American exceptionalism is an axiom.
Ah, I see. So the US just is a vewwy, vewwy special snowflake that just cahn’t be compawed to anything in tha wowld. Got it.
Then don’t reason from one bad experience to general principles. In any case, I don’t know anyone on the left who thinks it is good just because government is doing it. After all, the government might be run by Republicans. And I am indeed sick and tired of the right’s rant (made not just on blogs but by top politicians) that the government can’t do anything right.
You will employ fewer people. Every doctor I know has at least one person doing insurance full time. Get rid of that person, and costs go down.
Force younger people into the system. They may be paying more now, but you can think of it as a savings for when they are older and they are going to be getting more healthcare.
As already mentioned, any insurance system is more efficient and cheaper with more people in it. That is just statistics.
Get rid of the overhead of the private insurers - and their profit, and eliminate the incentives for them to have more overhead. The new law does some of this already.
Encourage people to use lower cost doctor visits rather than higher cost emergency room visits.
There are tons more.
I would have thought an annual salary of $145m for a chief executive in the healthcare industry might suggest the market’s not working too well. Maybe even that, perish the thought, a cartel is operating. Or maybe that’s not the ‘exceptionalism’ you were talking about.
The last accurate census had us at over 650,000 physicians and surgeons in the United States. Get rid of each of their ‘insurance’ people and you are looking at almost 1,000,000 individuals out of work with no skills other than that industry.
Regarding the new healthcare system, I think it creates something like 111 additional agencies and bureaucracies that weren’t there previously, so even if you could trim down our gluttonous insurance industry, you’d just be moving some of their pencil pushers to the healthcare sector.
I only wish they would have fixed the existing system first rather than add another 2,000 pages of red tape to it.
No skills? administration is a very transferable set of skills.
And do you have an comments on my suggested benefits for UHC upthread? they do deal exactly with your concerns here.
First off, apologies for disappearing. As mentioned earlier, the real world interfered <shakes fist at world>. I’ll try my best to pick up the thread <heh> of conversations. I’m not sure if multi-post carries over to the next page, so one set of replies here, and another set soon, so if something I say has already been responded to, please bear with me.
My entire motivation for starting the debate was stated in the OP and that hasn’t changed one bit. The rest of the OP was an (obviously feeble) attempt to explain that and set the context, and admit that there was a moral aspect to this which didn’t hold up the prospect of fruitful debate. I’ll have another go at explaining my basic question and where I’m coming from.
The motivation for this thread is to find out if healthcare has the characteristics that call out for a socialisation. I have no idea of the economics literacy level of the people participating in the thread. I presume it is quite high, but bear with me while I explain my own framework for approaching the issue. I think of these characteristics that I refer to above in terms of public goods. From wiki.
The best case for government/social provision and monitoring can be made for goods that are public or quasi-public goods AND also have significant negative or positive externalities with positive or negative (respectively) ‘internalities’. The examples that follow should make what I’m saying clearer.
**Air pollution **
It is non-rival in the sense that one person breathing bad air does not make the air cleaner for others, and no one can be excluded from breathing bad air. In addition, breathing polluted air has significant negative consequences for everybody(negative externality) but benefits accrue most to the polluters(positive ‘internality’). This is also the ‘tragedy of the commons’ but basically, this situation begs for socialisation of the regulation, monitoring and enforcement of anti-pollution measures.
This example holds in the reverse direction also. Let’s pick up law enforcement. It is a quasi-public good in the sense that it is not entirely non-rival and non-excludable, but it is to a great extent. One police patrol through a neighbourhood is non-rival and non-excludable for everyone in that neighbourhood. It also benefits everybody(positive externality), and were it to be organised privately by a few individuals, would only cost them (negative internality). This is also a great case for socialisation of costs.
Now come to healthcare. What I (and many governments) call Public Health (for e.g. sanitation, vaccination, maternal and child health, preventing spread of communicable diseases) is also a clear case of a public good. People cannot be excluded from the good effects of sanitary living conditions (positive externality), and were one person to pay for the neighbourhood’s sanitation(which you would have to, since you cannot live in sanitary conditions unless your neighbours do too) it would be a cost only to one person, a negative ‘internality’. Another great case for socialisation of costs.
