Sunday, April 12, 2009

Among The Best Of Reasons To Be Against National/Socialized Health Care

TANSTAAFL. Shorthand for "there ain't no such thing as a free lunch."

These people who want government to pay for health care, from whence does this desire flow? Do they think it'll somehow be cheaper, or at a minimum they won't notice the cost because it'll be taken from their (higher) taxes and not directly out of their pockets? (Income tax money, you see, never even makes it to your pocket.)

Government inefficiency. Individual rights and responsibility. Enumerated powers. Lack of competition. These are all good reasons to be against socialized medicine. They are, however, based on principle. Here's one that's based on practicality:

ONE OF Scotland's leading cancer specialists will tomorrow call on the public to confront the ultimate NHS taboo: that life cannot be "priceless" in a health system where cash is finite.

Speaking ahead of his lecture at the Edinburgh Science Festival, entitled The Future Of Cancer Treatment: Can We Afford It?, Professor John Smyth called for a more "rational" debate on how we apportion healthcare, and warned that society will face more "moral dilemmas" as pressure on NHS resources grows.

16 comments:

mazenko said...

Cash if "finite" in both public and private systems. There is no difference in that regard.

Neither can life be, or is, "priceless" in a system where profit is derived from paying out for less health care. Rationing happens as much with private insurance companies, as it does in a national system. In fact, the private system is designed to avoid payouts, and it can maximize profits by dispersing risk.

Health "insurance" companies seek to avoid health problems and patients with health problems. Right now health care is rationed to the millions who can afford premiums and file fewer claims. If you are in a system where many file claims, your prices will skyrocket -even if you file none - as many have. Health care is also rationed by being unavailable to many - the emergency room argument isn't valid for millions of people. I have a four-hundred dollar bill for an "ear infection" diagnosis with no treatment for those who want to dispute it.

Far from nationalizing health care, there are many ways to blend public and private with, as Darren has reasonably argued, people paying for more of their daily health maintenance/basic care. Caps on subsidy/payment for standard visits are an example Taiwan uses. Then, the "insurance" kicks in for those catastrophic issues like diabetes/cancer/accidents. In a blended system, people can purchase as much or as little coverage as they want from a "free market" of hundreds of providers competing for the business of a pool of 300 million people. However, they can be covered for catastrophic care and are never at risk for medical bankruptcy, which is clearly a detriment to the US economy and not one elsewhere.

The left needs to free itself from single payer obsession and the right needs to free itself from free market naivete. Matt Miller's explanation in The 2% Solution. So is the Healthy Americans Act, as well as the FEHBP.

Voters need to do some research outside their comfort zone before voting on this one.

allen (in Michigan) said...

I'm not going to engage in a point-by-point, you've covered way too much territory for that so I'll just address a couple of points that jump out at me.

The private system isn't "designed to avoid payouts".

The private system is designed to produce profits with an acceptable degree of reliability, over time, in a competitive marketplace.

One way to do that is to try to avoid payouts. However, in a competitive marketplace that's, at best, a short-term solution to boost profits. Once the company's reputation, or worse it's payout ratio, marks the company as penny wise and pound foolish, the customer base drops away and the company rethinks it's strategy or disappears.

Another way to achieve those necessary profits is the relentless pursuit of efficiency.

Part of the reason we're exchanging these comments via our own, personal computers is because that search for efficiency provided a market for computers that allowed the computer industry to develop into what it is today. Insurance companies are in a constant search to find ways to cut costs and improve the efficiency of their operations because that's one of the few ways, in the shorter term, to make profits.

In the longer term the insurance industry benefits by reducing the necessity for big payouts.

It wasn't government that published the first tables of scantlings, the means to measure objectively the seaworthiness of ships, but the insurance industry in the form of Lloyds of London. By systematizing and publishing the criteria by which Lloyds determined the seaworthiness of the ships they insured they also provided a means by which ship owners could buy ships that were reasonably safe, as measured by their insurance rates, but not overbuilt to the point that they could never earn a profit.

