Is Big Government really Bad?

Great Debates
21

Note that Americans without health coverage may still receive health care in several ways:

  1. Some of them have the money to pay for it.

  2. Some of them can borrow or save the money to pay for it.

  3. Emergency Rooms are required to provide care to all. Many poor people in America use the ER’s for routine health care.

This situation is far from ideal. However, my point is that in order to evaluate whether Americans or Canadians get better health care, one would need to actually study the care received by various segments of the populations.

22

Well…such problems are usually covered by the “external costs” (not sure at all of the english name) theory, the idea being that ultimately it’s a cost for someone (the town has to clean the water, or the neighbors lose an advantage, such as a great view over beautiful hills, which reduce the value of their house, etc…). In this theory, such costs should be estimated and due tax/indemnization should be paid (to a “clean air fund” or directly to the neighbors disturbed by the noise, etc…)

Their could be also “external benefits” (for instance you build a casino and the snack bar just beside it gains a lot of nex customers.

The issue is that it can be extremely difficult to estimate the actual cost/benefit (when it’s easy and obvious, legal provisions already exists). Choosing an extreme example, with the greenhouse gas issue, how much a greenhouse gas producing industry should pay and to whom, especially when nobody knows what are the actual consequences?

Also, though the concept of external cost is widely aknowledged, the concept of external benefit isn’t. How will you convince the snak-bar owner, in the previous example, he should pay the casino’s owner?

23

[QUOTE. I know that in Canada the payment amounts and methods are socialized, and that the rules regarding who gets what care are so tight as to be essentially socialized, but what about the provision of care itself? Is a doctor in Canada an employee of the State? What about the labs that do tests – state owned or private contractors? If one is PO’d at one’s doctor, can one make a change without State approval? I’ll freely admit to a lot of ignorance on the specifics of how the whole thing works up there. **[/QUOTE]

I don’t know concerning Canada, but on the overall, there are several ways to handle that in a public healthcare system.

Concerning payment :

-The doctors are employed by the state. They receive a fixed salary whatever they do (for instance in a public hospital)

-The doctors are paid by the state, based on the number of medical acts they make (in which case, if the same patient comes 10 times in a year, they receive ten times more money)

-The doctors are paid by the state, on the basis of the number of patients consulting them (they will receive the same money if the patient comes once a year or twice a week)

-The doctors are paid by their patients and the state reimburse the patient.

Concerning the choice of the doctor :

-Each patient is “assigned” a doctor, based for instance on the place where he lives (I don’t think there’s actually a country where this rule apply, but it could exist)

-Each patient choose a doctor. He is supposed to only visit this one. If for some reason he goes to another one, he must pay him from his pocket or he is not reimbursed,etc…

-Everybody freely chose whatever doctor he wants, and can visit another one whenever he wants.
Concerning the cost :

-The cost of an examination, home call, etc…is fixed. All doctors receive the same amount for each examination, or for each registered patient (depending on the system of payment used).

-Medical act costs are fixed. However, a doctor can choose to fix a higher price if he wants to. The patient pays the difference from his pocket.

-Medical act costs are fixed. However a doctor can choose not to be part of the healthcare system. He can ask for whatever payment he wants, but the patient will have to pay the whole cost from his pocket.

-Medical act costs are fixed and everything is reimbursed (I strongly doubt that such a system actually exists, since doctors would charge ridicously high prices and patients wouldn’t care, since it would be paid by the healthcare system, anyway)
You can mix the different part in any way you want. For instance, here (France) :

-The doctors are paid by the patients. They are then reimbursed

-You can choose whatever doctor you want

-Reimbursments are fixed for each medical act (a home call, a root canal, lab test, etc…). The doctor’s can charge more, but you won’t be reimbursed for that part (though you can pick a private insurance which will pay for the difference at least up to a certain amount).

24

But the purpose of Canada’s public health care system is to ensure that the populace’s health is cared for. If you’re concerned about profits, then yeah, the health care industry is the way to go. OTOH, if you’re more concerned about the “health” and “care” parts of the phrase, then you’d probably consider the public system to be more efficient.

25

No, no, and yes.

There are lots of kinds of health-care institutions. There are university hospitals, independent hospitals, CLSCs (Quebec government clinics), private practice, etc. A doctor is an employee of the hospital/clinic s/he works for, or else a private practitioner. Likewise, there are lots of kinds of labs (associated with hospitals, independent, etc). My GP sends my bloodwork to the Montreal General Hospital, which is part of the McGill University Health Centre.

Patients are completely free to choose one’s own doctor, which hospital one wants to go to, etc., etc.

The state part comes in like this: the provincial government issues its citizens with medicare cards. You present this when you go to the doctor or the hospital, and this entitles you to care for free; specifically, that in the case of a private practitioner or a hospital, they bill the government for your care. (I’m not sure what the accounting procedure is in the CLSCs.)

