I reported earlier about my recent adventures with America's "best health care system in the world." I can't imagine how all the right-wing fear-mongering about rationing and long waits can possibly be effective on anyone who has actually had to use our current health care system for any actual care, because I can tell you from first hand experience that unless you are rich (and sometimes even if you are rich) we already have rationing and long waits.
My PCP (primary care physician) read my blog and ran interference for me to get me in to see the dermatologist ahead of the queue. I was told that they didn't pull and strings, that there just happened to be a cancellation the next day, but I have no way of knowing if that was actually true. They may have just been telling me that because I specifically asked them not to pull strings. Either way, the fact that I got in early can't be counted as a victory for the system. At best, I got lucky. At worst, I got bumped to the head of the queue because I can afford to pay extra for access to a PCP who has enough free time to do things like read his patients' blogs.
At the dermatologist, I learned the following:
1. I almost certainly don't have cancer, but it's not a total slam-dunk. They told me to come back in three months for a followup just to be sure.
2. I was not waiting in line behind possible melanoma cases. I was waiting in line behind dermabrasions, botox, and facial hair removal.
So I believe it's fair for me to chalk up my experience as support for those who say that the present system is at least partially broken.
IMHO, the fundamental problem is that health care is (or at least ought to be considered) infrastructure, and free markets don't do a good job at providing infrastructure. I am a born-again capitalist. I believe in free markets, not for ideological reasons, but because empirically they tend to produce a net benefit for the well-being of mankind more effectively than any other system than has yet been invented. But free markets are not without their problems, and so various degrees of government regulation are needed to keep them performing their function even under the best of circumstances. If nothing else, government is needed to enforce contracts and discourage fraud. But even then, free markets work better for some goods than for others. They are really good at producing technology, commodities, and luxury goods. They are not so good at providing infrastructure. The U.S. is currently conducting an experiment at using free markets to provide wireless communications infrastructure, and the result is cell phone service that is not only universally crappy, but five times more expensive than anywhere else in the world. By way of contrast, the Internet, interstate highways, and the (wired) phone system are all cheap and reliable, and all are the result of government intervention of one sort or another.
I think health care ought to be treated as infrastructure. It's something everyone needs sooner or later, and it has a very long lead time to produce. Our current government-run health care plans, medicare and medicaid, work well enough to make them sufficiently popular that no politician dares to even suggest eliminating them. There are certainly ways in which government interference can go too far. Mandating centralized electronic record-keeping, for example, is an absolutely terrible idea. But opposing *any* government interference in health care because of possible abuses and inefficiencies is IMO throwing the baby out with the bathwater. The debate we ought to be having is not *whether* but *how* government should be participating in our health care system, because the system we have now is b0rken.
I think you go too far to say that, just because something could be labelled as "infrastructure", that therefore government intervention (of what kind?) is mandated. (And BTW: It's cheating to just hypothesize that there is some government intervention which would improve things. You can't compare real-world free market outcomes, with a hypothetical perfect government outcome. There are plenty of failures with any approach. You need to argue that things improve on average, in the real world, with such intervention.)
ReplyDeleteEven your examples aren't terribly convincing. The wired phone system was a government monopoly until 1984. Innovation skyrocketed and costs plummeted after deregulation.
The Internet was started with government funding, but it has been a free market for twenty years, including the skyrocketing dot-com growth in the '90s.
And the interstate highway system, while probably the best in the world, has recently been blamed for the suburban structure of US housing, and the loss of mass transit, both horrible choices forcing increased imports of foreign oil. (And possibly disasters if Peak Oil arrives in the near future.)
Health care, your main topic, is a different question. I think there are good reasons for government intervention (at least in health insurance).
But I think you've offered a weak argument. "It's infrastructure" is not a strong justification for government intervention.
My argument is that the current system, with enormous government interventions which create a synthetic market for profiteering insurance providers is broken because it is guaranteed to bankrupt all of us before too long.
ReplyDeleteWhat we have now is broken because it is breaking all of us.
I have frequently visited europe and even had a few visits to various hospitals in the UK, in the Netherlands, and in Germany (what can I say, on my honeymoon, I enjoyed myself a little too much). I also have family in Britain, Ireland, Norway, and Denmark. Their systems for health care are MUCH better than ours.
And the various right-wingers raise the specter of "rationing" as if it's avoidable. What crap. We have rationing by financial ability right now. Time with a doctor or getting tests or time on a machine is finite. Republicans don't advocate making health care a "right" because that "right" would obligate others to fulfill an abstract promise (which means it's a demand, not a right). For the various objectors to claim that Obama's plan would mean rationing is so far beyond irony that a word to describe it hasn't been invented yet.