This argument however, cannot be extended to all of healthcare. Most healthcare is neither non-rival, nor is it non-excludable. The large part of the benefit of being treated goes to the patient, as should(under debate) the cost. . If you are in a hospital bed, you’re taking up space and time and effort that prevents someone else from utilising that space. If the hospital provides a service to you, there is no reason(in theory) that it cannot exclude your neighbour from the service. The benefits of being treated when sick accrue for the most part to the patient and his/her family. This is why I think the costs of being treated should thus also be borne by the patient. To assure people I’m genuinely debating and not just wasting my own and everybody’s time, and also to organise the debate better here’s what would convince me
- Show that healthcare is a public good. i.e non-rival, non-excludable, or at least, has positive externalities(more on this last below)
- Show that there are other important ways in which the healthcare market fails and that socialised provision is a good/best way of addressing that failure. (What I’m hinting at here is the problem of information asymmetry in healthcare)
- Show that the above true criteria are not the only good ways of deciding what the government should do i.e show that the government is better at providing private goods than the market.
Going on from that -
Sure I can define what evidence would be good. The problem is, you’re looking at metrics that examine the results of healthcare qua healthcare. I’m trying to arrive at the premise that socialised healthcare is good. You can’t then look at the direct metrics of the coverage of healthcare systems like coverage and costs per head. Instead, I’d look at things like labour productivity (which is a very well defined term in economics. I don’t have to define it.) in countries with different systems.
In fact, I can tell you the exact social experiment which would answer my question. If socialised healthcare(beyond Public Health) were randomly introduced in different areas, and you could show that the introduction of socialised health care was a significant variable in an increase in labour productivity or GDP per capita of those areas where there was socialised health care vs. those areas where there wasn’t, I’d take that as enough evidence of positive externality. As that perfect experiment isn’t likely to be made available (although it is perhaps possible in India and I’m seriously considering it for my PhD thesis if/when I get admission), I’ll also take some proxy thereof, i.e if a peer-reviewed paper has attempted to control for other factors and isolate the effect of universal healthcare on any well defined measure of national productivity.
You don’t know about the failings you can’t see. From what I can tell, the US system sucks as much as it does not because it is private, but also because of a number of distortions like employer funded health insurance, high insurance costs for doctors and hospitals because of malpractice suits, high process and test costs because of these same malpractice suits. These issues arise because there is very high information asymmetry in health as a product. Your doctor knows a lot, you know very little(the internet is ameliorating this, probably for the better in the long run). However, if there isn’t a convincing argument for healthcare being a public good (there may be, see above) then we are much better off figuring out a way to make the healthcare market function effectively than we are papering over the fault lines by spreading out costs among everybody. Markets have a long history of efficiency, effectiveness and flexibility over time. Governments do not.
It isn’t necessarily. It may be if there are heterogeneous over-riding moral concerns, but overall, there is no reason why my discussion isn’t equally applicable to developed countries, except for government’s ability to deliver effectively, which is one way to convince me sure, but you would have to convince me that governments can deliver effectively in the class of goods that I believe healthcare to fall i.e private goods. Quite frankly, you have a much better chance of convincing me that healthcare is a public good or that a well functioning healthcare market isn’t possible.
If you think the only reason(or even one of the major reasons) India has higher “unnecessary deaths and disabilities, widows and orphaned kids, beggars and street crime” is that people have to pay medical expenses out of pocket, you need to revisit your education. Or maybe get a new one.
I’ve already retracted the homogeneity assertion. I tentatively think it’ll still be a problem, but I don’t see the issue being germane. Possibly good governance can avoid it as a problem like you mention. However, competent governance isn’t common. As for the ‘no work should be given to government if it is corrupt’ point that you’re making, see my rather extensive laying out of what work should be given to government above. Corruption is an independent matter, not of much consequence except in determining if governments can deliver better than private sector.
I accept medical insurance is different from car insurance, but I haven’t understood your point about you don’t know who will be more susceptible to health problems. Could you lay out what you think the implications of that are more clearly?
As I’ve mentioned above, it doesn’t seem like the current system in the US is free market. There seem to be a number of massive distortions. My take is that we’re better off trying to arrive at a properly functioning market, than to switch to socialised healthcare, because healthcare is a private good.
Sure, but a right to life is the right to not have someone come and hack you to death. It is not the right to have someone else’s resources used for ensuring your bad luck/genetic misfortune/bad lifestyle choices are smoothed out for you.
Read my differentiation of public/private goods above.
