The Market Does Not Ration Health Care

Understanding the difference between the free market and government control

Editor's Note: This column was first published on August 7, 2009.

Health care reformers say they have two objectives: to enable the uninsured and under-insured to consume more medical services than they consume now, and to keep the prices of those services from rising, as they have been, faster than the prices of other goods and services. Unfortunately, Economics 101 tells us that to accomplish those two things directly—increased consumption by one group and lower prices—the government would have to take a third step: rationing. The reformers are disingenuous about this last step, and for good reason. People don’t like rationing, especially of medical care.

But some defenders of government control acknowledge that rationing is the logical consequence of their ambition. They parry objections by saying in effect: “So we’ll have to ration. Big deal. We already have rationing—by the market.”

For example, Uwe Reinhardt, an economics professor and advocate of government-controlled medicine, writes, “In short, free markets are not an alternative to rationing. They are just one particular form of rationing. Ever since the Fall from Grace, human beings have had to ration everything not available in unlimited quantities, and market forces do most of the rationing.”

Efficient Pricing

Sadly, interventionist economists are not the only economists who talk this way. Most free-market economists would agree that where there is scarcity there must be rationing and that the most efficient way to ration is by price, that is, through the market.

This is factually wrong and strategically ill-advised. As we’ll see, markets—even completely free markets—do not ration. Thus the health care debate is not about which method of rationing—state or market—is superior.

Let me be clear about what I am not denying. I am not denying that economic goods are by definition scarce and that at any given time we must settle for less of them than we want. I am also not denying that the marketplace is relevant in determining who gets how much of those scarce goods.

I am denying that this is appropriately called “rationing.”

Markets Don’t Do Anything

To see that the market does not ration one need only see that “the market” doesn’t do anything. To talk as if it does things is to reify the market—worse, it is to anthropomorphize the market, ascribing to it attributes—purposes, plans, and actions—that only human beings possess. We may also see this as another instance of literalizing a metaphor, which, as Thomas Szasz has so often warned, is fraught with peril.

I’m not saying that economists don’t realize this diction is a metaphor. Of course they do, and there’s no harm in using this shorthand among those who understand it as such. The problem, as I see it, is that the general public doesn’t fully grasp the metaphorical nature of these statements. For the sake of public understanding, free-market advocates should not welcome a debate in which they begin by saying, “Our method of rationing is better than your method of rationing.”

Better to respond to the interventionists this way: The market does not ration or allocate. The market does not do anything. It has no purposes or objectives. It is simply a legal framework in which people do things with their justly acquired property and their time in order to pursue their own purposes.

Mises and Hayek

This is squarely in the Austrian conception of the market as set out by Ludwig von Mises and F. A. Hayek. The market order “has no specific purposes but will enhance for all the prospects of achieving their respective purposes,” Hayek wrote in volume two of Law Legislation, and Liberty.

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  • Ted S.||

    (i^4)th!

  • Suki||

    Are not elective procedures not covered by MaobamaCare, or most government schemes, dropping? Example: toe liposuction did not exist until recently and the price is supposed to be dropping. Same with laser eye surgery, breast enhancement, eye bag removal, and whatever. Amazing what can be accomplished without government rationing.

  • Fist of Etiquette||

    But in no sense is this rationing or allocation.

    Insulating people from the cost of things is seldom a good policy. We will be more judicious with our consumption of medical services if we have to choose between more cable channels and getting that sniffle checked. Each of us would self-ration healthcare, if you will, based on individual wants and needs.

  • Pound. Head. On. Desk.||

    more cable channels

    Yeah, that's what I want, a fourth channel that shows nothing but cooking-based contest shows! And God knows 11 religious channels just aren't enough.

  • Mr. FIFY||

    But they're public airwaves, so shut up and watch. Especially when Dear Leader speaks.

  • Mr. FIFY||

    Oh, and pay your tax/non-tax for the substandard health care you shall soon receive, and be fucking glad for the privilege. IF you know what's good for you.

  • Pound. Head. On. Desk.||

    "Throw physic to the dogs; I'll none of it."

  • Pound. Head. On. Desk.||

    But they're public airwaves, so shut up and watch.

    Inside my signal cables are private property. No trespassing. (Even if I can't seem to spell this morning.)

  • Mr. FIFY||

    Hah! You think you have *any* private property??

    Just ask one of the resident leftists; they'll scoff at the notion.

    Because they're geniuses, and Fuck You, That's Why.

  • C. S. P. Schofield||

    This argument is all very well, but it is not likely to gain any traction with people who think government health care is a swell idea. They don't like "the market", and aren't going to accept the philosophical distinction between rationing and what happens in the market.

    The argument to make is that with government health care what you need to get service is the perception on the part of some government parasite that giving you the treatment you want is less trouble than refusing you. A little thought will show just about anybody that this is a much harder hurdle to jump than simply getting together enough money.

  • Brett L||

    I sure do want the DMV people handling my healthcare approval process.

  • Ken Shultz||

    I don't want them making qualitative decisions on my behalf about my quality of life.

  • EDG reppin' LBC||

    You wouldn't know what your "quality of life" was, even if it bit you on the ass. Also, bite wounds are not covered under Obamacare.

  • Ken Shultz||

    You'd know that you'd rather have a hip replacement than be stuck in a wheelchair.

  • EDG reppin' LBC||

    Definitely take the hip replacement. Preferably something bionic.

  • Tommy_Grand||

    If you're looking for an argument that will help convince the less informed, Ask 'em if they enjoy killing time in the doctor's waiting room with a bunch of coughing sick people. Ask if they like spending time filling out forms. Then, ask if they'd like to wait much longer and fill out more pointless, redundant forms. Do they want a visiting doctor's office to become more like getting a driver's license /or dealing with the irs? When government runs something, we can look forward to standing in line while a big, fat, incompetent public union member gabs on the phone and pounds french fries or donuts. After all, with zero competiton, she has zero fear that she'll be fired for inefficiency. More central government means less competiton, always. Less competive pressure = more fat, lazy, smug clerks asking you to "please" fill out this form again and letting you know that the doctors will see you 'just as soon as possible.'