Upshot: everyone’s entitled to a medicare card, and medicare card = free health care.

26

And that, in my opinion, is what’s wrong with privatization. A lot of times, it’s more about the money than actually providing decent service.

27

matt, can you elaborate a bit on what level(s) of care that covers? I assume it covers regular checkups, office visits, flu shots, and all the “basic care” kinds of needs. But what about, for example, elective surgeries (cosmetic or otherwise), or birth control?

And what about care beyond basic health care, like organ transplants or other surgeries? As an example, two years ago I had orthopedic surgery to get some hardware installed in my leg. I had it performed at a “contract hospital” under my health plan, meaning that my insurer agreed to cover the procedure up to a certain (“usual and customary”) cost, and anything that the hospital charged beyond that, they had to eat. My out-of-pocket costs were $5 each for my antibiotic and painkiller prescriptions, and $10 per office visit. Would that be the case under Canada’s plan as well?

If you don’t feel like typing a dissertation, links are cool, too. Despite being a member of the Evil Libertarian Conspiracy, I’m enough of a pragmatist that I’m in a position to be convinced.

28

Medicare proper does not include dentistry, optometry (grrr), cosmetic surgery, or drugs (although individual provinces may have their own plans for drugs - Quebec recently cut its, to much fury.) As for birth control, it doesn’t cover condoms/the pill/whatnot; I don’t know about more intensive procedures such as IUDs, Norplant, abortions, etc.

Medicare definitely covers important surgeries such as transplants and the like. As for orthopedics, once again I’m not sure, and I imagine it varies from province to province. Tell you what, I’ll call dr_mom_mcl when I get the chance and report back.

29

Medicare does indeed pay for some kinds of cosmetic surgery (such as reconstructive surgery), orthopedics, medically necessary elective surgeries (hernia operations, etc.) and the procedures to implant birth control devices (but not the devices themselves).

Hospitals’ construction and budgets are provided by the government as a rule, although many big hospitals have foundations that pay for better equipment and such. Hospitals are typically administered by an independent board. Quebec’s CLSCs are administered by the régies régionales (government boards).

Drugs used in hospitals are covered. Prescription drugs and devices vary from province to province, as I said.

Although medicare and health in general is a provincial jurisdiction, the provinces are supposed to abide by the terms of the Canada Health Act, which provide for the above, and a lot of health care is financed by transfers the federal government.

30

Were that this last phrase were true! There are many other institutions, unfortunately, that can infringe on our rights or, as kimstu so aptly puts its, our ability to exercise those rights.

Sorry to use bold…but I think these are two really essential points…I would put this in flashing neon if I could. It is a real crucial distinction in how people view the world. I simply cannot comprehend how people can wake up and think the government is the only institution effectively restricting their freedoms. It’s like “same planet…different worlds”!

By the way, pldennison, I agree with kimstu, i.e., I am at a loss to understand your point about pollution and fines. If you are arguing that environmental issues are best dealt with in ways that allow market forces to choose the specific route to ameliorating the problem, I don’t think you’ll find too much argument here. For example, as much as I would sometimes fantasize about banning SUVs :wink: , I don’t seriously support such a policy. What I support is policies to make SUV owners (and all motor vehicle drivers) pay something more closely approximating the full costs (including the environmental ones) of their transportation choices. And, by the way, there’s an interesting article that I have cited several times before from The American Prospect [“Behind the Numbers: Polluted Data”, TAP, Nov/Dec 1997, also available online] pointing out that environmental regs are usually far less costly than either industry or government estimates predict precisely because such estimates do not tend to take into account the ways in which the market finds a way to more efficiently comply with them! It seems that some of the same people who extol the virtues of the market conveniently forget about them when it suits their purposes (although, to be fair, it simply harder to calculate the true costs than it is to do the more simplistic estimates that just measure the height of the obvious “mountaintop”.).

31

A couple of points:

  1. Much of private health care is provied by non-profit insitutions, such as religious-affiliated hospitals and mutual insurance companies. My impression is that those people who favor government-provided health care don’t generally distinguish between for-profit and non-profit providers. So, I wonder whether profit is somewhat of a red herring.

  2. We all work for money. Government employees providing health care are affected by personal income no less than if they were working for a corporation.

  3. In many cases, the profit motive leads an organization to perform a task better than the government. Government “efficiency” is a standing joke. Perhaps this principle applies to health care as well.

32

The “profit motive” is exactly the reason why high-quality services are provided. People provide high-quality services in exchange for money. If the government provides the services, then what is the incentive to provide high-quality services?