Yes, and for precisely these reasons I don’t think an insurance market should be forced to exist for healthcare, and I advocate out of pocket expenditure. There’s no reason for health insurance not to exist, as long as it can stand or fall on its own merits (i.e, without having demand created for it by government mandate)
You seem to be making the mistake of slotting me in with American conservatives. I have no problem in raising taxes on the rich(or anyone) as long as tax money is being used sensibly. I just don’t think healthcare is a sensible use, for reasons outlined extensively in this post.
You’re very right about the power elite not using the universal system leading to the universal system’s deterioration. But the thing is, the power elite will always find a way to not use the system.
I do doubt the model. If you have one set of people influencing decisions, it is often easier/more effective to lobby them for beneficial changes than it is to actually improve your efficiency and service delivery. But maybe I’m just saying this because I want to hear your Bell story 
Do tell.
Of course it is clearly defined. A police system can be(and is) non-rival and non-excludable. Sure you can come up with an alternative system which wouldn’t be, but why would you? A healthcare system on the other hand, is not the same.
bldysabba, why did you start this thread? Seems like you already have the answers you want to hear.
Everybody who lives in a UHC system prefers it that way, and defends it. You can raise as much ideology and amoral analysis as you like, but that’s all you really need to know, in my opinion.
There’s only one thing you’ve said above that I want to pick up on:
Isn’t that what India has already? How’s that working out for you guys?
Seriously dude, if you already have your mind made up, why the discussion?
And just ignoring the posts, you can’t dissect, makes you look extremely disingenuous. Next time, just be up front and overtly promote your agenda, instead of dressing it up as debate, okay?
Indeed. “I believe socially provided universal healthcare is a bad idea, for the following reasons…” would have been more honest and less irritating to participate in.
Sure, but by starting the OP by JAQing off, he doesn’t deprive himself of the opportunity for gotchas. Not that s/he has had many chances of that during the thread, but, hey, that’s life.
If you are looking for perfect answers that bear dispassionate and logical scrutiny. You won’t. Maybe in the unreal setting of academia the questions you pose seem like a good way of striving for some sort of objective truth and will read well in your thesis, so good luck with that.
However, we have to deal with the world as we find it and pretty much everything we do is a messy compromise, logistically, philosophically, morally and ethically. That is simply because any human interaction system with as many moving parts as a health service is too complex to analyse perfectly. It is different to the sum of its parts and riddled with unexpected emergent properties.
The best we can hope to do is decide for ourselves what we want from it and focus on those outputs that are important to us.
That leads some of us to say, “we want a certain level of cover to be available to everyone at a price that they can afford” and we say that for the exact same reason we mandate the police, judiciary, army, schools etc. Because we see it as a common good. It removes, or blunts at least one sword of Damocles that nature holds over us.
You speak of healthcare not being a right and I’d make that the starting point of your thinking. We have been through exactly that discussion before and some of us say that it is a basic human right.
Yes, I’ll say that again for emphasis…it is if we say it is.
We don’t need any philosophical jiggery-pokery to come to that conclusion, we just decree that it is so and demand our society act accordingly. That is a valid as any other reasoning on human rights. If you think differently, then fine, but be aware that you have no more weight behind your position than we do ours.
So we are left with deciding how best to achieve our aims. And, time and time again, we decide on Low-cost, single payer or provider and universal coverage. It isn’t a perfect solution but it has far more to recommend it than the alternatives (i.e.USA-style) and we’ve discussed that at length elsewhere on this thread.
I suggest for your thesis you might concentrate on what works in the real world. The world doesn’t need another paper on philosophy or ideology and it sound like the Indian health service could do with practical advice and insight from someone like yourself who is very obviously interested and intelligent.
I think this bears repeating. It’s certainly not a truism that government administration of things makes them more efficient. It’s equally certain that private administration doesn’t necessarily make things more efficient, either.
I think your basic thesis, baldysabba, is that the Indian government is inefficient and corrupt, and so putting healthcare in its hands is a bad idea.
However, that’s not an argument against universal healthcare. It’s an argument for reform of the Indian government. You might say that in the meantime, a market-based system makes more sense, but as you say yourself, most Indians simply do not have the funds to purchase medical care in the market.
India also has one unique challenge (versus the West), in that it’s paying to educate thousands of physicians who quickly bugger off to the US, UK, Canada and elsewhere. As far as that goes, the only likely solution is greater government subsidy of medical school, combined with some sort of future residence requirement.
My parents both attended Grant Medical College in Mumbai and both buggered off to the West more or less as soon as they could afford it.