We have to have a more rational means of determining who should and should not receive care for various conditions. Determining how to distribute a scarce resource is what capitalism claims to be good at. Coming up with some means of sanely distributing the scarce resource of skilled practitioners is the first, last, and only means of ultimately getting medical costs under control.
My first minimal proposal is that anyone other than a care provider who is collecting fees for medical services (insurance companies) must be a non-profit. Insurance companies made $4.5 billion in profit in 2008 in California alone. That's $4.5b paid from employers and individuals that didn't make it into the pocket of a doctor or hospital or pay for equipment or... in just one state. That money went to a government-mandated middleman and that's where the current government-managed system is completely falling down.
Health Care is already heavily regulated.
ReplyDeleteIn order to provide health care services, even the simplest ones, person much go through very costly and lengthy education and certification process.
No wonder that that health care cost skyrockets as a result.
Another problem -- huge tort amounts awarded by legal system against health care providers.
> Health Care is already heavily regulated.
ReplyDeleteThat's true. I never said that the government can't fuck up. Obviously it can. But some people seem to think that that's *all* the government is capable of doing, and I dispute that.
> Another problem -- huge tort amounts awarded by legal system against health care providers.
Nope. That's a myth.
> I think you go too far to say that, just because something could be labelled as "infrastructure", that therefore government intervention (of what kind?) is mandated.
ReplyDeleteThat's not what I said. I said that *empirically* infrastructure is better provided by government than the private sector. And it's not an arbitrary label. Infrastructure has a clear definition: it's anything that everyone needs and has a high cost and long lead time to provide: transportation, communications, energy, and health care.
> The wired phone system was a government monopoly until 1984. Innovation skyrocketed and costs plummeted after deregulation.
That's true. It's not the case that the private sector is *incapable* of building infrastructure, only that in the aggregate it seems not to do a very good job.
> And the interstate highway system, while probably the best in the world, has recently been blamed for the suburban structure of US housing, and the loss of mass transit, both horrible choices forcing increased imports of foreign oil.
That's a different issue. It may well be that building the interstate highway system was unwise. But *given* that you've decided to build an interstate highway system, you have to admit that the government did a pretty reasonable job.
1) Sure, there are things where government is useful.
ReplyDeleteHowever the more responsibilities you give to the government -- the worse it behaves.
My impression is that if we [gradually] cut government responsibilities [and budget] in half -- that would improve our economy (including health care).
If, on the opposite, we increase government size -- that would make economy work worse.
2) The article you linked to explains why that Dartmouth study is not correct. For example:
====
other studies have found that doctors' malpractice premiums increased more quickly in states without caps on pain and suffering, bolstering the group's position that caps are a solution to the problem.
====
Excessive tort awards are the heavy burden for healthcare. Without excessive tort awards healthcare would be much less expensive, more accessible and efficient.
Ron,
ReplyDelete> Infrastructure has a clear definition: it's anything that everyone needs and has a high cost and long lead time to provide:
Do search engines fall into that category?
Everyone needs, has a high cost and long lead time to provide.
> transportation,
Do you imply that government buses is better transportation than private cars?
> communications,
E.g. Skype?
> energy,
Does Exxon have to be nationalized?
> and health care.
I don't see how "health care" is an infrastructure.
When I need medical service -- I need help of medical specialist, not abstract "health care infrastructure".
> Do search engines fall into that category? Everyone needs, has a high cost and long lead time to provide.
ReplyDeleteSearch engines do not have a high cost. The original Google search engine was built by two graduate students. There are open-source search engines to be had for free.
> Do you imply that government buses is better transportation than private cars?
The cars aren't the infrastructure. The roads and bridges are the infrastructure. Just like in the phone network the handsets aren't the infrastructure, it's the cables and satellites that are the infrastructure. In the energy grid, the appliances you plug in aren't the infrastructure, it's the power plants and the distribution network.
> Skype?
Not infrastructure. Skype is a parasite on the Internet, which is infrastructure, which was built by the government.
> Does Exxon have to be nationalized?
There are certainly people who say we'd be better off if we did. I wouldn't go that far. But I will say that it's far from clear that the country is better off for having let Enron run open-loop for as long as it did.
> When I need medical service -- I need help of medical specialist, not abstract "health care infrastructure".
And what exactly do you expect this specialist to do for you in the absence of infrastructure? How is he going to diagnose what is wrong with you without lab tests? How is he going to treat you without medicine? Or surgical equipment? Or a dialysis machine?
As a Canadian listening to the right wing use the same arguments used in the fiftys in Canada is quite the joke.
ReplyDeleteI want the US to continue with the current broken system. Large companies like GM, Ford etc. will spend their money and ship jobs to countries with national health systems like Canada. As they will just not want to continue spending large amounts of money in a broken system.