  • Bill||

    Good points all, Tommy.

  • JW||

    And what could possibly go wrong with gubmint-run medical care?

    NHS bosses have suggested terminating all staff contracts and reoffering them on different terms, according to a leaked document obtained by The Sunday Times.

    New terms could include pay cuts of up to 5%, an end to overtime for nights, weekends and bank holidays, and reduced holiday leave, the newspaper said.

    The beatings will continue...

  • Ken Shultz||

    I am not denying that economic goods are by definition scarce and that at any given time we must settle for less of them than we want. I am also not denying that the marketplace is relevant in determining who gets how much of those scarce goods.

    That's the key right there.

    Some of us are using different definitions of the word "ration".

    If you assume that rationing is a function of scarcity, then even the market rations--but you're not being honest about what it is that critics of ObamaCare are complaining about.

  • Old Mexican||

    Re: Ken Shultz,

    If you assume that rationing is a function of scarcity, then even the market rations[...]


    To be fair, it is not the same thing. A market provides information that allows for more efficient allocation of resources - what we call the price system.

    Rationing means progressively dividing the amount of a total of goods between an increasing number of individuals regardless of personal requirement - what we call the "Soviet toilet paper queue."

  • Ken Shultz||

    Rationing means that our choice to purchase is restricted--regardless of how much we're willing to pay.

  • Old Mexican||

    Re:Ken Shultz

    Rationing means that our choice to purchase is restricted


    That's what the "regardless of personal requirement" means.

  • Keith3D||

    In a market, the rising price attracts more production by profit-seekers. So there isn't the same scarcity or "rationing".

  • James Anderson Merritt||

    Rationing implies not only scarce supply, but monopoly (or cartel) control of that supply. In a market, the supply may be scarce, but only under rare circumstances will the supply of a particular good or service ever be controlled by a monopoly. Also, competitors can offer substitute goods and services. To twist an old reference, if bread is scarce, then cake makers can compete for your business. Imagine a situation where cake is 1/10 the price of bread! It could happen, especially if leavening agents ever become expensive to obtain, for some reason.

  • mr simple||

    Haven't you been paying attention? Bread makes you fat.

  • DarrenM||

    Some of us are using different definitions of the word "ration".

    Yes. The main point is that the market is a mechanism for distributing goods. To my minde, it's still a matter of what works better. The negative about government rationing is the inflexibility and inefficiency. I have no reason to think health care costs will be coming down. Government actions will most likely offset advantages.

    One thing to think about is that when government becomes involved in one area, there is a spillover effect. Government will become involved in other areas where intervention is much less justifiable. It's always necessary to think about the larger picture.

  • Ken Shultz||

    I tend to think of markets as people making choices.

    I'm in favor of choice. My definition of poverty is people with few choices.

    I think of rationing as giving people fewer choices. Some people get upset when we talk about "free markets".

    When we take all the way down to its essence, though, how many people are really willing to stand up and say, "I'm against free choice"?

    The Pro-Life people won't even call themselves "Anti-Choice".

  • James Anderson Merritt||

    Well, but the pro-life people can also call themselves "anti baby-killing," thus equating "choice" with "baby-killing," at least in the context of the abortion controversy.

  • Ken Shultz||

    Point is that when we're talking with people for whom "free markets" may have a negative connotation, it's probably safe to use "free choice" instead.

    There are probably a whole lot of people out there who aren't so sure they want a "free market" in healthcare, but how many of them don't want to be free to make choices from themselves?

    How many of them don't want "free choice" in healthcare?

    Hell, I think "free choice" is more essential--gets to the essence of it more--anyway. I like free markets becasue they let me make my own choices.

    I'd say I like free choice because it gives me better outcomes, but the truth is that I'd prefer to make choices for myself--even if the outcomes were worse.

    So, free choice is its own reward--at least it is for me. ...and I think there are more people who want to make choices for themselves than there are people who think happy thoughts when they hear the term "free markets".

  • Ken Shultz||

    One of the problems when we talk about rationing is that people don't understand that the worst aspects of healthcare rationing don't just manifest themselves in terms of wait times and the nonavailability of care.

    Some of the worst aspects of healthcare rationing happen in terms of restricting quality of life choices.

    Just as an example, if wheelchairs are less expensive for the government than hip replacement surgery, then maybe the bureaucrats decide you get a wheelchair instead.

    The superiority of hip replacements over wheelchairs doesn't show up in any column on any agency's balance sheet--but quality of life are the most important choices we make. ...and not being able to make them for ourselves anymore may be the best reason to oppose ObamaCare.

    I don't want government bureaucrats making the decision for me about whether I stay on therapy for ulcerate colitis or have to spend the rest of my life with a colostomy bag. I want to make that quality of life choice myself...

    Free markets let us make those choices for ourselves--ObamaCare lets government bureaucrats make those choices on our behalf.

  • The Derider||

    The Affordable Care Act mandates minimal health insurance coverage. It does not allow government bureaucrats to make decisions about the type of medical care you receive. Those decisions continue to be made by insurance company bureaucrats, for good or ill.

  • Libertymike||

    Have you read all 2,700 pages?

  • The Derider||

    You think there are secret "government takeover" passages in the law that no one actually read?

    That's stupid.

  • wareagle||

    I think there are a hell of a lot of pages that no one has read. And those are written by lawyers in govt-speak so that no normal person can understand them. Just look at the SCOTUS decision where 9 allegedly intelligent people could not, and still cannot, agree on whether it is a tax or a mandate.

  • The Derider||

    I don't think there are any pages that no one has read. I think places like the Heritage foundation had people going through every page with a fine-tooth comb to see if there was anything they could make a stink about.