You haven’t given any reasons why a police service should more “clearly” be publicly funded than healthcare. Police can be non-exludable and are reasonably non-rival but that applies equally to the NHS, for example.
Are things like chemotherapy really cheap in India, even on Indian incomes? Because I don’t think there are that many people in the UK who could pay for that out-of-pocket, even if they saved every penny of the National Insurance they weren’t paying for the NHS.
Except for the really rich, it’s just not a sensible proposition. Even the really rich would surely also get fed up of having to drive themselves because yet another chauffeur’s dropped dead of a curable illness.
Each cop patrolling one neighborhood isn’t patrolling another. If there are capacity problems, say with hospitals, then care must be rationed. In the US this is mostly done by money, but wouldn’t it make more sense to be done by need? To continue the police example, the rich pay more in taxes, so should the rich get more policing?
Also, good healthcare can drive cost out of the system by prevention, and it also reduces absenteeism which makes a person more productive and his employer more profitable.
Private hospitals can exclude people now. It is much less likely to happen under a universal system, at least in places where equal access is required by law.
Cost is fine, but if there were worse outcomes with reduced cost, we could argue which is most important. However, the US has both worse outcomes and higher costs than places with UHC. And it would be rather odd to discuss healthcare without including as a metric the relative health of populations under various models.
In the US the major example of a UHC system, Medicare, is far more efficient than private alternatives. It also covers a population which could never get health insurance in a private market. Let’s start here - would you want to privatize Medicare, and if so, how?
In the US, economic decisions about safety must include assumptions about the value of a life, perhaps based on lost earnings. Does India do something similar? I’d be interested in knowing what gets put into models.
Maybe not in your neck of the woods, but around here government seems as least as competent as private industry on average. The consequences of incompetence are different, though. Government incompetence gets voted out or exposed by the press. Industry incompetence causes bankruptcy. I could give you zillions of examples of industry incompetence.
If you consider the population as a whole, you can model health costs and the number of ailments quite accurately. If you are considering an individual, you don’t often know if the next year will require little healthcare expenditure or significant expenditure. You can guess a bit better when you are older. It happened to me - I went from being perfectly healthy, I thought, to being a heart patient in a matter of days. BTW, I have good insurance. Without it I would almost certainly not gone to see my doctor for a racy pulse, and might well be dead now.
It is not a totally free market, because of regulation. Please describe what a totally free market would look like. Regulation pretty much has prevented insurers from raising rates excessively, and whether or not you agree about excessive, I can’t see how this hurts the consumer. No one is forced to get company paid healthcare, by the way. We do because it is much better than individual insurance.
This is exactly what we have now - and are not happy with.
Which is okay so long as they pay their share, like they do for schools. (And are not so greedy as to want out.) The rich have more expensive houses and so pay more in property tax even though they may be less likely to send their kids to public schools or be older, so they have no kids of school age at all.
In the days of the Bell System telephone rates got set to insure that the local TelCos got a certain return on their capital base. Much of this capital base consisted of equipment from Western Electric, the manufacturing arm of the Bell System. Thus, the more expensive the equipment, the more the BellCos would get in profit. Now, the cost of the equipment had to be justified. I started work in the Western Electric research center, where we worked on ways of making manufacturing more efficient (and sometimes even did so.) Each dollar Western paid for us went into the cost of equipment sold. But, they could point our budget out to the regulators as money to make equipment cheaper by making manufacturing more efficient, so the regulators would never question the expense. So, every buck they paid us for research the higher the profit of the Bell System as a whole. Thus, every year the WeCo board would come visit us, hear some talks in the morning, sign the check, and go play golf in the afternoon. And no one paid too much attention to whether we were really saving money. Paradise!
I don’t see how saying that cutting money from an industry will lower the amount of workers or their pay somehow suggests that I think everything should be done in the most inefficient way possible.
I was simply responding to this quote:
“When people have access to affordable health care, they can afford to save for retirement, buy houses, put their kids through college. Without it, tons of those families will fall into the expensive social safety net. For generations.”
They were saying cheaper healthcare helps people to save money .. I was responding that cheaper healthcare will inevitably pay either less people wages or the same people lower wages. We live in a closed system.
The reform you speak of IS pointless, vast, subsidised bureaucracy.
2,000 new pages of regulation, 111 additional agencies and bureaucracies, IRS involvement in healthcare and tax mandates in addition to insurance premiums.
All of that without fixing the majority of the problems that existed in the first place.
