This is sad. Far more than just family benefits from someone’s well being. Friends. People at work. Customers. Those using things created or built by a person. Do you really think that a system where each of us is bombarded by requests for help in paying medical bills is feasible? And what of those without families? Do they deserve to die?
How about a sick child’s potential contribution to society? Lots of those who now are important grew up poor. Should we toss that potential because the parents don’t make enough? Or have rich friends?
You don’t understand the housing bubble very well. This did not happen because of charity, but because mortgage companies could make greater profit by helping those who could not afford a house to get one, through helping them lie. Tax money was not involved. The partially government run lenders had higher standards. And the mortgage companies which did this basically went out of business. The big banks, who were buying mortgages are a different story. You seem to have a very superficial knowledge of what happened.
BTW, there is government support for those who can’t afford housing - not as good as it should be, but it is there. Many cities require that builders also build low income housing, for instance. We have homeless, but many of them have mental issues (not all) but we try.
Not having shantytowns is considered a public good in these parts. I trust that you have resources for healthcare, housing, and food. Good for you. I suggest that you try to put yourself in the shoes (if he has them) of a garbage picker. He is human also. Think how he might feel about a rich person who says that if he can’t put together enough money for a roof over his head he should sleep in the street, and if he can’t pay for a doctor he should die.
Medical insurance does drive up healthcare costs in the USA. But it’s not the only factor, not even the most important. Let me take an example : when I see my doctor, at the end of the visit, I hand him my healthcare card. He puts it in a card reader, input a code for whatever he did, and that’s the end of insurance-related paperwork for both of us (I’m reimbursed by a direct wiring to my bank account a week or so later). On the other hand, a doctor in the USA has to hire a staff to deal with assurance companies. That’s costing a whole lot.
In theory, that could be solved while maintening competing private insurers, if they somehow agreed to common procedures and documentation. I’m not aware of any attempt to do so in the USA, and I’m not sure they have any incentive to do so (especially since paying quickly, for instance, isn’t in their best interest, even though I would definitely consider this as “efficiency”).
I’m not American, but in the USA, it’s exactly the other way around. You’re billed much less if you’re insured than if you aren’t, since insurance companies negociate with health care providers while individual people can’t. The result is that in the pre-obamacare system, if you can’t afford an insurance, you’re billed more than people who can afford it. You’re doubly fucked. It makes perfect sense in a free market (If you can extract more money from a customer who lacks negociating power, you do so), but I wouldn’t deem this “efficient” for society at large. Poor people are in fact subventionning the medical expenses of both wealthier people (who have an insurance and reduced expenses) and poorer people (who won’t pay at all, and, say, will declare bankruptcy). This is bordering insanity.
Also, again from what I see, medical bills in US hospitals are extremely opaque. And often ludicrously high for minor procedures. Read any post here mentioning US hospital bills for evidences of this
Fine words Voyager. But I live in a system that suffers from the scourge of poverty and has been trying, unsuccessfully, to remove it for 60 years. (Guess what - our biggest successes came right after we moved away from the system that claims the government WILL take care of all the people) I’ve wrestled with these problems for most of my adult life, and at a professional level - I actually work in development. The emotive appeals are easy to make, and the intentions behind them are noble, but they’re the sort of appeals that led my country to disastrous experiments with socialism for nearly half a century. These are the same sort of words that get thrown around to stifle debate in India and prevent overturning crippling pro-labour regulation and a ‘right’ to food. But think of the poor labourers! But think of those that are going hungry! We most definitely should think of them, and do all we can to alleviate their suffering. But we shouldn’t think that tax money is the right way to do it. Because the thing is, these appeals don’t actually end up helping people. They’re just easy ways for us to assuage our conscience and for politicians to gull people into voting for them, without actually delivering.
You often tell stories from your experience about the extreme incompetence of government. That’s because governance is difficult. The private sector has it easy - one clearly defined goal, profit. One set of stakeholders - owners. One method of measurement - financial results. And yet the private sector has many failures. The government on the other hand, it has so many different dimensions on which people judge it, so many different competing areas on which it has to perform, so imperfect the information on the basis of which it has to act and be judged. No politician has to deliver on each and everything government is responsible for. They only have to deliver on a few or, even worse, seen to be delivering on some things. It is remarkable that government actually delivers at all. That’s why it is so important that those few be restricted to tasks that only governments can undertake - provision of public goods. Of which tertiary healthcare is not one.