    Remember the bullshit about "death panels"? That's exactly what happened.

  • wareagle||

    by any name, the equivalent of death panels are a necessary part of a govt run system. Happens in Europe, happens in every place with socialized medicine. People are often told 'no' re: certain courses of treatment, medication, etc. I have seen that first hand.

    If you have independent means for getting care, that is different. But few people can afford truly expensive procedures. And whereas the US gives grandpa another $500 pill so he can hang on for two more weeks, other countries suggest that the family make funeral plans.

  • Concerned Citizen||

    Join a union. They are among the 1,300+ who got waivers from Obamacare.

  • The Derider||

    Because they already provide health care coverage to their members.

  • Brutus||

    Because they already provide health care coverage to their members.

    If Obamacare mandates coverage and unions provide said coverage, why do they need the waivers?

  • Bill||

    I think that about 8 of them would agree that it is not a tax, but four of them would have changed their minds in order to not have it over turned.

    Derider: Any parts of the 2,700 pages that are vague will be open to interpretation by government and insurance company paper pushers which will come up with legally binding policies that are their own invention

  • Old Mexican||

    Re: The Derider,

    The Affordable Care Act mandates minimal health insurance coverage. It does not allow government bureaucrats to make decisions about the type of medical care you receive.


    You must be irony-impaired. Mandating a minimum of coverage IS making a decision about the type of medical care you receive: You will have to share the room with people with paper cuts and skinned knees while you wait for your spleen to be removed, because - after all - government mandated a minimum of care, which will ALWAYS be well above the care required for most cases.

  • The Derider||

    You're confusing a mandate to own health insurance with a mandate of specific services.

    The Affordable Care Act does not force you to go to the hospital if you skin your knee. It does not stop you from paying out of pocket for any health care you wish to buy.

    If your favorite hospital is overcrowded, it does not stop you from finding another.

  • Libertymike||

    I see you did not answer my question.

    I also see that you read a false premise into my question.

    BTW, I have got news for you, given that the state, i.e., local, municipal, county, state and feds, accounts for roughly 70% of all health care spending, its no secret: the government long ago "took over" the field.

  • The Derider||

    Ok, so what's with all the whining about Obamacare?

    If the health care market is already owned by the feds, what changed?

  • Libertymike||

    Its okay if you have not read the monstrosity - I have only just begun to read the thing in earnest and will continue to do so in the coming months.

    For me, I would whine if we lived in a perfectly anarcho-free enterprise-individualist nirvanna except for traffic lights.

    What changed? Your question is a good one for all of those red teamers who supported the SCHIP legislation in 1997 and GWB's prescription drug boondoggle in 2003.

    However, ACA added the individual mandate. Compelling a person to purchase a product or service is antithetical to liberty. Period.

    But, if you do read the legislation, you will discover that there is a whole lot more in there that has nothing to do with healthcare. Take for example, the provision which provides for a 3.8% surcharge on dividend and investment income for singles making over 200 large and couples making north of 250 large.

  • The Derider||

    That's to fund medicare expansion, yes?

  • VG Zaytsev||

    Yes, it's one of many tax increases in Obamacare.

  • wareagle||

    it's not a mandate to own; it's a tax on those who choose to not own. Whether you can pay out of pocket or not is immaterial to imperial DC. As it is, a good many of the uninsured willingly opted out of insurance.

  • The Derider||

    Well, no, because if you're too poor to afford insurance you either get a subsidy or you're exempted from the tax. So clearly Imperial DC cares a great deal about whether you can or cannot afford insurance.

    You're right, this law is about people who willingly opted out of insurance. Also known as "free-riders".

  • wareagle||

    those who opted out are often folks making fairly decent income, which means they can pay their own way. Others are young adults and don't see any great risk they face. That was in the Census - of the 47 million uninsured, more than 15 mil made more than 50K per year. Another 10mil were not even legal. Opting out of insurance is not the same as inability to pay.

  • Brandon Ross||

    "if you're too poor to afford insurance you either get a subsidy or you're exempted from the tax."

    Not quite; personal finance doesn't work that way.

    Besides: someone gets a "subsidy" to buy insurance. Where do we really think that "subsidy money" is coming from?

  • Ken Shultz||

    "if you're too poor to afford insurance you either get a subsidy or you're exempted from the tax."

    If you're too poor to afford insurance, then you either get Medicaid (in which case your choices are constrained by government bureaucrats), or you can go screw yourself.

    I remember when ObamaCare was supposed to be about making health insurance affordable for poor working people! Now it's about, "Let's sic the IRS on poor working people who try to keep their homes rather than buy health insurance"?

    That's called bait and switch, and I"m not about to pretend that what they set me up with is Miss America--just becasue it's Obama who put lipstick on the pig...

    What they've done to working poor people here is shameful.

  • Brutus||

    You're right, this law is about people who willingly opted out of insurance. Also known as "free-riders".

    That's about the stupidest thing I've seen come from you, Derider, and that's saying something.

    If Joe Blow pays for all of his medical care himself and uses no insurance carrier, how is he a "free rider?" By this definition, I'm a food free rider because I pay cash for my groceries instead of using a grocery insurer.

  • Old Mexican||

    Re: The Derider,

    You're confusing a mandate to own health insurance with a mandate of specific services.


    I didn't confuse anything - you said COVERAGE. I responded to your comment that the government will mandate minimal insurance coverage, which is true: It will mandate that people have insurance WITH a minimum of coverage.

    The Affordable Care Act does not force you to go to the hospital if you skin your knee.


    I never mentioned hospitals. What I am talking about is raising the cost of opportunity for not seeking a doctor for any little ailment one suffers.

    It would be like mandating having insurance with a minimum of coverage for landscaping. People would not bother mowing their lawns or planting their roses themselves, they would use their insurance to have somebody else do this for them, straining the resources of the landscaping industry. That would lead to automatic rationing as demand outstrips supply almost instantly.