A major part of the controversy surrounding health care is that what's referred too as insurance is treated, and viewed, as an unlimited entitlement and once the power of government is introduced into the situation it's political power that determines the outcome with the bulk of the spoils going to the most powerful. I don't believe it's in the best long-term interests of a democracy to encourage the development of situations in which might makes rights even if that's precisely the road we've gone quite far down.

By the way, lefties aren't obsessive. That's a medical diagnosis and while I'm opposed to the policies of lefties their reasons for preferring their positions don't spring from mental defect much as some of my philosophical brethren would like to think so. Even less worthwhile is a dismissal of confidence in the free market as evidence of naivete. The free market is the sole producer of wealth.

Darren said...

While I *have* argued that people should pay more for their "routine" health care, and that insurance should be more for "catastrophic" needs, I don't think I've ever argued that this need be a public/private partnership of any kind. I'm not sure if you were stating that I had, but one could interpret that I had from the juxtaposition. I just want my position to be very clear on this topic.

mazenko said...

Allen,

While I agree with you on the problems of entitlements - hence, my point about paying for standard care and insuring against unmanageable cost - you overestimate the history of insurance companies managing cost. When a company insures millions, and few people file significant claims, they can afford to marginalize small numbers without developing a reputation that loses them customer base. Just look at the history of State Farm, and how many times it has been sued - and lost - for rejecting legitimate claims.

However, the movement toward efficiency to maximize profit and loss is a benefit of the private sector, which is why I've always argued for a blend of public-private like the HAA or FEHBP.

Darren,

I wasn't saying you argue for public/private, I was. I conceded you have always had a good point with the consumer handling the real costs of the day-to-day stuff.

The reality is this: America is moving for health care reform/change. It is unrealistic to think that the government will not be a part of this change. The American people have shown a willingness/preference since Ike's time for some government funding of health care or insurance and two-thirds have said they would pay higher taxes for it. The government will and should be involved, and that does not mean that it will be automatically less effective. That is why I argue for a smaller role along the way of FEHBP.

The reason it will happen this way - and it's leaning more toward Welfare for all on several state levels - is because the industry and the GOP and conservatives have been able to offer nothing in terms of reform other than HSAs, and being alone to face health crises with only an HSA scares people more than HillaryCare.

More and more people are being screwed by the private/employer based system, or being completely priced out of premiums for anything but catastrophic coverage. That's true up to income levels of $75000. Thus, while Americans are not the whiny entitlement seekers that libertarians make them out to be, they want a chance to afford their health care. And they will take a European style insurance system over nothing.

And there's nothing wrong with that. I've lived under the Taiwanese system. It was every bit as efficient, effective, and comprehensive as anything I've ever had here. It contains the small clinic system that Darren has often mentioned. It caps people's ability to go to the doctor for fifty "colds" a year. However, no one's ability to get care is rationed because anyone can purchase all the additional care they can afford. But no one goes without.

That's all Americans want. And it's not unreasonable.

Darren said...

Why didn't it work in Tennessee or Massachusetts?

mazenko said...

What I'm talking about was not instituted there. In fact, they prove my point that it needs to be national, but even with that, libertarian Colorado is heading that way as well.

The public will go with the MA or TN or CO plans for single payer if there is no alternative they can afford. Colorado will soon follow MA even with all its bad press - because it's something better than the current system for many people. Those who disagree are not in that group of "many" but it's getting bigger everyday.

I contacted all my reps immediately (state and federal) upon hearing CO talk of single-payer because I said, "Look, I don't necessarily want this, but unless you do something manageable/practical on a large scale" the public is going to go single-payer because they are scared and just can't afford the status quo anymore.

And I won't refuse single-payer if the only other option is continuing down our broken path or trusting the GOP's HSA plan to lower costs and raise taxes anyway on the health care.

Keep in mind with other systems, while critics love to offer anecdotal evidence of rationing in other countries, none of their citizens are scrambling for a shift to our system. And don't think the French or Taiwanese citizens won't hit the streets in force to protest that which they don't like.

