cancer treatment, it's very hard to shop and you still can't walk away.

That means the government has to provide free housing to people so that they can all live within 10min drive of an emergency room with top-flight heart treatment facilities.

Let's face it, people make all sorts of choices that may have detrimental effect should an emergency strike. The idea that the government or anyone else can insure a person's health is quite absurd . . . because we are born to die some day! Being alive is the leading cause of death!

2. Food is cheap. If you had to, you could be perfectly well nourished in America on $5/day. And it is at least possible to grow your own food, but try to treat your own heart attack or cancer and you'll die.

Food is only cheap because there is a semblance of free market in food production and distribution, despite FDA's effort to undermine the free market process. Medicine used to be cheap too, that is, before the government regulations limited supplies with licensing requirement and FDA approvals, while artificially goosed demand through subsidies to the overwhelming majority of medical expenses in this country. Medicine is not a free market at all when the people most likely to get sick (the sick and elderly) are heavily subsidized.

The free market place can take care of the sick and the elderly far better than Plantation Health-care can: just like free market has made computers and cell phones far more accessible to the poor in the past 30+ years than any scheme of government buying computers for families with children could have done. When people spend their own money, they drive price down and encourage innovation; when bureaucrats spend someone else' money, they drive prices up and buy IBM mainframes and workstations!

3. Medical care is insanely expensive in the US compared to "socialized" countries like Germany described above. And they have a longer life expectancy, even with all that beer and sausage. And they smoke like fiends. I lived in Germany for 2 years, and they definitely have a better medical system than we do, and cheaper.

The life expectancy issue is a red herring. That of the US is weighed down by recent immigrants and poor families that have theoretical access to free health-care but do not or can not actually use them, especially in pre-natal care. That leads to higher infant mortality among particular groups. Infant mortality is the biggest factor in "average life expectation," not longevity of the elderly per se.

But the free market fails very badly in many cases. Take roads. Would you want toll roads everywhere?

Why would there be toll roads everywhere? When was the last time we had to pay toll when we leave our drive way and enter the development? There are numerous ways to road maintenance that does not have to involve the federal government.

Critical health care is kind of like that. Everyone really needs it, and our "free market" cartel has completely failed to provide it at a reasonable cost, because there is no real ability to shop or walk away.

That's because numerous market options and would-be providers are banned by the governments.

What's really needed is basic health insurance coverage at a reasonable premium for everyone, with a 10% copay to limit overuse.

What is a "reasonable premium"? Considering that health insurance coverage have gone up more than 10x in the last 20 years alone . . . what's to prevent the cost go up another ten-fold to make the 10% co-pay the same amount as the current bill? BTW, the average reimbursement rate of hospital bills is just over 10% the amount billed . . . so the 10-fold bill padding is already there.

But that would interfere with giant insurance company profits, and health conglomerate profits, so there is no way any Republican congressman would vote for it. It violates the prime Republican directive of redistributing income from the middle class to the ultra-rich.

It's not just the Republicans. Democrats are on the same bandwagon. Limited supply and government subsidy help goose up medical bills, so that the banks can charge enormous interest fees on hospital buildings, equipment and doctors' education. The banking cartel is overwhelmingly Democrat in their contributions, simply because all those government programs have to be financed . . . i.e. another excuse for the banks to levy interest from the taxpayers via taxation (and the scam called "public debt").

I'll take door number three: "government do what private market fails to do".

What ostensibly look to some like "what private market fails to do" is actually the result of government intervention: such as banning people from offering medical and insurance options that are priced lower.

The European health care system, while better run, has less funding. Expensive medical equipment is scarce in comparison with the US where expensive equipment and drugs are almost too common. Health care in the US is run like a business. Medical equipment suppliers and drug companies make deals with health providers. The drawback is more expensive care. The benefit is access to higher technology procedures.

One such expensive machine detected early stage cancer in my grandmother while she was visiting the US on a short vacation. I don't know what type of machine this was. It is so expensive that there are only one or two such machines in all of the Netherlands. She would have NEVER been granted access to this equipment in the EU. Luckily this equipment is common in the US. Unfortunately, we discovered some bad news.