If healthcare is a private good, then education is a private good. Let’s only educate those who can afford to pay for it. That should do wonders for the economy in a generation or so.
And why not go full Galt? Let’s have gated communities with private security, fire services, schools, parks and so forth for those with wealth, and the rest of the population can scrabble for what they can get. It’s all very properly Darwinian and no one has to pay for anyone else’s costs. What a blissful utopia that would be!
Dude, do you know how many physicians the US’ market-based system is stealing? More than a quarter of American physicians are foreign born and almost three quarters of those are South Asians. You should be crying out for a government run healthcare system in the US, with its attendant contraction in physicians’ earnings.
One interesting fact for those focusd on free market incentives is that in the U.K. family physicians are compensated based on success at keeping their clients healthy. In U.S., of course, compensation increases as more doctor’s visits are required. :smack:
Google “goose gander.”
I think only those who supported the Biblical War against Gog and Magog should have paid for that multi-trillion dollar adventure.
What’s that you say? Bush’s Boondoggle was to help America as a whole? Google “goose gander.”
You could build up and tear down straw men all day long. Do have fun.
A government system in the US would be unlikely to reduce incomes below the level that would make it unattractive for third world doctors. On the other hand, it IS likely to make it unattractive for people in the US considering it as a career. So, no, I’m not hoping for that.
This is a good point. The information asymmetry I spoke of earlier, and definitely a problem. Serious enough to require fixing, but not unfixable IMO.
Oh, I am. But you asserted that healthcare was a private good, not a public one. The same argument applies to education, and in both cases there is a real long-term public detriment to widespread lack to access to either. So there may be a private benefit individually to universal healthcare, but collectively there is also a public one.
I’m not criticizing your system, just your philosophy. I certainly agree with you that excessive meddling by the government held India back. But that has nothing to do with the provision of healthcare. The UK is hardly a socialist country, after all.
Please give me an example of where dumping people in need on charity came out well. I can give you a counterexample - England when Dickens was young. To make the poor more self-reliant the government cut all support, and the suffering was tremendous.
By the way, much of your objection to health care funding seems to cover private insurance as well as government insurance. (In the US they are similar except for the source of the payment.) Do you support outlawing health insurance? The group pays when a single member has medical costs, which you seem to have a problem with.
How do you propose to fix it? Let’s say that all hospitals publish their rates for all procedures. It is unlikely that Hospital A is going to be uniformly more expensive than Hospital B. Since you have no idea of all the procedures you will need when entering a hospital, even for elective surgery, you cannot pick an optimal one. Not to mention that price is not going to be your sole criterion for picking a doctor or a hospital.
And that is for elective procedures. When my wife’s retina detached we were sure as hell not going to research the cheapest provider.
In fact, for much insurance, the insurance company does all this research for you, and as I said negotiates prices better than you can do. (Your insurance companies will eventually figure out how to reduce their costs.) So, your system is both more expensive and produces worse outcomes than even our pretty broken one, not to mention cheaper and better ones in Canada and Europe. Unless, that is, a better outcome by your definition is people without enough money being excluded.
No, it doesn’t. Maybe college level education, yes but even that is arguable. Public goods are characterised by being non-rival and non-excludable. Primary education isn’t a perfect public good, but it is non-rival to some extent because of how it is delivered. The marginal cost of educating one more child is low. So even small externalities (although the externalities are possibly large) give it the characteristics of a public good. Keep in mind that I don’t think all primary care in health is necessarily disqualified as a public good either. There is an entire subset of healthcare called public health which definitely comes under public goods.
Any number of possible fixes can be explored - government accreditation of hospitals and practitioners so you can be assured of minimum quality, review and rating systems similar to the one I linked earlier, medical malpractice rules. I’m not advocating laissez faire markets in health care. These are important questions, but they’re separate from the premise that tax money ought not to pay for healthcare.
I’m not sure what you think my underlying point was, but my point was that government run systems ought not to be touted as cheap while they are being subsidised by others.