  • Bill||

    There are people known as drama queens and hypochondriacs who go to the doctor and ER any chance they get and will go even more often if it is made cheaper or more convenient.
    As a college professor, I see a few students each semester like this and I have a few friends whose wives/girlfriends are like this.

    I worry that this is yet another thing we will see increase and lines and waits will become even longer.

  • Ken Shultz||

    Incidentally, the mechanisms by which the government decides whether or not to cover care in any given case have already been in place for decades.

    http://en.wikipedia.org/wiki/N.....ermination

    I would guess that most people over the age of 70 have had something their doctor told them they needed--that was rejected by Medicare or Medicaid on the basis that it wasn't a "medical necessity".

    I know someone, for instance, whose cardiologist told him he needed a certain procedure. Medicare rejected it as not being a "medical necessity". His response was, "If my doctors says I need it, how can it not be medically necessary?"

    When critics of ObamaCare are talking about rationing, this is the sort of thing we're talking about--but it's going to become much more widespread and sweep into whole new classes of codes.

    Once ObamaCare goes into full swing, the economics are such that many things that are considered a "medical necessity" by government bureaucrats now--will be rejected as not being a "medical necessity" in the future.

    ...as sure as the sun will rise tomorrow.

    Does anybody really need a hip replacement?

  • The Derider||

    Medicare is a minimal health care coverage program. Medicare does not stop anyone from paying out of pocket for service the government will not pay for.

    Either you can afford the medical procedure you want, or you accept what medicare gives you. Sheldon Richman just spent 2 pages describing why the inability to afford medical care is not accurately described as rationing. I see no difference.

  • Old Mexican||

    Re: The Derider,

    Medicare is a minimal health care coverage program.


    This is true. It is a cost ceiling for recipients, covered by the taxpayers.

    Medicare does not stop anyone from paying out of pocket for service the government will not pay for.


    Indeed. What it does is increase the opportunity cost for living healthy before one is eligible for it. After all, you have a guaranteed minimum coverage for most ailments, regardless of your previous lifestyle.

    Sheldon Richman just spent 2 pages describing why the inability to afford medical care is not accurately described as rationing.


    The reason you think this is extraordinary is because you think "rationing" means "not providing." This is not the case. Rationing means progressively dividing a total of goods between an increasing number of individuals, regardless of requirements.

    Saying that affordability is the same as "rationing" is confusing means with freedom. Just because I don't have the means to buy a Mercedes does not mean I don't have the freedom to seek those means to exchange them for a Mercedes. All I would have to do is produce more goods for exchange, that's all.

    RATIONING would mean I would have access to ONE Mercedes (or more likely, a Trabant) sometime in the future, maybe - on the whim of a bureaucrat.

  • The Derider||

    Yes, this is the crux of the argument. You divorce the freedom to engage in some activity from the means to engage in that activity. I think the freedom to engage in some activity is meaningless without the means to engage in it.

  • Old Mexican||

    Re: The Derider,

    You divorce the freedom to engage in some activity from the means to engage in that activity.


    I don't divorce them - one is not contingent to the other. The fact that I don't have the means is just a TEMPORARY situation, whereas the FREEDOM to act exists while I am alive and conscious.

    I think the freedom to engage in some activity is meaningless without the means to engage in it.


    It may be meaningless to you. What you think matters not. The freedom to act exists. The fact that you don't have the means is just a temporary situation. Seeking the means can provide you with purpose and and incentive, but the freedom to act is not predicated on the means you can apply.

  • The Derider||

    Not having the means is not just TEMPORARY to many, particularly in regards to health care. If you're too poor to afford needed health care when you're 25, you can't pull yourself up by your bootstraps and buy health insurance next year because you're dead.

  • Brandon Ross||

    How many 25-year-olds died last year because they could not presently pay for healthcare?

    When I was 25, I needed emergency care. I couldn't afford it at the time. I am decidedly not dead.

  • Ken Shultz||

    Medicare is a minimal health care coverage program.

    When you see Richman and others writing about the rationing of care, do you imagine they're only talking about Medicare?

    Once again, the mechanism by which such medical procedures are rationed is already in place and has been operating for decades.

    When the economics of ObamaCare kick in, it will necessarily put the same pressures on the rest of the system that made the government put things like "medical necessity" in place.

    This is our future under ObamaCare. The fact that rationing doesn't exit (without ObamaCare) for the rest of us isn't an original observation or an objection to anything I've written here.

    My point is that ObamaCare will necessarily result in rationing--of care and qualitative choices. This is what happens when you organize things the way ObamaCare has organized things...

    ObamaCare already fines companies for offering healthcare plans that are too generous, and that is an admission of guilt.

    Even the Obama Administration understood rationing was the result of what they were doing. ...they've even did things to plan for it!

    Fining hospitals for buying new technology (which ObamaCare does) is likewise an attempt to ration quality--without calling it rationing.

    When ObamaCare kicks in circa 2014, this is what we're getting.

    This is what will happen, and pointing out that it isn't happening to people off Medicare right now is completely beside the point.

  • Virginian||

    Then you're a moron.

  • Virginian||

    Obviously directed at The Derider.

  • Brutus||

    Then I must not be free to buy a Bentley.

  • Rasilio||

    This is missing one key point, it is not the market that is doing the rationing, it is the consumers themselves who are chosing to self ration.

    The real question is who do you want making the rationing decisions, a distant and impersonal bureaucrat or yourself.

  • Ken Shultz||

    This is missing one key point, it is not the market that is doing the rationing, it is the consumers themselves who are chosing to self ration.

    I do not believe the market rations.

    The market does not limit the supply of healthcare to consumers--regardless of how much the patient is willing to pay.

    That's what rationing does, and by doing that, rationing actually limits the amount of care, over the long run, that providers are willing to offer, too.

    ...the market doesn't have that problem either.