If I already had the answers I wanted to hear, I wouldn’t have started the thread. I have a position which is open to change.
That’s funny. I thought this was the Straight Dope. Are you seriously going with that line of reasoning?
Have you read the article in the economist that I linked to? It’s a long long way from good (forget perfect), but the out of pocket expenditure system has driven lots of efficiency into the system, and for middle class India, the health system is actually excellent and cheap.
India has a lot of very poor people who have universal healthcare, but the reasons why it works out horribly for them are different, and why I haven’t brought up India as a specific example against UHC, the way everybody has been holding up America as a specific example against health insurance. It’s because that’s not what my question is.
It’s quite strange you should take this view when I’m explicitly pointing out that I don’t have my mind made up, and why it isn’t. As the thread has evolved, I’ve been able to clarify my own thoughts and put them into a economic framework. Since most of the debate(IMO) hasn’t even been addressing the point I want clarified in my head, I’ve also explicitly noted what would address it. I quite simply don’t understand what would make you say this.
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There’re 7-8 posters on the thread arguing the other side from all sorts of angles. I’m only human. I’ve been picking up posts that seem germane or posts that otherwise catch my eye. Voyager has made a lot of sense in his responses. His point on medical ethics is a good reason why healthcare may be non-excludable. A lot of the posts I’ve ignored have to do with comparisons of the US and European systems, and I haven’t responded to many because they don’t address the point. Sure, the US system is broken. Sure the European system does better. Does that mean the US system can be fixed in only the one way?
If there are any particular posts that you want me to respond to, point them out and I’ll be happy to respond or at least tell you why I didn’t respond to the post.
Eh? I raised a topic for debate. My mind is open on the topic, but of course I have a position which I’ve been able to clarify better as the thread went on. Are you somehow used to debates where no one takes an opposing position to yours? Because I think that’s called preaching.
Think I got you pretty good earlier 
YMProbablyV
Also, thanks for your earlier post that you think I’m engaged/open minded. I certainly think I am. But the ‘unreal’ setting of academia that you speak of is what often guides real world actions. Sure it may not be immediate, and indeed may never happen, but answer a question in a way that bears muster for enough people, and your solution will find its way into the real world. In the past, the answers that passed muster were those that sounded the best and appealed to the most people. Today, the gold standard is objective truth. And while it’s harder to come by in the social sciences, I assure you it is not impossible.
I agree with you completely on the moral/ethical part of the debate. There is no debate there, and I’ve said that in the OP itself. However, morals and ethics are often influenced by harder analysis. As the first example that strikes me, take smoking or drinking when pregnant. People would not think it immoral before they found out that it harms the foetus. Similarly, again as a hypothetical, if peer-reviewed economics found…actually let me flip your earlier question around. I have noted what line of reasoning and also what evidence would convince me that healthcare is a public good. Can you do the same and tell me what line of reasoning or evidence would convince you that it isn’t?
No actually. Now that I’ve had time to think about it more, my basic thesis is that there are some things that only the government does well and should take care of, and some things that only the private sector does well and should do. Some of these things are clearly defined. To reiterate once again, I DO NOT think Healthcare is clearly defined. I think it falls into the private realm, for reasons I’ve outlined, but I know many people think it doesn’t. I want to understand their reasoning for it.
That’s an interesting point. India’s subsidising the NHS! Also, as far as I know, this isn’t that big a problem anymore. Our parent’s generation, definitely. Ours, it happens, but not quite as much. There’re more opportunities for doctors in India now, and life is comfier than the west if you’re rich, which doctors usually are.