‘The public good’ and ‘a public good’ are not the same thing, and it may be an important reason that we’re having difficulty communicating. ‘The public good’ is vaguely defined. A public good is a precise concept. ‘Good’ here is not the normative descriptor ala good/bad. It is the positive descriptor from ‘goods and services’.
To expound on this point - every single child needs education to go from uneducated to educated. Primary education has externalities, or rather let me say that non-education has negative externalities, particularly in democratic setups, similar to how pollution has negative externalities. Primary education is also, as I posted earlier - partly non-rival. A teacher’s time input is not scaled by a linear factor of how many children they teach. It is a step function. These things together make primary education A public good, which is a valid item to tax.
On the other hand, only a small proportion of children need advanced healthcare. Doing our utmost to keep these children alive, in my eyes, makes us a better society - but not if the only way we can do so is to tax people who do not value the lives of these children so that they contribute towards saving them. Because those children’s lives do not have positive externalities - the people who don’t value them enough to contribute towards their living will not free-ride off any benefits from those children living. Nor will their deaths cause negative externalities.
You earlier made a point about the potential that children represent. I think it is a fair and valid point, and I promise to think about it.
Mine isn’t a purely philosophical position. And of course you’re right that the UK is not socialist. But I think it’s instructive to examine why attempts to implement Socialism failed. My (very considered) opinion is that it failed because governments tried to take on too much, and because of the factors I presented in the last post (diffuse accountability, poor information) governments are not equipped to take on too much. The question then becomes - where and how do you draw the line? And to me, after a pretty reasonable amount of study the answer is clear - public goods are the domain of the government, and private goods are the domain of the market.
In the case of India (and many, if not most developing countries) I’m confident that the problem lies in not focusing on providing public goods - law and order, primary education, public health(sanitation, vaccination, basic primary care), and focusing instead on emotive appeals towards providing private goods like food, housing and employment. The problem is that NOTHING gets delivered - neither public nor private, because governments are over extended and accountability is diffuse, while markets are ill equipped to deliver public goods, and the markets for private goods are distorted by heavy government involvement.
Of course in developed countries public good provision is already at an advanced stage, and at that margin you may think it is ok to err towards some private good provision by government. I just think it’s not a smart move.
We don’t live in Victorian England. My reasoning isn’t to cut all support so that the poor should be dumped in the deep end and sink or swim. It is so that the poor don’t look towards the goverment to solve all their problems in procuring private goods. They most definitely should look to society, and society should step up, and I think it would. People are already incredibly kind and generous. I think if they were freed from the expectation that their tax money is supposed to help feed and provide healthcare to the poor, I think people would donate, and pick their donations wisely, because they cared about whether their money was helping or not (solutions like givewell.org would be prominent IMO). May not happen instantly, but I think it would.
Here’s the thing though - if they didn’t care about healthcare for the poor, and didn’t donate in large enough numbers, then on what basis can we claim legitimacy for using tax money for the same purpose? Especially since there are no externalities involved?
The son of very close friends was recently one of the “small proportion of Children need[ing] advanced healthcare”. He developed Hodgkin’s lymphoma a couple of years ago and spent a fair chunk of his last two years of high school in treatment. This is, fortunately, one of the most treatable cancers, and he is now enjoying his freshman year of engineering school, and should live a long, productive life.
His total cost of treatment was about $1M. He certainly could not have saved that kind of money in an HSA, being a minor and all. Nor could his parents have saved that kind of money, given their solidly middle-class salaries. But they had health insurance, so they paid a few thousand dollars in each of the 2 years of treatment (deductibles and co-insurance up to the maximum out-of-pocket for their plan). That’s the point of insurance, of course, to cover those low-probability, high-impact risks.
It seems to me that without the system of risk-pooling that allows people of modest means to be treated for very expensive conditions, there would be no capacity to treat them at all. Think of it this way: if only extremely rich people, who are a small fraction of the population, can afford treatment for Hodgkin’s, which is quite rare, would a facility capable of treating the disease be able to stay open without charging even more?
Here’s the thing though - if they didn’t care about healthcare for the poor, and didn’t donate in large enough numbers, then on what basis can we claim legitimacy for using tax money for the same purpose? Especially since there are no externalities involved?