What I've offered in terms of HAA or FEHBP makes sense. No one else here, including the critic whose words started this discussion, has offered a counter comprehensive plan that is viable on a scale for 300 million people.

Anonymous said...

ALL systems must have a form of rationing. That is just part of what happens when you have a finite amount of doctors, hearts, beds and drugs. The question is about how best to ration something. Not many people in the UK would like a system where the rationing was based on who could afford something.

And you seem to be opposed to going to the doctors for the little things, when it is regular checkups and preventative medicine that actually saves the system money in the long run.

allen (in Michigan) said...

What's interesting, reading your posts Mike, is that you seem to be utterly blind to the fact that many, if not all, your objections to a health care industry in which there's no government intrusion would show up in a health care industry in which there's any government intrusion up to and including a completely socialized system with the added inefficiency, rigidity and unresponsiveness that typifies government solutions.

You'll have, do have, all the shortcomings of a private system along with the shortcomings of a public system.

Allstate denies claims? The Canadian Health Service denies people treatment, in some cases until they die. So the case for socialized medicine, in any guise, on the basis of greater access to health care rests not on its reality but on the unarguable certainty of the proponents of socialized medicine.

Also, the reality isn't that America is moving toward socialized medicine. I'd argue that America is very resistent to the idea of socialized medicine, but being driven toward socialized medicine by manufactured fears and drawn toward socialized medicine by the greed born of false promises. I'd say that there's a great deal of skepticism at the implication of unlimited, free access to health care that's the stock in trade of proponents of socialized medicine.

We already roundly rejected socialized medicine the last time a proponent, Hillary Clinton, made her bid to remake American medicine and while Saint Hillary's apologists like to lay the blame on insurance companies my own feeling is that HillaryCare ran aground by promising too much and thus engendering suspicion.

What's interesting is that while you and your fellow proponents of socialized medicine want to move the U.S. towards socialized medicine several of the nations that you like to hold up as examples of the modernity and justice due to their socialized medicine systems are starting to delicately back away from socialized medicine. Canada, England, France, Germany and Sweden at least have reduced barriers to the entry of private medical businesses.

Darren said...

Anonymous, not true at all. I'm opposed to paying for and having insurance that covers everything up to and including the sniffles. I think insurance should be for bigger issues.

You don't call the insurance company every time your car needs washing or a new tire.

mazenko said...

Allen,

I am not proposing socialized medicine, though you tend to narrowly focus on limited aspects of what I say - most often clearly centered on your abstract beliefs about government, not on any real world experience, of which I offer plenty, including personal in-depth knowledge of other systems outside the US.

I am proposing a move to that which you correctly identify many other countries are moving to. They won't go fully to a private system. They will, and have, pursue a blend of public and private. Everyone will get a basic level of affordable care. Everyone will be protected from bankruptcy by catastrophic costs. Yet, there is no rationing because anyone can purchase, beyond the basic plan, as much care and insurance as they can afford on the open market. It can and will work, and it will do so far more effectively than the current system that apparently hasn't bankrupted or marginalized you - yet.

allen (in Michigan) said...

We've been down this road a couple of times already, Mike. You propose that there are differences between, say, socialists and the political positions espoused by Barack Obama and thus the two have nothing in common and I reply that for purposes of horseshoes, hand grenades and politics, close enough is good enough.

If you're particular approach to socialized medicine isn't quite the same as, say, the old Soviet Union's approach to socialized medicine then the two have to be treated as if they having nothing in common.

My position is that what where they differ is less important then where they are similar and that similarity will result in all the shortcomings you ascribe to a private system with the addition of those that are peculiar to a socialized system.

As to your personal experience, come on. The necessarily anecdotal nature of your experience isn't even offset by a knowledge of your personal circumstances which might, or might not, make those experiences more valuable in this discussion or prove them to be largely immaterial.