I can see quite easily how the police is non-rival, but not how it applies equally to the NHS. One person using a doctor’s time is preventing another one from doing so. The mere presence of a doctor or the NHS does not reduce disease incidence (apart from communicable diseases, for which there is a case to be made for socialisation, but it comes under public health, not healthcare, and includes things like education about disease and sanitation)
I don’t know about chemotherapy. Here’s a medical tourism tour operator’s rates from the web. It shows costs in India being 1/4th to 1/10th the costs in the US). I would link, but that may count as advertising. Take with a fist of salt, but some of the procedures I personally have experience with(lasik, dental, bypass) have reasonable basis in reality (+/- 10%). Keep in mind that these rates are typically at the best hospitals and adjusted upwards for foreign ‘medical tourists’. However, these are also not PPP adjusted, so they’re obviously not apples to apples affordability comparisons. (sorry for the formatting, I tried adjusting it in the post but it doesn’t work. A hyphen denotes that a value for that country is missing)
US UK (Private) SINGAPORE INDIA
Bone Marrow Transplant upto 200,000 upto 200,000 - upto 25,000
Bypass Surgery 35,000 25,000 - 6,000
Breast Lump Removal - 3,200 1,000 700
Haemorrhoidectomy - 3,800 1,500 1000
Knee Joint Replacement - 15,000 7,000 5,000
Lasik Surgery 4,000 2,800 1,600 700
No Stitch Cataract Surgery 4,500 2,600 - 700
In-vitro fertilisation (IVF) cycle 15,000 - - 1,800
Hernia Correction 2,800 2,700 2,500 1,000
Dental Implants 3500 2800 1600 800
First off, thanks for your posts, they’re certainly food for thought. You are right, each cop patrolling a neighbourhood isn’t patrolling another. Each detective on one case isn’t looking at a different one. It is still a clear (quasi)public good. Each neighbourhood is made up of many people. One cop car can benefit them all. A detective who apprehends one recurrent criminal makes the world safer for all his potential targets. In healthcare, that view can be taken for communicable diseases. But how much of preventing the spread of communicable diseases is treatment? Isn’t most of it sanitation, education, issuing public notices/warnings, closing schools, that kind of thing? I’m open to correction.
You make a good point that labour productivity is likely to go up in a universal healthcare system, and this is the one that is most likely to convince me that healthcare is a benefit to society rather than the individual who falls sick. In fact, as I’ve already said upthread, if someone can show or can guide me to evidence that universal healthcare is a significant variable in increasing labour productivity or GDP per capita, I’d be happy to shelve my ‘it’s not government’s job’ objections.
But I’m not looking at either cost or outcomes to begin with. Both are internal to the system. I want to look at externalities to be able to decide whether there are social benefits beyond those that accrue to the individual. Hence I mentioned GDP/capita or labour productivity.
If I were evaluating current healthcare systems, of course I’d look at both costs and outcomes. Is it your view however, that the US has high costs and poor outcomes because it doesn’t have UHC? Or are there other flaws in the system? As I noted earlier, my reading led me to believe that the litigious nature of the US system makes it very expensive. I could be wrong, and am always eager to be educated. What do you think are the root causes of the American system’s poor performance?
I’m afraid I just don’t know enough about Medicare. I’ll read up and get back to you.
The part of my post you’re responding to here was in response to someone else, and doesn’t seem to fit what you’re asking, so I’m somewhat confused which decisions of safety you’re talking about. Could you clarify please?
Here’s a data point on government effectiveness from Kaufman et al. world bank 2002 (http://siteresources.worldbank.org/DEC/Resources/WPS2772_2002.pdf)
I have the dataset. It has scores for 175 countries. The average government effectiveness index is .061 on a scale of -2.5 to +2.5 68 countries are below 0. Only 24 countries in the world have scores over 1. Only 10 have scores over 1.5. None have a score over 2. Competent governance is not all that common.
And of course industry incompetency causes bankruptcy. It’s how the market drives efficiency. The individuals or organisations that can do more with less will survive. It’s an evolutionary model of sorts. Some individuals/organisations will go bankrupt, but the industry as a whole will be more efficient. It isn’t perfect, it needs regulation and it can’t do everything, but the things that it can do, it does very well indeed, and far better than government could do them. Considering the reception I’m getting, I think it is important to note that the same is true for governments - the things government should do, only it can do properly.
Another good point, and more reasons why a) Health insurance is a difficult market and b) this is a complex issue. Human cognitive biases are not very well modeled currently. We discount the future heavily. I’m unsure of how it should be factored in though. Should we aim to protect people from the consequences of this evolutionary impulse while evolution catches up, or should we not?
They should have an emoticon for sheepish. I don’t have a ‘perfect’ model in mind. But it would be market based, just not a totally free market though. <Warning, lots of potentially idealistic statements follow> Regulation should attempt to strike a balance between protecting patients and allowing the market to function, as also correct for the sources of failure - information asymmetry being a big one. Costs should be borne by the people that benefit - patients/families. This would drive supply to the optimal price/service level.
But I thought your original point(which I emphatically agreed with) was that if the rich don’t use the universal system, it won’t get better?
Hahah. Nice story, resonates with me(my dad was in a power sector utility, heard similar ones), and underscores the importance of regulating the right way.