    So, no. The market doesn't ration. It gives people whatever amount they're willing to pay for given scarce resources--the market does not limit supply regardless of what people are willing to pay.

  • Almanian 1||

    Exactly. "The Market" actually does the OPPOSITE of ration - because it "responds" by INCREASING supply (or contracting, as is appropriate) to meet demand when it's allowed to function.

    Therefore, I submit that there'd be MORE healthcare available at a WIDER variety of pricepoints if there were less Federal and state government restriction, regulation and rigamarole.

    Absolute certainty, like death and taxes. But it's never gonna happen, unfortunately.

    I'm sure everyone here knows that...well, except they willfully ignorant Usual Suspects.

  • Ken Shultz||

    I'm sure everyone here knows that.

    I'm not so sure about that.

  • Ken Shultz||

    I'm sure everyone here knows that.

    You know what I think it is?

    Some of us are old enough to remember when the government decided that because the gas lines were so long and there wasn't enough gas to go around?

    That my dad could only buy gasoline on ever numbered days because his license plate ended in an even number.

    I'll never forget watching people sit in their cars for hours waiting to buy gasoline, and I'll never forget that situation disappearing completely with the stroke of a pen.

    This ObamaCare is the same thing. There's nothing mystifying or new about it. It can only end badly.

    The only question is whether the end will be so bad that people will start to wise up, or whether they've become so parasitic, psychologically, that they'll refuse any solution that doesn't involve other people paying their bills.

  • Almanian 1||

    Gas lines -good analogy. I was, like, early teens when that happened. I distinctly remember thinking, even at that age, "How is restricting the days people can buy gas gonna help with ANYTHING?" And it didn't.

    Fortunately, I grew up in a rural area, so it really wasn't a big deal where we were. But watching on TV - "why are they doing this?"

  • Ken Shultz||

    Right!

    A lot of people have forgotten about that experience. It demonstrated to people for a long time why shortages happen, and why rationing in response to shortages is such a bad idea.

    It's the same thing with healthcare. It's all the same thing.

    Younger people haven't really had an example to deal with. They grew up in the era right after everyone learned those lessons.

  • Mike M.||

    Of course it's going to end badly; it's intended to!

    Like so many of the vile things this administration does, Obamacare is specifically and intentionally designed to have negative outcomes.

  • The Derider||

    If the market can't "ration" because it isn't a conscious being, it can't "respond", either.

  • wareagle||

    are you serious? Markets are based on the premise of responding. It applies to virtually any product or service. Almost nothing is offered by just a single provider, except in areas where govt monopolies exist (see: utilities, often health care, etc.)

    If the market could not respond, Windows would be the only OS ever. And there would be one car company making one or two styles of vehicle.

  • The Derider||

    This is Richman's argument. I agree that it does not seem to square with our usual understanding of the world. I agree that markets respond efficiently to changes in supply and demand. Richman's argument is that this is an illusion-- markets are collections of self-interested human beings, not conscious beings in their own right.

  • wareagle||

    but isn't self-interest a big factor behind entrepreneurship? Folks see an opportunity and create something that fills it. Guess I disagree with Sheldon on that score as the motivation seems explicitly conscious.

  • Bill||

    The market is the mechanism whereby other people respond to the price signals.

    So you are right. The market does not respond and this is Richman's argument about anthropomorphising.

  • Ken Shultz||

    Markets are people making choices.

    If ObamaCare is an alternative to markets, then it's an alternative to people making their own choices.

    I don't want bureaucrats making choices for me. I don't want politicians making choices for me either. Winning an election doesn't legitimize Obama making choices on my behalf. I want to make my own choices, and markets let me do that.

    ObamaCare doesn't.

    And that's the end of it for me.

  • gaoxiaen||

    The AMA?

  • Rasilio||

    I never said the market does ration, In fact I specifically said it does not. I said that rationing does occur in a market based system however it is each individual actor in that market who sets their own rationing limits.

    You are also correct that a market does not restrict supply, however the nature of reality does that both because infinite supply is impossible and because would be suppliers determine how much supply they desire to provide and at what price they are willing to provide it

    That said, to argue that rationing does not occur or that the supply of medical care would be greater than it is today in a free market is massively disingenuious.

    Rationing does occur because you must ration yourself as you do not have unlimited resources. The advantage is that each of us gets to determine how much of our scarce resources to allocate towards health care based on our means and desires. This does not guarantee us all the health care we want but at least the decisions are ours

    On the supply side it is entirely possible that in a free market medical system we would actually have LESS supply than we have today because there is no guarantee that people would be willing to pay the full costs of the health care which is being provided at current rates leading to less demand and less supply.

    It would certainly not be "the market" which is causing this restriction in supply but that would not change the fact that supply would in fact be smaller than it is today.

  • The Derider||

    So people that are too poor to afford health care chose to self-ration their health care by choosing to be poor?

    That seems like a hard sell among normal people.

  • wareagle||

    people who are "too poor to afford health care" are on Medicaid. They don't self-ration anything; to the contrary, they use the system for anything because nothing comes out of their pockets.

  • The Derider||

    This is not strictly true. Medicaid has copayments.

  • wareagle||

    yes, it does and good luck collecting them. Co-pays are measured in single digits and if the patient does not have the money, nothing the provider can do. Might be nice if recipients were genuinely required to pay something rather than required in govt speak.

  • Old Mexican||

    Re: The Derider,

    So people that are too poor to afford health care[...]


    You're begging the question.

    chose to self-ration their health care by choosing to be poor?


    You must be one of those that think medical services are provided by rigidly-programmed robots and not by people that act with purpose. Even people that are "too poor" have access to medical care - it's what we call "charity." Doctors have been providing charity care for decades EXCEPT recently, precisely BECAUSE of Medicaid/Medicare and insurance mandates.

  • The Derider||

    The supply of charity does not always meet the demand for charity. It's a red herring in this discussion.