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The thing is everyone in this country everyone does have access to healthcare for serious illnesses. There are people who do die for lack of care but most of the time even a bum can get treated for cancer or serious accidents etc.
The bad part is that the hospitals have to make up for that somewhere else mostly through insurance companies who are sure to mark it up by the time it gets back down to us. I am kind of shocked that you really believe that people would step up and donate money for those who are needy. That aint gonna happen.
I have no problem in theory with medical insurance as a method of risk pooling where people are concerned enough about low probability catastrophic risk (like you recount) to buy insurance. One could perhaps even make the argument that people being irrationally optimistic, they should be forced to buy insurance (or deposit into HSAs).
However, there are two problems with that where health care is concerned. For one thing medical insurance as it stands doesn’t work like that - insurance has been given tax breaks to artificially inflate demand for it. It has then been used to pay for every medical cost you incur, not just low probability catastrophic risks. This drives costs up to begin with when large parts of your population are healthy, because you have the money from healthy people and unhealthy people to pay for problems only unhealthy people are having. There is no pressure to innovate to reduce costs(not to mention additional overheads for insurance), and you end up with the sort of high prices you have in the US. But this is just a fault of how the system has developed, and can be mitigated by changing the model for medical insurance to restrict it to low probability catastrophic expenditure.
This is where the second and perhaps bigger problem comes in - the risk of high expenditure events is not exogenous i.e it isn’t truly random. The die is loaded against some people. And we are beginning, more and more, to be able to identify indicators of this. What that would result in is ever higher premiums for folks that are at higher risk, and an ever increasing number of healthy people that would choose not to participate. That defeats the purpose of risk pooling. And to solve it by forcing everyone to buy insurance, as I think the US has done, is IMO not a good solution.
I’m not sure what the first part of your comment was intended to convey, so I won’t reply to it. As for this part, I will reiterate. If people, knowing that their tax money is not going towards helping the needy pay for their (tertiary) care, do not come forward and make up the difference, how can you justify taxing them for it, given that there are no benefits accruing to them from it? For taxes that go towards national defence, benefits must accrue to everyone, whether they want it or not, so they shouldn’t be allowed to free ride. For taxes that go towards maintaining law and order, benefits have to go to everyone, whether they want it or not, so they shouldn’t be allowed to free ride. Advanced medical care is NOT like these things.
But in my view, yours is a needlessly pessimistic view of humankind. I think people are basically good, and like helping each other. We’re social creatures, and we get little warm glows of satisfaction inside when we help other people out. We may not like tax for all sorts of reasons - it doesn’t give us options because it is forced upon us, we may believe that it doesn’t actually help people(often true) and even then is being forced upon us, it may not give us the direct sense that we’ve made a difference, all sorts of reasons. I think it is a far better approach to leave government out of private goods, and get social expectations involved. Pulling together as a community and a society should involve voluntarily putting in money and effort to help those who are the least fortunate, not just being forced to do so.
But they will get a benefit from it in the form of reduced insurance rates via taxes instead of insurance. We will still be sharing the risk not knowing he will need it and when.
I must have missed this. I don’t know why the point of comparison bit is important. I wasn’t holding the US up as a superior system at any point.
Also, more subsidised? I haven’t seen a single cite that the UK has fewer foreign trained doctors. In fact, the more recent cites I can find are showing numbers between 33% and 40%. Other English speaking countries - Australia, Ireland have slightly higher or the same as the US. Only Canada seems to have a couple of percentage point fewer.
And, like I pointed out earlier, the US also subsidises new drug development for the rest of the world - I dug around the financial reports of the top pharmaceutical companies. For every one I checked (GSK, Roche, Pfizer, J&J, i.e the top 4 *), more than 50% of the revenue from drugs(i.e excluding consumer products) came from the US(and the rest from the remaining world). That’s pretty massive don’t you think? Again, like I said earlier, this is not good for Americans, but I think it means other countries healthcare expenditure numbers don’t reflect true costs.
*The pattern across these 4 was pretty consistent. I have no reason to believe the other pharma companies are substantially different, so I stopped checking after 4.