Your friend Jim George thinks you'd be a great addition to Ricochet, so we'd like to offer you a special deal: You can become a member for no initial charge for one month!
Ricochet is a community of like-minded people who enjoy writing about and discussing politics (usually of the center-right nature), culture, sports, history, and just about every other topic under the sun in a fully moderated environment. We’re so sure you’ll like Ricochet, we’ll let you join and get your first month for free. Kick the tires: read the always eclectic member feed, write some posts, join discussions, participate in a live chat or two, and listen to a few of our over 50 (free) podcasts on every conceivable topic, hosted by some of the biggest names on the right, for 30 days on us. We’re confident you’re gonna love it.
Dan Hanson’s
Ugh, so much wrong with this I’m not sure where to begin. I’ll try .. first
Government directed spending distorts free markets. Sure we had medical progress, but in not the same way as if Medicare had not been created. Free markets put money where it gets it’s best return. The internet wouldn’t look a thing like today if government had directed spending. Uber wouldn’t exist for 10 more years. Insurance products, for healthcare, certainly didn’t progress. Doctors are more office and hospital based than before–would a free market bring about the same result. I doubt it.
Medical insurance, what is it? You allow someone to take your financial risk for a fee. Just think of all the levels of cover possible today if Wall Street or Silicon Valley types were set loose on these products. Years ago I read an interesting article about mortgages and all the ideas mortgage companies had for mortgage products but couldn’t get them past regulators. It’s only in the last few years reverse mortgages have come to be. That’s the government regulated mortgage and insurance industry.
My point is your thinking is still inside the box, old world, 1960’s. The Medicare program has caused the medical insurance world to come to almost a standstill. And you want to base reform on that?
One way out of this mess, is for the federal government to purchase insurance policies or reimburse the cost of what people missed out on if they had purchased a real policy. Then wash it hands of the program.
Even the Republican’s are proposing things like refundable tax credits for health insurance. So in some sense you are correct that the American’s expect the cost of health care to be socialized through the tax system.
This is not to say that we can’t socialize health care costs while maintaining as much market incentives to create value as possible. The key is to make patients consumers and providers competitors for those tax payer dollars. A big step is just outlawing any an all mandates on health insurance products and health care providers.
Where progressives get hung-up on market solutions is that they believe every consumer in a market has to be well informed to produce good outcomes. In reality, only a small sub-group of consumers in any given market are required to be well informed to produce market incentives that improve the quality of goods and services for all market participants. e.g. In the car market it doesn’t matter if you know nothing about internal combustion engines, just the fact that others do will create price signals about the quality of a car’s engine and drive manufacturers to increase the reliability, power, and fuel mileage of their vehicles.
Without endorsing the rest of the argument, DrRich is talking about innovations in health care, not health insurance. Government subsidy of health insurance means that there’s comparatively more money for expensive and marginally less useful treatments. Because of that, there’s been a standing price signal for any kind of innovation that can be said to have medical uses; that doesn’t mean government is directing the research. So you get your private sector innovation, even though it’s chasing after federal dollars. Just at one remove.
DrRich is contending that government subsidy of health insurance produces a massive R&D effort into health care, and that even though it’s a distortion on the market, we’re getting good enough value off of that R&D to make it worth paying for.
Euthanasia’s way cheaper.
Wait, What?
I’m under the impression that rational suicide for the elderly is the way to go.
Is that true? I hadn’t heard this argument before.
I think of the “informed consumer” problem this way: I take my kid to the emergency room. The doctor evaluates my kid. The doctor says “I suspect that the problem is X. I am admitting your kid to the hospital.”
As a mother, even a reasonably well-informed mother, I am generally not in a position to say “no, DoctorRich, you may not hospitalize my kid. I think the problem is actually Y.”
I could if I smelled an actual or metaphorical rat, that is, but in general I am inclined to trust the doctor, and besides, this is my kid we’re talking about.
“It was this taxpayer funding of healthcare that triggered our current Golden Age of medicine.”
More like, as one of your colleagues recently put it, “Medicine… is the Titanic, heading toward the icebergs.” (That’s from memory.)
You might find this description of the Swiss system interesting, as it features universal coverage, and a mixed public/private system.
Sure, but you hear rumors. I remember hearing that a hospital was actually a slaughterhouse as a kid. It was in a third world country. My mother is a nurse, so I never darkened it’s doors. If I got serious, we took the bus up to the capital city to get treated at a clinic (that the other missionaries had properly vetted) there.
Well, I liked it. Seemed a good mix of sound economics and pragmatic politics.
I remember Andrew Sullivan arguing (a decade ago?) that though healthcare is expensive, healthcare is also enormously valuable, adding value and sheer time to human lives that would have been unthinkable a generation or two ago.
My husband, at the age of 55, has two new hips. Owing to a combination of wonky genes and a lot of athletic wear-and-tear, my husband was miserable. Seventy-five years ago, he’d simply be a cripple, and live the rest of his days in constant pain and dependency. Today, he’s a hockey-playing, snowboarding, tax-paying wild man.
As it happened, we have health insurance that paid for most of the cost of the surgery—40 grand. For the first hip, the policy cost 12 grand, and the deductible was 10 grand. The surgery definitely did not feel inexpensive…just very, very valuable.
And I don’t know enough (anything, really) about the economics of healthcare: if well-insured (as opposed to simply rich) arthritic Americans had not existed in sufficient numbers to enable the development and refinement of this surgery, would orthopedic surgeons have had an incentive to innovate?