  • Old Mexican||

    Re: The Derider,

    The supply of charity does not always meet the demand for charity.


    Oh, indeed? How do you know this?

    Besides, wouldn't this be true with government care, which is nothing more than forced charity?

    See how I am right about you being irony-impaired?

  • The Derider||

    I know it because sometimes people die because they cannot afford life-saving health care.

    If the supply of charity always met demand, this could not occur.

  • T o n y||

    Somehow government suppresses the full capacity of charity. You know, by giving tax deductions for it.

  • Virginian||

    Government suppresses the full capacity for charity by its massive fucking taxation.

  • Bill||

    And many diseases are untreatable and people will die even with the best care possible.

    I wish that the media would spend 10 minutes each night advertising people who need charity instead of running around looking for the most sensational nonsense they can to put on the air.

  • Ken Shultz||

    Somehow government suppresses the full capacity of charity. You know, by giving tax deductions for it.

    You're right, Tony, and it's absolutely disgraceful when that happens...

    Take Medicare and Social Security, for instance. Those programs have somehow trained people to imagine that taking care of their own elderly parents isn't their own responsibility--oh no! That's the government's job.

    And look how we treat our elderly becasue of it--it's disgraceful.

    Go take a look at your neighborhood nursing home. Middle class people could do better than that if the government weren't interfering in that market...

    I'm glad you pointed that out.

    Good job!

  • T o n y||

    You're claiming the elderly would fare better without government assistance--not because there would be more resources for their care. Clearly there would be less (and their children would have a lot less to do things with their lives). A mere attitude adjustment would make up for that?

  • Ken Shultz||

    You're claiming the elderly would fare better without government assistance--not because there would be more resources for their care.

    I lived amongst the truly poor in southern Mexico for a year and a half--where they don't have social security and Medicare like we do.

    One of the questions locals always asked me there was whether it was true that Americans send their grandparents off to warehouses to be taken care of by strangers--and that's why you hardly ever see any elderly people in public.

    For them? Doing such a thing to their own elderly relatives is unimaginable. They think of that the way we would think of abandoning our own children.

    And if you're so far gone that you don't see the moral hazard--that taking care of your own elderly relatives is better than shipping them off to be cared for by strangers?

    Then, like I said, take a trip to your local nursing home and volunteer. You don't know what you're talking about.

  • Ken Shultz||

    Doing such a thing to their own elderly relatives is unimaginable. They think of that the way we would think of abandoning our own children.

    Before Medicare and Social Security, mind you, the nations elderly mostly lived at the same standard of living as their children who took care of them. Indeed, being good to your children and providing for their educations was extremely important--if you wanted to enjoy a decent retirement.

    ...now we imagine that educating our children is the government's responsibility too! And how look how disgraceful so many of our public schools are as a result.

    It's shameful what we've done to our elderly.

  • T o n y||

    You're claiming the elderly would fare better without government assistance--not because there would be more resources for their care. Clearly there would be less (and their children would have a lot less to do things with their lives). A mere attitude adjustment would make up for that?

  • Old Mexican||

    Re: Tony,

    You're claiming the elderly would fare better without government assistance--not because there would be more resources for their care.


    There WOULD be more resources for their care without government assistance, for one simple reason:

    Government creates nothing, it has to TAKE people's productive efforts [i.e. wealth] in order to pay for the assistance. Ergo, government merely consumes the resources that are created or saved, but in their very own particular way: wastefully.

  • Old Mexican||

    Re: The Derider,

    I know it because sometimes people die because they cannot afford life-saving health care.


    Are you sure is because they couldn't afford it, or because they did not want to pay for it?

  • EDG reppin' LBC||

    My close friend just had a medium sized tumor removed from her breast this week. She will start chemotherapy in about a month. The doctors at Cedars Sinai here in LA, have been amazing.

    She lives (meager) paycheck to paycheck, and has no insurance. Her surgery, hospital stay, and chemo are going to end up costing her... $0. Cedars Sinai is doing it all for free. It's charity. It happens.

  • wareagle||

    as it is, the amount of indigent care provided by even mid-size hospitals surpasses the budgets of several countries. I wonder what impact Obamacare, as it stands, would have on that. The cost of free care is subsidized, to an extent, by private pay customers. When the insurance market is forced out of business, folks like your friend may face a far more dire outcome.

  • ||

    how should we deal with poverty? Government run health care gives everyone an equal level of inefficient service.

    Maybe just have government programs for those who can't afford care and leave the rest of the system alone?

    We get into big trouble when striving for equal results. Scores are tracked for a reason.

  • Ken Shultz||

    Maybe just have government programs for those who can't afford care and leave the rest of the system alone?

    If they ran free emergency rooms for the poor, it would be an enormous improvement for the rest of the system.

  • DarrenM||

    This is missing one key point, it is not the market that is doing the rationing, it is the consumers themselves who are chosing to self ration.

    So it's still rationing. It's just semantics as to *who* is doing the rationing. Consumers *must* self-ration because of the inability to pay or unwillingness pay the asking price. The market itself does not ration by that you mean a conscious entity making decisions. However, it does ration if you take the market to mean the combined decisions of the individuals partaking in that market.

  • James Anderson Merritt||

    ^ This. In free-market health care, the individual self-rations based upon his own needs and means. More importantly, the forces of the market combine to ensure that goods and services are available at the lowest possible prices, so that the self-rationing decisions are made easier and more palatable, as any given set of means will satisfy more needs over time.

  • James Anderson Merritt||

    My comment above was actually directed to Rasilio|7.15.12 @ 11:12AM.

  • Almanian 1||

    I've had this discussion with many of my Progressive Libtard friends, and I've given up. They simply won't acknowledge that "the market" doesn't "ration", so I've simply stopped having the discussion. It's pointless. And it greatly shortens the conversation: "You're wrong, and I'm tired of arguing with you about it. Talk about something else, or stop talking."

