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The Left Just Doesn’t Appreciate “The Miracle”
I’m friends with many different sorts of people, as my Facebook feed would attest. My acquaintances range from Anarcho-capitalists to religious conservatives to people who are, well … socialists. I’m frequently reminded of that fact whenever I log on and find things like this:
When I saw this yesterday, I was sorely tempted to respond. However, Facebook doesn’t lend itself to carrying out this sort of chewing, so I decided to bring it here to begin digesting it. Yet, where does one even begin with such a movable feast?
For starters, some additional details. The post came from a friend of mine (who shall remain nameless here) who shared this complaint from a fellow disabled person — he too is a paraplegic and is a college instructor. Admittedly, if you’re disabled, the situation described is a serious impediment. His complaint extends further though, and goes on to indict the free market as this is a thing which it “cannot solve” and a situation about which we should be “ashamed.”
Let’s begin by clearing the ground of the underlying complaint. If we take it at face value, I can see several issues from the get-go. Even not knowing the whole story, how plausible is it to think that a company whose client is in good standing with them would simply elect to stop taking their money? I suppose it’s possible, but there are service providers for nearly everything, and a great deal of competition to boot. A comparable service is likely available at similar prices. Perhaps this person is in arrears on payments to their in-home assistance? Perhaps she’s earned a reputation among such service-providers as a person who pays slowly or not at all? Maybe she’s just a pill to deal with. Relatedly, doesn’t she have any family who could help her? Does she have friends or perhaps her employer values her enough to lend assistance in this matter? These are all fundamentally unknowable to us unless we were to honestly discuss the details with her, but more importantly: these are issues which have nothing to do with the Free Market and its ability to help consumers of products and services meet producers at agreed-upon prices.
Now I want to tackle my friend’s complaint head-on. In this particular case, he accuses the Free Market of “not being able to solve” this problem … which is approximately like accusing hammers of being bad because you can’t eat soup with them.
Wrapped up in his complaint is also a series of incorrect assumptions: First, that people have a “right” to healthcare, second, that the Free Market deprives people of this “right” and third that we even have a “free market” in healthcare to begin with.
The assertion that we have a “Right” to healthcare has been widely asserted and frequently debunked. For starters, Rights are things which don’t cost other people anything for you to exercise. My right to swing my arm stops at the end of other people’s noses. Economically, healthcare is a competitive, exclusive consumer good. If one person consumes a unit of healthcare, it is unavailable for another person to use. Somebody must pay for that unit of healthcare … unless we are going to expropriate people’s labor and turn them into healthcare-providing slaves. But the left doesn’t like or comprehend that resources like “the number of hours healthcare providers work” are finite but demand is essentially infinite. The Free Market (nominally) allows for the division of those finite resources via the price mechanism.
Next comes the idea that the Free Market is bad because of how it divides up this limited resource. Is it also bad because it divides people’s labor in every other field in the same fashion, with certain jobs or skills being more valuable than others? Brain Surgeons earn considerably more than tellers at Wal-Mart. Is that fact merely arbitrary or is it entirely appropriate given the very rare combination of desire, skill and years of training which go into making a person a Brain Surgeon? Not to mention the fact that if you need a brain surgeon, you probably don’t want a Wal-Mart teller to wield the blade. (Bob’s Discount Brain Surgery’s prices can’t be beat! We consistently get three stars on Yelp!)
Last comes the notion that we even have a genuinely “Free Market” in healthcare, which is a laughable idea on its face. Is there an industry in this nation which is subject to more government regulation or subsidy than Healthcare? Far from being a “free market,” healthcare more closely resembles a “state-funded agency” when you consider where the monetary inputs come from. In 2013, some 64% of all healthcare spending was provided by the Government via programs such as Medicare, Medicaid, sCHIP and the VA. It’s arguable that part of the reason why Healthcare is so expensive in the first place is that the Government has flooded the zone with so much money that the “third party payer effect” hopelessly distorts the price mechanism. After all, are you going to be more or less likely to order an expensive meal and dessert at a restaurant if you knew somebody else was picking up the tab?
But all of this misses the fundamental point: that without there being some manner of free market in health care… many of the services which the central planners’ dream of divvying up more equitably simply wouldn’t exist in the first place. When I say “The left doesn’t appreciate The Miracle” (in the Goldbergian, Suicide of the West sense) the mere existence of these services is a manifestation of it.