At the same time, the productization of healthcare in the US has resulted in a reduction of expertise and common sense in the medical practitioners themselves.

Neither system is perfect but I would choose a 100% privatized, market driven system over socialized/private hybrid. I want the choice of visiting the $5 witch doctor on the corner or spending $10K to get access to the expensive equipment, or both! I don't think health care is a right. Universal access to health care presents a moral hazard in that it encourages unhealthy lifestyles.

it is at least possible to grow your own food, but try to treat your own heart attack or cancer and you'll die.

Have you ever actually tried to grow all your own food? Without gasoline/diesel powered machines, it is nigh impossible for the overwhelming majority of this country's population. A couple tomatoes in a pot can only last you one day, not a whole year till the next crop is ready for harvest.

Having lost one relative in his 80's to heart attack, and another to cancer in her 90's (different sides of the family), I'd say their refusal to serious medical treatment probably gave them extra 5-10 years each. Both lived very fulfilling lives in their final years. The widow actually started dating in her 90's! BTW, the grandpa did self-medicate with nitroglycerin on a couple occasions to save himself from dying or even a rush to the hospital in the past two decades. So there, while people do eventually die, self-medication does not mean death. Having breasts or colon cut out at 70+ so that some doctors and/or hospitals can bill the insurance company or taxpayer does not mean longevity or quality of life.

The statstical average for life extension after operations at advanced age is measured in a few weeks to a few months, if at all. The 90+ lady lived with her cancer diagnosis for nearly 20 years before dying of senility (not even of the breast cancer that she was diagosed).

NuttBoxer says

Unfortunately, most of us are in the sad state of believing we need central government to do everything short of wiping our asses.

False dichotomy! http://en.wikipedia.org/wiki/False_dilemma

As Roberto put it for housing:

Why do the buy side idiots ALWAYS fall for the FALSE CHOICE FALLACY????
Choice 1: Buy today, right now, this second.
Choice 2: Rent until you die.
Um, I'll take door #3: let prices fall another couple hundred $K on a home
like this, and buy it in a year or two. What did I win?
--Roberto Aribas

Same for health care. It's not "government do everything" vs "government do nothing".

I'll take door number three: "government do what private market fails to do".

I see your point here, but it's a bit too idealistic for me. Any time you involve our central government in regulation or distribution it is a dichotomy, because they will not stop at simply fixing what's broken.

Reality says

Medicine used to be cheap too, that is, before the government regulations limited supplies with licensing requirement and FDA approvals

It may have been cheap, but was it safe? I don't mind new drugs needing FDA approval considering the potential dangers inherent in drug treatment.

Reality says

The free market place can take care of the sick and the elderly far better than Plantation Health-care can: just like free market has made computers and cell phones far more accessible to the poor in the past 30+ years than any scheme of government buying computers for families with children could have done.

This seems like a compelling argument. A big difference is the human "emotional" factor, though. We don't feel guilty if a poor person lacks a cell phone or computer (they're ultimately luxuries), but we do feel guilty if a poor person can't afford to cure his illness, especially in a life-or-death situation.

mieses says

he drawback is more expensive care. The benefit is access to higher technology procedures.

Bullshit. The drawback with American care is just the economics rents being captured.

but I would choose a 100% privatized, market driven system over socialized/private hybrid.

This is because you are an ideologue.

Universal access to health care presents a moral hazard in that it encourages unhealthy lifestyles.

More Bullshit. Norway has the most expensive "Eurosocialist" system and their per capita health care costs are about half ours.

"we do feel guilty if a poor person can't afford to cure his illness, especially in a life-or-death situation"

Then individuals or groups should try to help that needy person. We instead distance ourselves from moral responsibility by creating ineffective programs and increasing other people's taxes. It should be called "virtual morality".

Google the essay "Reversing the Decay of London Undone" written by Britain's chief rabbi on the moral disintegration since the 1960s.