    Down into the abyss. Ancient Rome - I can almost see you now!

  • Almanian 1||

    PS I write this seated in a hospital bed as I'm being readied for transfer to another facility to take care of a little issue they can't take care of in my hometown hospital. Their biggest bitch? Dealing with my insurance company to approve admission, and now transfer. All ultimately resolved satisfactorily, all handled - but I'm sure this will be improved with the heavy hand of Gummint Healthcare® to move things along more quickly in the near future. Right? RIGHT?

    Fuck Obama and even more-socialized medicine. And fuck John Roberts while we're at it. And mostly fuck Pelosi and Reid for ramming this abortion through. Fuck all of you - rot in hell you fucking power-hungry, authoritarian pricks.

    And God Bless the Nurses, for surely they do the Lord's work. Amen.

  • EDG reppin' LBC||

    Be well, Almanian.

  • Almanian 1||

    Very kind of you, EBC - thank you!

  • Almanian 1||

    EBC? That's the painkillers typin'!!

    "EDG" :)

  • EDG reppin' LBC||

    They got you on the Norco/Dilaudid cocktail, eh?

  • Ken Shultz||

    I hold on to the hope that the ultimate effects will be so drastic and devastating that people will come to see the error of their ways.

    Although there are an awful lot of parasites out there right now, who really can't do anything valuable enough to make their lives better than they are when they're parasites.

    That's a big problem.

    Also, it's really a superficial thing, this ObamaCare--it's basically bread and circuses.

    One of the funniest things about it is that it won't work as advertised. It will not bring down costs. It will not improve care.

    When middle-class soccer moms start seeing the healthcare they had disappear and get even more expensive? I'd like to think that they won't put up with that for very long.

  • VG Zaytsev||

    I hold on to the hope that the ultimate effects will be so drastic and devastating that people will come to see the error of their ways.

    There are two problem with that idea:

    1st is that the catastrophic consequences of socialized medicine will hit the seriously ill and injured, who are a very small part of the total population. Meanwhile a much larger percentage gets the illusion of 'free healthcare' or some such nonsense and so supports the system.

    2nd is that socialized healthcare becomes fundamentally dishonest, prevent an overwhelming majority from seeing its consequences. People aren't told, Well we could do this procedure but the bureaucrats rejected it because it will cost too much and instead are told We can't do anything more.

  • Ken Shultz||

    1st is that the catastrophic consequences of socialized medicine will hit the seriously ill and injured, who are a very small part of the total population. Meanwhile a much larger percentage gets the illusion of 'free healthcare' or some such nonsense and so supports the system.

    I don't think they're going to be able to contain the adverse effects.

    Like I said, watch suburban moms. Suburban moms will divorce their husbands if their standard of living drops significantly.

    If the cost of health insurance skyrockets--which I expect it to do--and if the quality of care they and their children receive suffers--which I expect it to do--then even the suburban moms may go on the warpath.

    Right now they see the Obama as a nice guy who's trying to help them, and they see the right as a bunch of homophobic, immigrant bashing...

    But screw with their healthcare? and they may be off to see the divorce attorney about the left. Right now, all the critics of ObamaCare are just making predictions--as far as the soccer moms are concerned.

    When the results come in, and it means bad news for them? I'm thinkin' that'll be a different story.

  • EDG reppin' LBC||

    When middle-class soccer moms start seeing the healthcare they had disappear and get even more expensive? I'd like to think that they won't put up with that for very long.

    I would like to think they won't put up with it as well. Unfortunately, soccer moms usually run in the same circles as doctors, and other professionals. What will most likely happen is soccer mom will use her social relationships with physicians to gain access and services that others can't. Long waits to see the doctor? Not soccer mom, because the doctor's kid plays on the same soccer team. Does little Cody need a procedure that's not government approved? No problem, soccer mom can get the doctor to influence the government decision.

    Obamacare is going to add a new layer of influence peddling, corruption, and scandal. I bet it will create a new privileged class as well.

  • ||

    Sadly, you're probably right about this. And you could have said,

    "[insert any legislation or executive order signed by Obama] is going to add a new layer of influence peddling, corruption, and scandal. I bet it will create a new privileged class as well."

    and it would have been true.

  • 35N4P2BYY||

    --it's basically bread and circuses.

    One of the better analogies I have heard in a while. I do often wonder how many progressives see behind the curtain but buy into the charade anyways.

    But the Affordable Care Act is yet another exercise in government logic that has gotten us to our present circumstances....

    Problem---- Policy Maker: "We must do something!" ----- Half assed, image heavy, content light policy enacted ------ Policy Maker: "We have done something!"

  • Almanian 1||

    When middle-class soccer moms start seeing the healthcare they had disappear and get even more expensive? I'd like to think that they won't put up with that for very long.

    My belief is that they'll collectively say, "THERE OUGHTTA BE A LAW!" and some congresstards will oblige, making things worse, as always.

    I'm such a cynic any more. *sigh*

  • wareagle||

    I'm with A-1. The sheep will cry out for even more govt to fix the problem that govt created in the first place.

  • JW||

    This. Oh, and blame the Republicans.

  • Mike M.||

    You simply can't argue or debate in good faith with people who deliberately twist the meaning of words to suit their agenda. There's no point in even wasting time trying.

  • Heroic Mulatto||

  • EDG reppin' LBC||

    Thanks for that link, HM. My blood pressure is racing now. Jerk.

  • Almanian 1||

    Oh. My. God.

    I was hoping for "funny bungling" and got "wrongful death."

    That is horrible!

  • DEG||

    Cancer will never both him again. See, NHS works!

    /sarc

  • DEG||

    urgh... "both" should be "bother"

  • ||

    Is "bothing" like "othering"? Or just the opposite?

  • JW||

    So that's what it looks like when an entire country goes insane.

    Thanks Fabianism!