The direction those "other countries" are moving too is away from the more thoroughly socialized systems that've proven inefficient, expensive, unresponsive and not quite as uniformly accessible then they're sold as. Those countries are unbending to allow a greater component of privatization and where that movement will end is anyone's guess.

I wouldn't be all that terribly surprised if some governments got totally out of the business of providing medical care with the exception of, probably, their militaries. Several nations have fully privatized their equivalent of Social Security. Why wouldn't they get out of the medical care business as well?

With regard to your contention that if everyone gets "a basic level of affordable care" then "Everyone will be protected from bankruptcy by catastrophic costs" is there some component of magic that you've neglected to mention?

Interference in a free market, regardless of how it's tarted up, is still interference in a free market and it'll distort that market. A significant part of the rise in medical care costs is a result of just the sort of interferences in the market that you seem to think won't, if they bear some superficial to a free market, result in the usual sorts of cost escalations and supply constraints that typify market interference by government.

You seem to be getting a bit annoyed with me, Mike. I can understand that. I refuse to where the rose-colored glasses you profer and that, in the words of the great philosopher Pauly Shore, harshes your mellow. Sorry buddy but there really isn't any such thing as a free lunch.

mazenko said...

Annoyed, Allen? No. Amused. Always amused and enjoying the engaging debate, as I noted to Darren in a recent post.

I simply pointed out in my previous post that you speak in sweeping generalities drawing from an ideological basis, rather than offering anything more tangible than the increasingly tired mantra of "the free market works."

I agree that it works. Which is why I seek to maintain that which works, while, in the words of TR (whom we know you have a contempt for, though history tends to disagree) we also regulate "the more unsavory elements" of the free market.

And, with your most recent post, you have validated my point, offering once again sweeping generalizations about socialism and the Soviet Union. Yet, you offer no details about the weaknesses of the current system, nor evidence that what I'm proposing would fail.

Of course there's no free lunch.

And Adam Smith didn't only say, "let the invisible hand" work its magic. Smith had about four hundred pages of qualification that Sean Hannity and his ilk have never read, probably because they wouldn't understand it.

As I said, always a pleasure, never a bother.

Michael

allen (in Michigan) said...

Sorry Mike but the evidence of annoyance is pretty hard to miss.

Once you start personalizing your arguments which you do when you claim that the only reason I could have for not being supportive of socialized medicine is that I haven't, personally, suffered financial hardship due to the lack of a socialized system, then you're annoyed with me for not seeing what you see and not believing as you believe. Conversely, you seem to think that personal experience confers a special insight. Your experience with the Taiwanese system allows you to extol its virtues with some special credibility, you seem to feel.

But personal experience cuts two ways.

I could introduce you to a Canadian relative of mine who had repeated appointments with an oncologist canceled. Of course any discussion would be somewhat one-sided but I do have the address of the cemetery and a map to the plot he occupies.

If we're discussing national policy then the discussion had better consist of sweeping generalizations because that's what national policy consists of.

You seem to be laboring under the assumption that if the precisely proper factors can be brought together then some variation of socialized medicine will be workable, and workable over the long term. That if the hospitals are privately owned and everyone has a mandatory minimum level of what you refer to as insurance that's substantively different from Soviet-style socialized medicine and thus, it's just got to work. Those variations you see as important, worthwhile.

I don't.

You'll pardon my vulgarity but from my point of view all you're doing is painting a turd a new color. Regardless of the color the underlying qualities have'nt change and thus, neither has its attractiveness.

With regard to the free market you're displaying one of the classic, and purposeful, mistakes of the left. You insist on claiming that a free market is a lawless market and thus requires what you prefer to refer too as "regulation".

Of course, a free market can't exist without a framework of law. Agreements lawfully entered into must be enforceable, coercion is never acceptable and private property must be respected. Without that framework of law a free market can't arise and once the framework is shattered the free market disappears.

The vast shortcoming of the free market from the point of view of the left is that it works without regard to the preferences, demands and certainties of the left. People will do as they see fit within the framework of law necessary to the operation of a free market and many of the decisions that free people make don't satisfy those among us who see themselves as natural, if powerless in a free market, leaders of mankind.

mazenko said...