"More Bullshit. Norway has the most expensive "Eurosocialist" system and their per capita health care costs are about half ours."

Perhaps because everyone is absolutely terrified of getting sick! I know I would be. Anyways, you made one good point. I should refine the moral hazard argument since socialized healthcare does probably make people healthier, though not for the reasons you think it does.

mieses says

I don't think health care is a right. Universal access to health care presents a moral hazard in that it encourages unhealthy lifestyles.

Really? Care to document how the US has a healthier lifestyle than any of the countries with public health care?

Yes, I agree with mieses' statement. If someone gets stomach, prostate, or breast cancer, it was obvivously their fault since they lhad an unhealthy lifestyle.

Seriously though, do you conservatives evn try anymore, or have you given up and just spew whatever nonsense you can think of?

HousingWatcher says

Seriously though, do you conservatives evn try anymore, or have you given up and just spew whatever nonsense you can think of?

So what about the liberals? Why does a family of 4 making 80K+ need health care credit? Insurance premiums even at 2K per month is easily affordable for a family of 4 making 80K. Of course if liberals really start taking personal responsibility, how can they buy their iPhones and iPads (and still stand in line for the next one).

Food stamps -- yay!! Make sure that food stamps are only used for nutritious food -- Nay (liberals)

Taxes -- yay!! Actually pay the taxes - Nay! (this is almost the minimum requirement to be considered for any government post).

sack says

Why does a family of 4 making 80K+ need health care credit?

Basically because only giving benefits to a minority like the bottom 30% or whatever won't get through congress, there has to be something for everyone (or most everyone).

Of course if liberals really start taking personal responsibility, how can they buy their iPhones and iPads (and still stand in line for the next one).

wat

Taxes -- yay!! Actually pay the taxes - Nay! (this is almost the minimum requirement to be considered for any government post).

drivel. Start a new nym. This handle is off to a real stupid start.

mieses says

I should refine the moral hazard argument since socialized healthcare does probably make people healthier, though not for the reasons you think it does.

Not ever having to worry about access to healthcare is healthier in and of itself.

It is true that population-dense countries like Singapore, Sweden, Denmark, and Germany have no excuse for not delivering healthcare more efficiently than us, free market or no.

But the free market fairy is not strong enough to cut through the rent-seeking in medical care. The need is too great, as are the other asymmetries between buyer and supplier.

mieses says

Then individuals or groups should try to help that needy person. We instead distance ourselves from moral responsibility by creating ineffective programs and increasing other people's taxes. It should be called "virtual morality".

you're wrapped up in your free-market fairytale bullshit and ignoring the successes of Norway, Sweden, Germany, Canada, Japan, and others.

I lived in Japan for almost 10 years and would prefer going back there to our screwed-up system, even though I've been able to be among the "haves" as far as good insurance coverage goes. This will get harder as I get older though, and I still may go back to Japan, especially if Justice Kennedy shoots down PPACA next summer.

I'll take door number three: "government do what private market fails to do".

Can the private market compete in a space where the government sets prices through reimbursement rates?

You'll often hear that "single payer" in the United States is Medicare. So just expand that to cover everyone. They will say it is because medicare has the lowest costs.

What they won't tell you is the government doesn't have to factor the costs to collect the money. What they won't tell you is that Medicare is already adminstered by the same private insurance monopolies that practice regional market rigging.

All the government sponsored or single payer examples of glorified health care also do not count the costs associated with collecting the capital to finance the programs.

Not ever having to worry about access to healthcare is healthier in and of itself.

Bullshit. Never having to worry about the allocation of scare resources is a fairy tale dream world operating on borrowed time.

There is very little standing in your way of stealing resources from people that support your causes to build the kind of health care model you want. You just choose to steal capital from people that do not agree with you because you think you can allocate it better than they can.

bob2356 says

Care to document how the US has a healthier lifestyle than any of the countries with public health care?

I did not say that the US has a healthier lifestyle nor did I mean to infer it.

I said that socialized healthcare promotes unhealthy lifestyles because a persons' good health is, in theory, insured. Reality differs from theory. Let's first look at pricing, quality, and availability of care in three extreme cases.