The fact that services such as personal healthcare assistants who will come to your home to do things like “help you bathe” exist in the first place is largely because of the free market. But the left presumes the production of such goods and services as if the market for that labor were static. The thought that such a thing wouldn’t exist without that market doesn’t seem to occur to them, just as its mere existence doesn’t imply their right to have it.
Then there’s the aspect of the future to consider. My contention is that my friend is fundamentally incorrect in his assertion that the Free Market can’t solve this problem – especially if “solving” it in his mind means free healthcare for everybody. In fact, the exact opposite is the case. Who else but the free market and the entrepreneurs associated with it have any hope of easing the burdens with which the disabled live? Is it possible that Honda or Toyota could develop a “home healthcare assistance robot” that can help people meet these basic needs — like this one — and obviate the need for more expensive home healthcare workers? We may never find out if the left get their way, as I can see their next complaint warming up in the bullpen: It isn’t “fair” because only the “Rich” could afford to purchase such golems.
This is at its core the lack of gratitude that Jonah talks about in Suicide of the West: That because The Miracle of Democratic Capitalism doesn’t produce a utopia or Immanentize the Eschaton that it is necessarily grubby, bad and in need of being throttled. But the left doesn’t consider the alternative, where we don’t even get the luxury of contemplating how to divide up such riches in a fashion more pleasing to their eyes. They might, in their anger and impatience kill the very process through which these problems are ultimately ameliorated.
I’m certainly not ashamed to make that argument.
Published in Healthcare
yes this is so. I hvae been slammed for pointing this out.
Thank you Zafar for some of your clarifications.
As someone who did in home health aide work, let me say this: the disability insurance industry was an industry wherein people often found themselves the victims of scams. At least in the 1990’s, such “insurers” would take on policies for a set number of years, and then fold. Since often if you sign up for such an insurance policy, you are agreeing that it will not be available for your use for two to four years, you can see how this sort of thing is easily manipulated via Ponzi-like manipulations. (For the first two years of operating, no such insurer is going to have a single customer utilizing the insurance policy’s purpose. Money in to the company – no money out.)
Also although so many here at ricochet seem to think they have their lives in control and beyond reproach, if the person sitting smugly typing at their computer ends up with ALS in their mid-thirties, and manages to live four years rather than dying after only two, they may well have exhausted the upper limits of their policy. It can and does happen to all types of people, even those who at one time were rather smug.
So….the $160k hip replacement is allegedly subsidising pharmaceutical research?
I confess I’m a little sceptical.
You might notice that there is a wide range there. Replacement hips can be made from a number of materials, and each of them has to be approved by the FDA as an internal prosthetic material. (So, not only the research and development, but the regulatory hoops jumped through.) The cheaper range of those hip replacements are probably the tried and true materials, which also are cheaper here than in Australia, you might note. The problem is that the internal prosthesis definitely has a wear period and can cause allergic reactions. So, it is possible that the higher cost hip replacements are with newer materials that last longer or are hypo-allergenic. And yes, research and development costs do have to be recovered, as well as regulatory costs.
Maybe because this is about new drugs.
Back in the day of Cadillac health plans, I had a patient who owned an insurance agency selling health and life plans who had exactly that “pre-bought” attitude.
That’s what I was going to say.
But we’re not judgmental, or anything, are we?
Canada uses the US system as a cheap backup. Canadian patients flow over the border for tests or surgery, or in some cases to deliver their kids.
Not all do. Not all can afford it.
Another insight:
https://www.aarp.org/politics-society/government-elections/info-03-2012/myths-canada-health-care.html
or
https://www.denverpost.com/2009/06/04/debunking-canadian-health-care-myths/
“Sorry, we couldn’t find the page you were looking for.”
I tried it and it worked for me – could it be because I’m on a smartphone?
But anyway:
http://www.bbc.com/news/world-us-canada-37603883
And
http://knowledge.wharton.upenn.edu/article/lessons-can-u-s-learn-canadian-health-care-system/
From which:
“In one sense, what Americans can learn from Canadians is nothing, because we don’t share the same views of society as they do,” says Mark Pauly, Wharton professor of health care management.
And the poetic ‘Phantoms in the Snow’
http://www.pnhp.org/news/2002/may/phantoms_in_the_snow.php
You’re right on all points. Only the free market can solve these problems for a large number of people. Either by responding to patients’ demand by suppling willing home care people, providing an insurance market to solve the more expensive problems or generating the wealth so that someone else will pay for home health service. The latter, if sufficiently bureaucratized and centralized will eventually destroy the other options. We’re pretty far down the latter path now and can’t seem to reverse course.
