Kevin Williamson lays out an argument regarding access to medical care that basically says (if I am interpreting it correctly) “Life is unfair- resources are limited - feel good promises are useless - capitalism will (eventually) solve the problem if left to it’s own devices”.
His “3 apples - 4 kids” argument seems logical but it (I think) ignores the possibility that society may choose to prioritize making 4 apples available at some point if the idea seems like the right thing to do.
What are the flaws in his argument for the US as it stands today?
I live in a country with universal health care. Doctors still have expensive cars. Rich people still get better health care. The article is just extremist rhetoric.
As has been said, his argument falls at the first hurdle because there are enough apples. Every country that implements universal apple distribution has no problem sourcing and providing fairly standard apples to all of their population. They are cheap, there is an economy of scale in sourcing them and if people sometimes get an extra one that they don’t really need then that is a small price to pay for ensuring everyone at the very least gets that base level of fruity goodness to keep them healthy.
The more exotic fruits are comparatively rare and more expensive of course but not everyone requires them and so in those circumstances we use special panels of experts to decide who has the greatest need of them. It is based on strict nutritional criteria though, not on ability to pay. (but as with all things, those wealthy people who choose too can source their durians and dragon-fruits from independent or overseas suppliers)
I think the writer of that article started with his analogy, political standpoint and conclusions fixed in his mind and worked backwards from there.
And I don’t care what car my doctor drives. I do have more concerns about a health system within which a doctor feels free to say “Do you really want a doctor who can’t afford a Ferrari?”. Does that single statement not capture much of what causes the problem?
It never did in the centuries before the principle of the welfare state: nor could it unless and until there is a much more equal distribution of means to acquire/purchase whatever medical care is needed - which doesn’t only mean the financial means to pay what is asked, but also the knowledge and judgment to be able to negotiate successfully with the provider, which is more or less an impossibility for the individual patient, however rich.
So the question is, what sort of intermediate agent is efficient and effective, and what kind and degree of market regulation achieves the best balance of interests for all concerned? What constitutes “efficient”, “effective” and “best balance of interests” are inherently debatable and not capable of simple objective answers. Political and legislative judgment has to come into it.
Thinking further on this, if the article writer had extended his thinking on apples and automobiles he might have twigged why “the market” is not applicable to healthcare.
To give someone enough food to remain living and healthy costs X, give or take a small variation. No-one wakes up in desperate need of a wagyu steak or a dozen Colchester native oysters, their lives and comfort are not substantially diminished because they had a burrito rather than the £350 a head tasting menu at The Fat Duck. They are not plunged into misery because of a lack of civit-shit coffee.
For cars, If I trash my car tomorrow through no fault of my own I know that there is a an upper ceiling on what I need to pay in order to have functional transport again.
Now in both cases above, as a luxury, as an enhancement, people may choose to spend more. that is where the market and all its perverse machinations apply.
Healthcare is totally different. I can guarantee that I’ll go through the whole of my life never needing a Lamborghini, sadly I cannot say the same regarding, for example…treatment for MS.
I will never have a plate of finest belly bluefin forced upon me, unrequested, together with a massive bill. Whereas my pancreas could give up the ghost tomorrow and demand the equivalent bill to found every day for the rest of my life…or I die.
That asymmetry and randomness of healthcare requirements and ability to pay is why the market can never properly work and why schools, military, roads, police, fire, judiciary, coastguard etc. etc. are not left totally to the whim of the market either. Healthcare seems to fit perfectly with those state provided services and I’ve yet to hear solid reasoning to convince me otherwise.
Wait, the “Do you want a doctor who can’t afford a Ferrari?” bit is his stinger, what he’s ending the article with? I clicked through specifically because I was curious how he was going to frame that argument. Clearly, there must be some clever rhetoric to justify such a question, because on the face of it, it’s absurd. And even he apparently thinks it’s absurd, because he initially thought that his doctor owning multiple Ferraris was evidence that he was paying him too much (which he probably was, since paying directly almost always gives you a worse rate than what the insurance company would pay). And yet, he treats it as some sort of unassailable argument.
The automobile analogy isn’t a good one, Bubble. Just think about why most states require you to have auto insurance-- it’s not to insure you, it’s to ensure other drivers you might do harm to. And that harm has no upper limit, or at least it’s an upper limit far, far above the replacement value of your vehicle. Not to mention that you could, in fact, do quite a bit of harm to yourself that isn’t subject to some “upper limit”.
I have done a totally unbiased survey of the physicians parking garage at my hospital, and don’t recall ever seeing a Ferrari parked there. Rarely a Jag, some Audis and BMWs - but mostly you’d be hard pressed to see major differences from the sort of cars parked at a typical suburban shopping mall. I even see the odd Prius. :eek:
I’ve used snapshots as evidence to try to convince my representatives in Congress that we need to stop the semiannual cut-Medicare-reimbursement-for-physicians ritual, but no luck yet.
I’m talking purely about the purchase and replacement of a consumer item, I’m sure the dopers can mentally replace “car” with something else for which insurance is not required.
Stereo, bicycle, washing machine…you get the picture. If any of your your consumer items stopped working tomorrow there is a hard upper limit on the cost you have to bear.
The “free market” is what gave us the working class conditions of the late 19th and early 20th century which is what directly led to the entitlements that conservatives whine about now. But we already know how capitalism treats the working class when left to its own devices: we’ve seen it first hand (and this was after the period where “Just own humans as property and work them to death” was considered acceptable in pursuit of the dollar) and I have little faith that it’s changed since then.
Emmanuel Goldstein (1984) said the purpose of perpetual war was to waste the surplus wealth generated by efficient labor, rather than to let it fall into the hands of the working class, and thus erode the social distinction between the privileged and the proletariat.
I don’t mind if the doctor can afford a Ferrari because he won some other sort of lottery. But I don’t want my doctor to be someone who became one in order to be able to afford a Ferrari.
“Society may choose to prioritize” is a meaningless phrase.
His point was that if you want to provide more healthcare than you need to do certain things, increase the number of doctors, hospitals, nurses, drugs, etc. That all takes huge amounts of resources. Declaring a right to health care provides none of those resources and so is an empty platitude.
As a whole? Of course not. In regards to capitalism? Sure. Hell, you don’t even need to look back in time (though it’s helpful) – look at unregulated work around the world today. The only difference between child labor in 1902 and child labor now is that now we have to outsource it to 3rd world nations because pesky laws prevent it in the US.
And that rather clashes with the fact that all other western countries have chosen to declare it a right, and are providing it for far less resources, most also delivering better quality.