- Free high quality healthcare encourages unhealthy lifestyles. (This situation is a utopia that will never exist. The Wall-E spaceship.)

- Free low quality care discourages unhealthy lifestyles, especially in the absence of market choices. (The completely socialized case fails, despite misleading data and stats about the EU, etc.)

- Access to high quality care at market prices discourages unhealthy lifestyles. (This is not the condition in the U.S. We are very, very far from being a free-market. Talk to any doctor.)

Let's look at how scarcity influences behavior. The biggest health issue in the US is obesity. The classic healthy European diets come from a history of scarcity and famine. Scarcity leads to better decisions. The American diet has derailed due to an over-abundance of resources and a general anti-culturalism (food is culture). We have comfort food and corn starch subsidies.

Just like famine leads to healthier diets, socialized healthcare may, perversely, lead to better lifestyle choices. Europeans are more afraid to get sick because their healthcare sucks. (And it does suck. Save your misleading data for the naive.) Health care costs go down when people don't visit the doctor or because the waiting list it so long that they die waiting.

A market driven system produces the same outcome as socialist scarcity by discouraging people from consuming healthcare. But at least good healthcare is available.

The compromised corporatist hybrid system (what the U.S. excels at) provides the worst of the two extremes - the most corruption and the most demoralization.

Which is the better way to discourage poor lifestyle decisions? Market pricing of services or the fear of relying on ineffective entitlements? In the second case, your own personal survival may depend on the existence of other countries with free market care.

wtfcapinv says

Never having to worry about the allocation of scare resources is a fairy tale dream world operating on borrowed time.

Medical care is not a question of scarcity. Most of it is just pure face-to-face services with minimal consumption of resources other than the doctor's available tee times at the local country club.

Care is expensive due to the rents. Uber-capitalists like yourself have a massive blind-spot about economic rents and the damage they do over time.

There is very little standing in your way of stealing resources from people that support your causes to build the kind of health care model you want. You just choose to steal capital from people that do not agree with you because you think you can allocate it better than they can.

blah blah blah same old tiresome righty refrain. You guys were wrong in your opposition to Medicare 50 years ago and you're still wrong now for the exact same reasons.

Japan, Canada, Norway, Sweden, Denmark, Finland, Germany, the UK, and perhaps France do healthcare better than us.

We can learn from them or not. Our choice.

mieses says

Free high quality healthcare encourages unhealthy lifestyles.

bullshit ideology ignoring real world facts that having a healthy lifestyle to begin with heightens ones' quality of life in so many areas.

Your commitment to silly right-wing economics is producing assertions that are counter to reality. Kinda like Marxists in that respect.

Famine, in Europe? Utterly bizarre thesis.

By the way, are all the user accounts that start their replies with the word b**sh** the same IP address or is bullying and crassness the default conversational style of the socialist leaning members of patrick.net?

I play the ball not the man, mieses. Utter bullshit, and I will call you on it if I feel like it.

But I'm done with you now. Welcome to ignore.

B-Bob, you clearly did not read what I wrote or missed the point entirely.

Please preface your reply with the requisite b-word.

wthrfrk80 says

It may have been cheap, but was it safe? I don't mind new drugs needing FDA approval considering the potential dangers inherent in drug treatment.

So how safe was the Cox-2 drug any way? The idea that a government bureaucracy can decide what's safe what's not is quite absurd . . . yet it's repeated over and over again since at least when Levitacus was written. Those regulatory bureaucracies are guarateed to be captured by the very industries that they regulate, to the detriment of consumers.

This seems like a compelling argument. A big difference is the human "emotional" factor, though. We don't feel guilty if a poor person lacks a cell phone or computer (they're ultimately luxuries), but we do feel guilty if a poor person can't afford to cure his illness, especially in a life-or-death situation.

Anyone can voluntarily help the needy at any time . . . except for when the government bans unlicensed individuals to render help to the poor so that the rent seekers making loans to build licensed hospitals, buy medical equipment and get medical degrees can run up enormous sums of profit.

