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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
Yep, that’s what happens.
You can always import all the doctors from poor countries. They don’t need doctors; they’re a hardy people.
Just wait for Bubonic Plague to have a break out. There are several cases per year, in the Western US and Canada. 1 guy just needs to be infectious and fly to NY or Toronto – global pandemic within a week.
I’m not suggesting that no one should pay for single rooms, nor for excellence. I’m saying that the average person earning $150k and the average person earning $15k is going to have a different amount that they will rationally want to spend on healthcare and on comfort. At the moment, we’re really bad at saying that if it’s a big deal to you not to have a C student, you should pay high prices, but that if you’re less worried about the particular thing you’re having done you should be able to pay a little less. When I get my hair cut and when I get corporate legal services I’ve often been presented with a menu offering a variety of skill levels. When I go to a hospital, I will sometimes get someone amazing, sometimes not, but there isn’t generally the mechanism for rationing by price that one sees in other services. Likewise, selecting rooms by cost is something that hotel chains make easy, but hospitals often do not. This sort of one size fits all approach one of many ways that the system doesn’t behave a lot like a typical market system.
Importing medical staff from developing countries does not reduce the supply of medical staff in developing countries in the medium term. When you make good grades and professional achievement in a field a pathway to employment in the West, you enhance the degree to which that career path is attractive. There’s currently about one Filipino doctor per thousand Filipinos. A couple of decades ago, it was about one per ten thousand. During those decades, there’s been a lot of people complaining about the constant brain drain and about the strain on the education system; the left *hates* the idea of doctors being motivated by higher pay, so it’s the one area of immigration they feel really comfortable complaining about.
Just so. Insurance is for catastrophes, not conveniences.
[Removed due to a better written post saying the same thing; curse your erudition, @judgemental!]
@jamesofengland
I actually agree that health care provision systems the world over are run by similar people with similar concerns.
Insurance systems are likewise run by the same sort of wonks wherever you go. But their concerns have one important difference: for profit insurance has to turn…a profit. Not for profit, or national insurance, has to break even.
I completely get how the free market makes a better mouse trap or surgical procedure by focusing on innovation and efficiency.
When it comes to insurance, I don’t see it. The only innovation or efficiency that drives profits here comes from denying coverage, or from delaying payment or increasing premiums. (There’s an immense admin cost from this – which is just serves profit, not efficiency or coverage.)
Apart from that – a human group is going to have a certain spread of ills. Universal insurance takes that into account, individual insurance implies that there is more individual choice involved. Is there always?
The multi tier system you talk about sounds like what we have here in Oz. (Public universal and then Private on top of that if you want, with significant subsidy.). I think Catherine’s sister is here – how does she find it compared to the UK?
I’ve worked for a government owned investment bank. I’ve worked for a privately owned investment bank. It is not my experience that there was any difference whatsoever when it came to cost cutting efforts. The belief that private sector bureaucrats faced with a budget and set of priorities sent from on high behave differently from public sector bureaucrats faced with a budget and set of priorities sent from on high have dramatically different priorities is not one that I’ve ever seen substantiated. Maybe there’s something magical in healthcare that makes it different, but the differences between privately run publicly paid for hospitals and government run and paid for hospitals doesn’t appear to be enormous in most European countries where they co-exist and nor do the Veterans or Indian Affairs seem to get more effective, thoughtful, or caring use of their dollars than the private sector hospitals they run alongside.
That you don’t understand a business doesn’t mean that there isn’t something to understand. The different ways of incentivizing cost cutting behavior from patients are diverse, as are the different ways that things can be packaged to appeal to them.
The admin cost for publicly funded stuff gets entangled with the admin cost for a lot of other stuff, both on the extracting money from the public side and the doling it out side, which makes them a little harder to compare than one might think, but admin costs are not profit for the insurance companies any more than they are for the state. Admin costs are, I guess, profit for the bill collectors, the paperwork handlers, and other people employed to do administrative work. If you think that those guys rub their hands with glee at the possibility of additional red tape, though, either your experience of them is different to my experience of people working hospital costs (in both public and private sectors) or you simply have unusual priors about how much people enjoy that sort of thing.
Profit is profit. How much profit do you think the insurance companies make? Do please guess before you look the answer up.
Well, there’s some. Are you willing, for instance, to limit your selection of doctors in return for lower costs (HMO) or do you want to prioritize choices (PPP)? The HMO revolution was the single most effective moment in US cost cutting. The cost cutting innovation is generally at the partner level rather than at the insurance level, though; it’s hospitals, workplaces, etc., that engage in innovation. Insurance companies help to provide an marketplace for that.
Catherine’s sister finds the idea of profiting from healthcare repulsive. Also, she thinks that doctors and nurses should profit more from healthcare. Relatedly, she thinks that the word “profit” to describe salaries is offensive.
Private care in most places with a universal government provision tends to be better at performing in the marketplace. In the US you have some provision for making choices like that, but it’s all very macro stuff, akin to deciding to go private for everything for a year, rather than being like deciding to go private for a particular service. If we could have a system that was more like Australia’s, but for a richer country, and had made that call some decades back, I think it would likely have resulted in better value for money, with less luxury for most. Today, as Megan McCardle often notes, we’ve already built our absurdly pampering hospitals and already overpay absurdly for our healthcare professionals. It’s hard to pull back.
I’ve seen numerous times in the corporate world where a department head will be told to reduce their budget by 10%, typically given a couple of weeks to make the cuts. I’ve also seen the same departments told to do it again the next year.
I’ve never heard of a government department or agency doing anything like that.
I worked for a company nationalized by the French government, and that’s what I found too. We were given a budget by the government and at the end of the quarter if we hadn’t spent it all, the regional office would grow a party and dream up other ways of spending it because if they didn’t, then Paris would reduce our budget to what we had actually used. And we can’t have that now, can we.
To be fair, that happens in the corporate world as well. They have the same kind of budget making process. The real difference is that in government, it only ever gets larger, while companies sometimes go the other direction.
And the government is spending taxpayer money.
My point was that most of this admin is focused on sorting between who gets and who doesn’t get based on what kind of plan they bought and what deductables, loopholes, etc. it comes with. None of it is about making health care more effective, per se. Its focus is to make sure nobody gets what they aren’t entitled to (and to minimise what they are, not because evil individuals but rather Good Woman of Szechuan) thought this might end up making everything cost more for everybody.
No idea, but if it isn’t very much (??) then what value does a private sector insurance industry add compared to a publicly owned single payer? The point is single payer is more efficient, which is one reason it costs a lot less to run. The fact that you pay for coverage via a levy or tax rather than insurance premiums to a private company shouldn’t blur that.
My question was more along the lines of what does she think of the health care in Australia. As good as the UK? Better? Worse? Adequate? Inadequate?
Such a true statement.
There is already a shortage!
I disagree with this point. We do not overpay professionals.
I think if anything, the Government needs to get out of buying healthcare. We want to help people who are poor? Vouchers.
And force everyone to be public with 100% of their pricing; no secret deals with insurance.
America won’t be perfect until every man, woman, and all those other genders has been given a high-paying government job with good benefits.
I know you well enough by now to know this is tongue-in-cheek, but I still shudder at the thought.