Clearly.
I am surprised that you didn’t bring up another Goldbergism. ‘Family is not capitalistic. Family is communistic. “From each according to his ability, to each according to his need.” is the proper operation of family.’ Where is this woman’s family? If we really want to solve our social problems, let’s stop looking toward the State. The State is not your family.
Even if this woman doesn’t have family to rely upon, the thing is that government is greatly responsible for this woman not being able to acquire affordable in home healthcare. I am sure that home healthcare costs 3 times what it would otherwise in a free market because of over regulation largely in the form of rent seeking.
@zafar,
There are many reasons why the US spends so much more than other countries on healthcare. Arahant has laid out a few of them.
Here are a couple more:
I saw a Canadian woman on one of the morning shows years ago. She had been diagnosed with cancer and they told her she was scheduled for surgery in 18 months (a pretty blatant sign that they hope you die before you use up any services). She crossed the border to the U.S and had surgery within 2 weeks.
I thought question “Does one person have the right to labours of another person?” was settled decisively in 1865. I see the democrat party is still on the wrong side of that debate.
If you trust the government and stay for care. There is the case of Amanda Scharf, who died in Oct 2016, at 26, after waiting 5 years for treatment of her (fatal) heart condition.
Every anecdote is potentially a valid data point, but ‘it worked out well’ rarely becomes an anecdote – which skews your average score fatally, because those are also a valid data points. That’s why I’m into the stats of it.
Here’s Peterson-Kaiser’s healthtracker on how cost (and insurance) affects access to health care.
And here’s their broader health system dashboard.
I get that it can become an honour type argument about systems and countries, but I think that profoundly impoverishes discussion.
It’s foolish (imho) for anybody to dispute that America is a great source of medical innovation, and that the profit motive is what drives that. Other countries who want to become research hubs would do well to take that into account. (And some of them certainly do.)
I think it’s equally nuts to argue that there are no drawbacks to a society when it focuses primarily on profit and less on access and the broader impact on society of medical spending.
Both of these are essentially ‘religious’ positions about society and the economy – that is to say positions which are based on a belief about what should be rather than what can be tested and proved.
Years ago, I knew a guy who had a curious device on his desk. It was an early calculator. It was a big thing. He had received it from the calculator company while it was still in development. He was friendly with the salesman and was quizzed about the price he was willing to pay. He was told that it would be US $5,000 back in the late 1960s or early 1970s. That could have bought a small house or a luxury car at the time. But companies were willing to pay it because of the features and because there was nothing else like it out there. So, he agreed to having his company pay $5K. When the bill came, it was for $500. He called up his friend the salesman and said, “Hey, what’s the deal?”
“We found that we could make more profit with a lower price point. We’ll sell so many more of them at that price that per unit manufacturing costs drop and we’ll make a bigger profit selling for $500 than for $5,000.”
So, he authorized payment of $500 for his calculator, and thirty years later still had it on his desk.
High profits and high access are not exclusive attributes. Elective or cosmetic procedures that insurance does not cover in the US tend to cost less than similar procedures insurance does cover. Why? Because the most efficient system is consumer-driven. Any sort of third-party payment system introduces inefficiencies. Instead of an agreement between provider and consumer, having a government or insurance company in the mix means another hand out wanting to get paid for their services. Not only that, but to show how good of a job they are doing, they require the consumer and the provider to fill out forms that they can evaluate. The reason providers will bend to single (government) payer is because they only have one set of forms instead of one for each third-party, so it can make the system more efficient again. Another factor is that third-party payment leads the consumer to see endless services. So, they abuse the system until the third-party payer says, “Stop! You don’t need to go to a doctor every time you sneeze.” The solution is not to consolidate all of the third-parties into the one least efficient third-party, it is to eliminate the third parties and their market distortions and let the market work.
You want wider access? Make it as inexpensive as possible.
I was struck by the adamant declaration that the matter “would not and CANNOT be solved by the free market, or privatized health care” because for the last few years of his life (he suffered severe dementia and died last year), my father received excellent home care by a team of freelance home health aides that my step-mother hired on the open market. It even was cheaper than a nursing home would have been (granted, he didn’t need full 24 hour care because he reliably slept overnight).
The liberals actually believe that capitalism and the free market are synonymous with evil. They sprinkle their rhetoric and arguments with “big business” and “multi-national corporations” as if those phrases should strike terror into the hearts of the masses. Apparently “multi-national” is only non-scary when it pertains to globalist open-border crap.