The silly people who can not see beyond their noses in terms of consequence analysis has blood on their hands as they drive more and more middle class into poverty because medicine is over-priced. Ultimately it's this poverty and high price of medical service that kill people by making medicine unavailable on a timely basis. Feel guilty about that!

HousingWatcher says

Yes, I agree with mieses' statement. If someone gets stomach, prostate, or breast cancer, it was obvivously their fault since they lhad an unhealthy lifestyle.

Seriously though, do you conservatives evn try anymore, or have you given up and just spew whatever nonsense you can think of?

The moral hazard argument is primarily not about life style choice by the patients, but doctors and hospitals going around digging for gold in patients' breasts and colons . . . unnecessary procedures that generate profit for hospitals, doctors and their bank creditors.

Reality says

The moral hazard argument is primarily not about life style choice by the patients, but doctors and hospitals going around digging for gold in patients' breasts and colons . . . unnecessary procedures that generate profit for hospitals, doctors and their bank creditors.

Free market at work. Asymmetries of information will tend to do that.

tatupu70 says

OK--here's what I think. Insurers can sell health care plans in any state they want right now. There is no restriction against a health care company operating in all 50 states. They do have to follow the laws governing each state, however.
So what you are proposing is a way to circumvent state laws that some insurance companies find objectionable. And as such, you would not reduce health care costs per service but rather simply reduce services.
It wouldn't be more efficient--it would just be crappier coverage. That's not the direction I'd like to go in...

Exactly right. State laws restrict what consumers can buy, simply because the consumer lives in the particular state. It's easy to circumvent with physical products, but not so easy for services such as health insurance. And the most immediate issue in this thread is not reducing health care services in general, but reducing the cost of obtaining health care insurance by small businesses such as Patrick's. What if Patrick found a plan provided by some company operating according to another state's rules, that allowed a la carte coverage selections? What if that plan covered only certain services that Patrick reasonably believes that he needs or should provide for himself and his employees? What you consider "crappier coverage" might be just the solution that certain people find appropriate for themselves, given their own circumstances, given their own desire to go out on their own into business and be able to afford something, rather than nothing.

What's really needed is basic health insurance coverage at a reasonable premium for everyone, with a 10% copay to limit overuse.
But that would interfere with giant insurance company profits, and health conglomerate profits, so there is no way any Republican congressman would vote for it. It violates the prime Republican directive of redistributing income from the middle class to the ultra-rich.

What you fail to realize is that the whole "allow people to purchase policies across state lines" would actually allow such a choice. You live in CA, which is to my knowledge run primarily by Democrats, and the limits to what policies are provided are rooted in your own state laws. But being as that you've slid so far to the left in the couple of years I've followed this site, I can only hope that you'd get beyond simply hating Republicans, and look at what is really driving some of these situations.

Why doesn't CA allow such a plan that you need?

tatupu70 says

Reality says

The moral hazard argument is primarily not about life style choice by the patients, but doctors and hospitals going around digging for gold in patients' breasts and colons . . . unnecessary procedures that generate profit for hospitals, doctors and their bank creditors.

Free market at work. Asymmetries of information will tend to do that.

No it is not. The victims in those gold-digging expeditions are the tax payers who have to foot the bills. Those who can pay the bill for themselves certainly have the right to have whatever body part of their own taken out, regardless the doctors's opinions.

mieses says

Just like famine leads to healthier diets, socialized healthcare may, perversely, lead to better lifestyle choices. Europeans are more afraid to get sick because their healthcare sucks. (And it does suck. Save your misleading data for the naive.) Health care costs go down when people don't visit the doctor or because the waiting list it so long that they die waiting.

You are aware that public health care and Europe aren't synonymous aren't you? There are public health care systems all over the planet. Oh, sorry , that's a misleading fact.

Can you provide anything at all concrete to document that people in "europe" are afraid of getting sick because their health care sucks and they don't visit their doctor. Oh right, you don't deal in actual facts, they are misleading. It's much better to deal in anecdotes and ideological misstatements.