I hadn’t thought about it this way before—that there aren’t really enough rich people (rich enough to be able to pay cash for 80,000 worth of hip surgery) to make any given procedure worth developing. You need a bigger pool of consumers, right? Health insurance creates healthcare consumers, who then drive the creation and improvement of products…
Seventy-five years ago, people didn’t need hip replacements at the rate they do today, or get a variety of other maladies that are now common.
Right, otherwise no Soylent Green in the deli department.
I brought this up because I’ve met a couple of people in the 50/60 year old age group who think going quietly like this if things are bad enough or if they are not mentally competent is right. Heck Dr. Emmanuel thinks 75 is old enough, not that he’ld comply.
Ah, but that’s where euthanasia comes in. What makes Zeke think it’ll be voluntary?
I guess this is where euphemisms and managing expectations will end up. If abortion can be called a woman’s health care issue than who knows where we can end? After all what’s more universal than meeting your maker?
My point here was that taxpayer-subsidized health insurance has unleashed decades of real, substantial medical progress, and thus has not been the unmitigated disaster we like to think it is. In other words, while this goosed-up medical progress has backed us into a very dangerous fiscal corner (and may indeed be a net negative), a lot of good has come of it.
I agree, however, that without such taxpayer subsidies some kind of medical progress still would have ensued, and that it would probably be very different (possibly better) than what we have today.
You’ll need to re-read my proposal for healthcare reform if you think I want to base it on Medicare. Nothing of the kind.
The health insurance industry recognized their business model was beyond repair by the time Obama was elected, which explains why the industry supported Obamacare (whereas it fought the Clinton plan tooth and nail). Health insurers are pleased to have become public utilities under Obamacare, where the products they offer, the premiums they charge, and profits they can keep, and the losses they can sustain, are all determined by government overseers. It’s not glorious, but it’s a living.
Not quite. A lot of good has come out of the explosion in medical progress over the past few decades – but so has a lot of waste. I do not assert that it is all worth paying for, especially since paying for it threatens to wreck our society. I’m just pointing out that the collectivization of healthcare payment has not been an unmitigated disaster, since many patients have been helped by the medical advances it has led to.
Here, I’m simply asserting that a straight Libertarian healthcare system (where everyone pays their own way all the time, and doesn’t get what they don’t pay for) is no longer feasible.
Kate,
This is why the classic doctor-patient relationship (wherein it is the doctor’s duty to advocate solely for what is in the patient’s best interest, without regard for what society might want) was so important. That classic relationship, of course, is now officially dead. Doctors are obliged to make their true overseers happy if they’d like to continue practicing medicine. And the precepts of “medical ethics” have recently been officially amended to make “working for social justice” (i.e., the needs of society at large) an imperative doctors are expected to honor at the bedside.
Rich
After all what’s more universal than meeting your maker? Catchy! I can imagine this motto chiseled into the frieze above the entrance to the Federal Department of Final Destinations. They could put in on their business cards too, and underneath something like, don’t wait till the last minute, contact us to schedule a “departure time” convenient for you and your loved ones.
But isn’t that because they died sooner? People were certainly afflicted with chronic ills back in the old days. I remember thinking that my asthmatic daughter would have been called “delicate” or “sickly” then, and she would have died of the pneumonia that put her in the hospital once. And people could be crippled with rheumatism and simply live with the pain. 55 is a spring chicken these days, but I read novels from the 20s and 30s that routinely refer to 60 year olds as “elderly.”
How do we determine what falls into tier 2, and what do we do with people with no money for tier 1? On the whole I think the idea has merit, but the fear is a creating 3 classes of people rather than just 3 tiers of healthcare.
No way. This is a sure path to a complete single payer system. Once you have tiers between people then the left will agitate for equality. No way can I ever support any form of a single payer system.
You have medicaid for those who can’t afford healthcare. That’s it and every one else should buy their own plans.
This is a problem, but not the problem. Nevertheless, it is a very real, and critical issue today.
There is no question that the mechanism by which we obtain healthcare is broken. I suggest that among the many problems is the fact that the government is involved. I would prefer a solution that eliminates, at the very least, the federal government. You might say that is because I think universal health coverage smacks of socialism. But really it is because I trust the government to do exactly one thing: get it wrong.
Kudos to Dr. Rich (and to Dan yesterday) for trying to sketch out a system of healthcare payment which finds the most free-market solution given the social and political realities of our society.
However, I am also skeptical about the feasibility of this plan. As King Prawn points out, the devil would probably be in the details of your Tier 2. In order for the system to work, it would have to be bare-bones, but picking and choosing the actual coverage for that tier would end up being a game of which patient group has the most political influence.
And even then, the cries of class warfare would be huge. Again, the only way for the system to work is for Tier 2 to be quite thrifty, with a large room for extra treatment available in Tier 3. But by definition, that would allow rich people to buy extra years of life over poor people.
Still, better to have an unworkable proposal than unworkable platitudes.
The problem is that something like 50% of healthcare costs are generated by 2% of patients.
Even if that figure is somewhat inaccurate, there is no question that a very small slice of patients generate an inordinate amount of the costs – and of course those patients can’t afford those expenses. So by your plan, the government still subsidizes over $1 trillion of healthcare a year, making the US government the biggest single payer in the world.