I’m not sure that that’s really what’s being measured there. My wife’s life was put in substantial jeopardy by lack of access to care in Scotland; her blood pressure was absurdly high, but because she was hoping to get pregnant she couldn’t use the most common medication. They told her that she should wait for lebetalol, and did not tell her what the numbers meant, so she waited five months. When US immigration forced us to see a proper doctor, they made sure that we got her medication. Particularly with her family history of strokes, it was incredibly lucky that nothing terrible arose from this.
The difference between the private system and government healthcare, for the most part, is that governments hide the restrictions that are due to cost. You’re vastly more likely to be in a large shared ward with dramatically lower costs than somewhere with privacy. You’re more likely to have your entertainment limited to a coin-op TV that works some of the time. But you won’t be given the option of better choices, so these sort of opinion polls won’t show complaints.
I think it would be helpful for you to disaggregate things a little more. To take the first step of aggregation, Whether the person paying for care is a government entity or a private entity might make some difference, but the profit motives for the hospital, for the doctors, the nurses, the bureaucrats, etc. aren’t super different. In most single payer systems, considerable portions of the funds go to private entities that construct buildings, provide utilities, audit accounts, and sometimes that provide medical services (in the UK, most medical care is provided by market actors; the NHS makes much of the country single payer, but it’s only partly nationalized; nationalization is, obviously, separate to single payer).
Disaggregate it further beyond the corporate form; If you become a middle manager for a hospital anywhere in the world, you’re likely to have the bulk of your responsibilities focusing on fighting rising costs. It doesn’t matter whether it’s a government or an insurance company (often so heavily regulated that it’s not so far from being the government anyway), everyone in healthcare management is trying and failing to stop costs from rising as fast as they are.
I agree that one should always be aware of trade-offs, but the trade off here is not between countries that focus on access and those that don’t (for instance, one of the things that makes America expensive is that it has a more broadly geographically distributed system, with a significantly stronger focus on the provision of excellent rural care), and particularly not on those that focus on the broader impact. One of the worst of the studies used to deprecate American healthcare was the Liz Warren thing on medical bankruptcy, with untold morons claiming that medical bankruptcy wasn’t a thing in countries with single payer. Having a slower and less convenient system is far more likely to mess with your career, though, than a merely inconveniently expensive one. The American system is responsive to the sorts of needs that show up in McKinsey reports, which is a set of priorities that is often decried, but generally means that they’re better at reducing the broader impact of health problems in society; the market is much more sensitive to nuance than centrally issued diktats can be.
I feel like the belief that middle management in government is composed of virtuous people, while private bureaucracy is composed of greedy people is a depressingly common, but quintessentially religious belief; moral salvation comes through the expansion of the state.
It’s also partly about inequality; wealthy people rationally spend large amounts on healthcare, particularly on chronic stuff. It’s not uncommon to see people in the US having skilled medical professionals spending considerable amounts of time in patient’s homes, with expensive equipment. If you’re in hospital, you can live as if you’re in a nice hotel. That sort of stuff doesn’t make a large dent in the healthcare statistics (the top 30% of society will generally get enough healthcare to take the low hanging fruit of concerns anywhere, and it’s the low hanging fruit that makes the vast bulk of the difference), but it still makes pretty substantial impacts.
There isn’t a lot to be done, though. Fighting to reduce pay for nurses isn’t popular, and there’s essentially no group as dedicated to exerting influence on politicians to promote their own interests as doctors, in any country (although the ways in which one does that when one has free political speech are different to those in places where there’s more restriction).
When I was in the hospital in 2016, one of my nurses was from Canada. I was in a private room, and after four days I joked that my bill must be close to a million dollars because of it. She said, “Oh, all we have are private rooms. If you were in Canada you’d have three roommates.”
I should be clear that I’m not sure this is a good thing; American medicine should be, to my mind, more like French medicine. You’d save a lot of money if you had the median socioeconomic patient having a less luxurious experience. American medicine gets super-inegalitarian at the top, but there’s more equality over the fat part of the bell curve. If someone would choose a Howard Johnson over a Marriott for a vacation, it seems like those values should probably transfer to their health care consumption. It’s a problem in America that it’s so hard to come by merely mediocre healthcare.
I don’t care about luxury (well, I mean I don’t want three roommates though), but I do care about rationing of services and tests and hiding it, and that’s an unavoidable result of socialized health care. Also in the long run, won’t the best and brightest no longer even want to be doctors? I don’t want the C students operating on me.