Government services will float at a level just above what will cause voters to vote out incumbents wholesale. The managers of the government services have no incentive to save money, so wasteful spending is the rule. In fact managers are punished for increasing efficiency…if you save money you’ll just get less funding next year.

Now, some services are difficult or impossible to get from the public sector, notably national defense, police, and courts. Additionally there are many public goods that are quite inexpensive to provide but are unprofitable, such as vaccinations and basic scientific research. Those functions are the core functions of government.

33

jshore and kimstu, I’m sure you’re correct that other institutions and situations limit our freedom, but IMHO government has the potential to limit our freedom to a far greater degree. The limitations are so great that we take them for granted. Here’s a brief list of some limitations of freedom that only government could do:

– take any amount of our money via taxes
– draft us and force us to fight in a war
– imprison us for violating one of their laws
– prevent us from reading certain books
– imprison us for using birth control
– imprison us for getting married according to our religion (e.g. bigamous Mormons)
– prevent gay marriage
– enforce slavery

All these examples have been done by state or federal governments in the the US. Imagine what the list would look like if it included bad governments like Hitler or Stalin in the 1940’s or Sudan today.

34

Actually, the US mostly private health system is given a very low rank (world 36th or such) by the WHO as compared to the public healthcare systems of other western countries.

My understanding is that this low ranking is the result of a somewhat lower life expectancy, a limited access of part of the population to the best treatments, and more surprising for a mostly private system, a very high cost for similar results (which would rule out the “government ruled systems are less efficient” argument).

However, I’m not totally sure of these reasons. Do someone knows how this ranking is etablished exactly and what explains the US low “score” (I couldn’t find it)?

35

In answer to your original post “YES”

In answer to your questions regarding the purpose of government that is simple. Under the laws of nature, natures God, and the laws which are made in pursuance thereof the U.S. Constitution, (only those laws are laws) the government has one and only one function. Really, I mean it. Believe it or not, argue it or not, the sole purpose of government is, and always will be, “To secure the rights of the people.” It is amazing how many people will argue this idea. No matter, it is fact. The problem is trying to explain it to idiots, self righteous clowns, politicians, 90% of the populous, and law enforcement.

People say they hate the government. Translation-they hate themselves.
People say this is the law, or that is the law. Truth- only those laws which the people have consented to, are laws. Further the people must be at liberty to consent, and actually have consented.

In the end, governments are formed to protect peoples property. (Property is more than just possessions) The right to have and convey property, free of intervention by others, is the foundation of society. Each and every person has the right to order their life as they see fit. As long as it does not harm the rights of others. Translation- “To secure the rights of the people.”

Simple huh?

36

jshore and Kimstu, that’s pretty much what I was getting at–a situation in which the government encourages (or mandates) market-based solutions for problems like pollution, as opposed to simply taking the responsibility on themselves and taxing the citizenry for it. Remember, even in hypothetical Libertaria, pollution is vandalism, and the polluters are wholly responsible for cleanup and damages. A system in which polluters are allowed to escape that responsibility or to significantly externalize those costs is, IMO, extremely inefficient.

37

My point was that matt was comparing apples and oranges, and asserting that, because the orange wasn’t very apple-like, it was inefficient. That is fallacious.

december - health care is very often provided by non-profits. However, since Blue Cross/Blue Shield went for-profit about 10 years ago, I do not believe that any major health care insurance company, which is what we are talking about in terms of coverage, is non-profit.

Sua

38

from Weird_AL_Einstein

Assuming for a second that not all government officials and employees are not scheming power mad tyrants, I believe that the government has better motives when running an institution (say Health care as it has been brought up numerous times) rather than a profit motive. The motive that they must run on (and once again I’m referring to democracies not dictatorships) is ensuring the welfare and happiness of its voters. Happy voters keep you in office.

In the case of Health care bigger government involvement has actually increased efficiency of hospitals in that they are not as busy bean (or tounge depressor)counting to keep up profits and reduce waste for the shareholders.

This is a really basic view and I know how much more complicated the situation is.

39

You really shouldn’t drink so early in the morning, king. :wink: “waste” EQUALS “inefficiency”, that is, resources that are not being utilized in fulfilling the function of the enterprise. Thus, if a government running a hospital isn’t attempting to reduce waste, it is allowing funds that otherwise would be used to care for patients to be wasted on unnecessary administrative expenses, etc. Of course, government-run institutions do try to eliminate waste, as do non-profit hospitals, as does, when you get right down to it, everybody. A question that remains is what system provides the most incentive to eliminate wastage of resources.

Sua

40

ok maybe I need to sober up a little :wink:
What I meant to say was that the primary efficiency focus is geared towards patient care and not profit margins. True, when funding drops the hospitals must try to reduce waste, but the hospital care takers here concentrate more on the patients needs rather than billing for Band-Aids etc.