Allen,

While I've never advocated for the Canadian system, I understand the reason for you to jump to it from my extolling the virtues of an entirely different system in different countries. Of course, it's easy to take shots at Canada and England. But as I've noted before, we are not they. Simply because they foul up a system, doesn't mean we would. Additionally, I don't advocate going to that system. Switzerland and Taiwan, however, is a different story for which I don't see you having any answers.

In terms of the rationing - and your story of a relative - we could also bring in my good friend and colleague, whose mother is also resting in a cemetery from the failures of the private system, notably Kaiser Permanente who refused to cover some treatment and put her on waiting list after waiting list for others until, of course, it was too late. Or we could discuss the pain and suffering of another colleague who plead with Kaiser for sixteen months - and suffered pay loss from a debilitating injury - before Kaiser would even order the MRI which led to the back surgery which an independent doctor had diagnosed but which was not covered until Kaiser did it. Or we could talk about the eight weeks I waited for an appointment with a specialist - all the while taking antibiotics - that were identified as not helping once I got to the specialist and the problem was cleared up in two days. Efficiency? Hardly. Sometimes deadly inefficiency for which there are numerous, seemingly endless lawsuits against Kaiser? Absolutely.

Yet, Kaiser posts record profits and was identified as far back as Nixon as the answer to the health care problems. Ultimately, I don't see the free market as a "lawless market," and I never have. So, it's interesting to note me making mistakes of the left.

I am a free market proponent, though I acknowledge its weaknesses. It has them, just as government does. Both sides have flaws and a rational person would balance his faith in both. As I do.

Thus, as I've noted, I've contacted my representatives arguing that we should step in and save the free market side of health care, lest we do nothing and public opinion leads to accepting a socialized plan which I do not prefer and which I believe would be a mistake since we can maintain the free market aspect of the system.

Each time I have proposed that, you have aligned my beliefs with a single-payer socialized system. That's simply not true, and it's a non-sequitar from my original position about HAA or FEHBP. All that reveals is that you don't actually read or interpret my position carefully outside your bias for there being only one solution which is the status quo.

Ellen K said...

All of the various nonsense of using quasi-science to push political agendas is a prime example of GIGO-Garbage In/Garbage Out. Don't you miss the old computer axioms?

allen (in Michigan) said...

The difference between our two stories though is that proponents of socialized medicine find fault with private systems for not doing what the the private system was never meant to do - provide universal care - while ignoring the failure of socialized systems to do what proponents of socialized medicine promise socialized medicine will do - provide universal care.

With regard to the differences you feel are crucial in the Swiss and Taiwanese systems that differentiates and renders them superior to the Canadian and English system, you're certainly welcome to your opinion but my view is that the underlying weakness of any socialist enterprise will transcend any differences in the details of its implementation.

If you mandate purchase of health insurance then it isn't health insurance any more but a tax disguised as health insurance.

If the route between the source of the money and its final resting place is a trifle more circuitous then in a single-payer system the purchase is still mandatory removing the crucial component of individual choice, and determination of value, by the receiver of the service. That doesn't mean there are no more choices to be made. Hardly. But the people now making the choices aren't people who have to determine whether they are, individually, receiving value for their purchase price. We can see how that plays out in the public education system.

With regard to your views on the free market, sorry but I don't see you as all that different from people who are vocally opposed to the free market. They also want to improve it by improving it out of existence. The illusion is that there is some way to improve a system in which agreements are freely entered into or that such a system needs improvement when it's a thousand or a million agreements being entered into rather then any individual agreement.

The agencies assigned to perform that improvement function inevitably have their own agenda which, depending on how carefully the enabling legislation is drafted and how active the legislative entity is, takes on greater importance as time goes on. At some point in the future it becomes clear that the agencies charged with improving some function of society are now in business, to as great an extent as they can manage and legislative oversight allows, for themselves.