I will put in one bit of "misleading data". The cost for public health care countries that don't have any waiting lists is about 10% higher than the countries that "ration" health care with waiting lists. That is still about half the cost of health care in the US. This article is a bit older, but still is interesting. http://www.commonwealthfund.org/Publications/In-the-Literature/2005/Jul/Health-Spending-in-the-United-States-and-the-Rest-of-the-Industrialized-World.aspx

Not that any of this would be relevant to someone who doesn't believe in "misleading data".

Paralithodes says

What you fail to realize is that the whole "allow people to purchase policies across state lines" would actually allow such a choice. You live in CA, which is to my knowledge run primarily by Democrats, and the limits to what policies are provided are rooted in your own state laws.
[ad-homonym comment snipped]

Why doesn't CA allow such a plan that you need?

I don't see any evidence at all that removing the ability of states to regulate health insurance (another way of saying 'allow purchase across state lines') would improve anything. I do see LOTS of evidence from around the world that heavily regulated health care/insurance systems can work in a variety of ways. Witness every other first world country. Evidence trumps ideology, sorry.

Or is there some first-world country with a health care system that works the way you think ours should work?

Teach a man to fish, feed him for a lifetime. Teach a man that he's entitled to other peoples fish, ensure collective starvation.

Allow the rich to buy and fence off all the productive fisheries . . . well, whatever it is, we're soaking in it now.

Teach a man that he's entitled to other people's fish because he owns the ocean, and you've created a Republican!

Bellingham Bob says

Allow the rich to buy and fence off all the productive fisheries . . . well, whatever it is, we're soaking in it now.

"What's the bigger crime - taking away the goose from the common, or the common from the goose?" - A 19th Century Aussie convict on his 'crime'.

Honest Abe says

Teach a man to fish, feed him for a lifetime. Teach a man that he's entitled to other peoples fish, ensure collective starvation.

Hmmm... I am starting to see your point, so...

Give a man health care, and you cure/care for him for the day.

Teach a man to preform his own diagnosis, surgeries, and medicine production and you cure/care for him for a lifetime.

Yes, seems like it could work.

mieses says

- Free high quality healthcare encourages unhealthy lifestyles. (This situation is a utopia that will never exist. The Wall-E spaceship.)

- Free low quality care discourages unhealthy lifestyles, especially in the absence of market choices. (The completely socialized case fails, despite misleading data and stats about the EU, etc.)

This has a very good chance of being Shrek (under a different handle), because it is very worthy of a place on the stupidest things ever heard on Patrick.net. Sherk specializes in this kind of quarter baked nonsense.

For one thing Free Quality healthcare may be a problem because of overuse/abuse wasting too many resources, so let there be copay. Maybe even as high as $30 to $50

But your premise, even if true at the margins (yes, some people would be more cautious about their diet and exercise, if death rather than diabetes or heart disease was the consequence), but let's face it, for the most part these choices are made when people are young when the long term consequences of choices are not a factor in their thinking anyway.

But the markets and environments that bring them crappy choices in the first place, such as fast food and high fructose corn syrup, that's another story all together.

Poverty is by far the single biggest factor. I guess cynically one might argue that cheap junk food keeps the cost of higher quality food down for the rest of us. But that would be more than offset by the higher health care cost and lower quality of life later. Besides, I don't believe that to be true in any case.

(side note: maybe owning up to all of us paying for everyone's health care - other than at the emergency room - will positively impact our junk food culture)

Also, you have a highly inflated view of what doctors can fix, and the damage that they can undo. The lifestyle issues don't catch up to us until later, except in the extreme cases. Sure doctors treat these, but they usually can't undo the damage. They do address chronic and critical illnesses and diseases that happen to a small % of younger people. They dispense wonderful modern antibiotics and other medicines when needed (some are wonderful).

But otherwise a huge part of what they do is providing the advice and psychological support for our bodies to heal themselves when they can.

Teach a man that he's entitled to other people's fish because he owns the ocean, and you've created a Republican!

Only governments attempt to own oceans.