  • Brutus||

    But HM, this is a desireable social outcome. I know this because Tony insists that State intervention is always required because the evil capitalisms don't bring about desireable social outcomes. And, since the State is in charge of the NHS, it clearly thought this young man's death by dehydration was the best possible social outcome.

  • Palin's Buttplug||

    As Heritage said, O'Romneycare is a solution based on private insurance when they were pushing this monstrosity. Until Medicare is killed a "free market" solution is impossible.

  • Almanian 1||

    Gotta agree with you, esp. re: "until Medicare is killed". That's the hefalump in the room that - while it exists - precludes any real "free market" in medical care in the US.

  • Ken Shultz||

    Until Medicare is killed a "free market" solution is impossible.

    I disagree.

    Medicare is a huge part of the problem. The solution is to allow some hospitals to refuse service to Medicare and Medicaid patients.

    No admissions through the ER.

    Nothin'!

    Call then "charter hospitals", sort of like "charter schools".

  • Anonymous Coward||

    Mein Gott! Did shriek say something...rational? Quick! Someone check the calculations, we might be approaching the singularity!

  • Generic Stranger||

    Just wait for it; he's going to say something stupid later on that will completely negate anything sensible he's said here.

  • Brutus||

    I'm playing 7, 15, 12 and 07 in the lottery tomorrow...Shriek actually said something sensible.

  • Almanian 1||

    Remember when having TV's in every room was cool? Then it was a TV per bec - cable - headphones so you don't bother your roommate?

    I love that now it's, "Can I bring my laptop, and do you have wifi?" "Yes and yes."

    God Bless America - USA! USA! USA!

    For now...enjoy it while it lasts, which isn't much longer, I fear.

  • Beowulf||

    While i abhor obamacare, I don't find richman's attempt to split semantic hairs useful or compelling. In common usage, markets ration. Their utility is they do it far more efficiently and with less favoritism than alternative methods, and they empower consumers relative to alternatives.

    Semantic self stimulation aside, the difference between rationing by governments and rationing by markets is not yes or no, but rather how much of the decision making is in the hands of the consumer.

  • Almanian 1||

    I must disagree - markets don't "ration". The actions of free parties in markets to interact for their benefit results in products and services being produced in greater or lesser amounts (or not at all) based on these interactions.

    No one or no thing says "you can't have this" - which is what government rationing does. I can be denied a service or product through government rationing even though I have the ability to pay for it. The likelihood of being denied service I can pay for in a truly "free" market approaches zero. Yeah, some asshole or racist may deny it for some fucked up reason...but it's almost certain someone else will be willing to provide it.

    If I can't afford a particular service, that does not mean that service has been "rationed" - esp because I may be able to get that service through other means (charity, barter,etc). If that service or good is RATIONED, I can't get it, period. If I can't afford it, it's still available to me as soon as i can get the money together, because supply WILL expand to meet demand if allowed to do so.

    "The only color I care about is the color of your money..."

  • T o n y||

    No one or no thing says "you can't have this"

    Except every seller to every buyer who doesn't have enough money.

    And there's no inherent reason government rationing must entail forbidding people from buying extra services if they can afford it.

  • Old Mexican||

    Re: Tony,

    Except every seller to every buyer who doesn't have enough money.


    Well, there's always the government-way: Steal it.

  • Brutus||

    Except there's this guy here named Tony that says government **should** prevent someone from buying it because that means someone else can't have it.

    Can you believe the silliness of that?

  • gaoxiaen||

    Except that you need a very expensive permission slip from a doctor to buy cheap medicine.

  • Emperor Wears No Clothes||

    And there's no inherent reason government rationing must entail forbidding people from buying extra services if they can afford it.

    You've heard of Canada, Tony? That big country to the north of you? You'd like it here. Full of fellow marxists. People dying on health care waiting lists. And where it's ILLEGAL to pay for extra services.
    AGAINST THE LAW, ASSHOLE!

  • Rasilio||

    Actually yes there is and many government health care systems have done this and it was a central part of the original Hillarycare plan.

    What is the reason? Fairness.

    Without a regulation preventing private services outside of the goverment system you set up a seperate but unequal health care system where the best doctors, equiptment, and drugs are funnelled into the VERY expensive private health care market that only the very Rich can afford while everyone else is left behind in the underfunded government health care system where there aren't enough doctors or equiptment and what is present for both is substandard in terms of quality.

  • Fluffy||

    To me, rationing is a situation where no matter how much money you're willing to spend on something, you can't get it without a government permission slip.

    The semantic confusion arises from the fact that early "government permission slip" systems used a verb - "to ration" - that has other usages, and which can be applied to different situations.

    But those other usages are actually no longer "common" usage. When someone colloquially says, "I don't like rationing!" everyone knows that they mean government permission slip rationing.

  • Libertymike||

    So, one must present a government permission slip in order to buy an item from a black marketeer?

  • Fluffy||

    The entire discussion is predicated on the notion that we're obeying the law.

    You may as well scoff at the notion that people don't like the drug laws. "What, can't you just go buy pot from a black marketeer?"

    Douche.

  • Libertymike||

    No need for name calling.

  • Virginian||

    Eh, it's a fair cop. You are kind of a douche.

  • EDG reppin' LBC||

    Grow up, Vaginaian.

  • Virginian||

    Lighten up Francis. Just a little humor.

  • EDG reppin' LBC||

    I know. I was trying to be silly.

  • Virginian||

    Well don't I feel stupid.

    I did like Vaginaian though.

  • KriegsEA||

    There is entirely too much money in health care, both public and private, chasing services. The result? Proliferation of unnecessary and overpriced service.

    The health care market is also opaque - you cannot get price info from the current system. That's not gov't chicanery - that's a decision by the providers and insurers to not give it to you.

    Lastly, purchasing health care is not elective. You have no choice about setting a broken arm, or addressing a heart attack.

    Not an argument for or against gov't involvement in health care; just pointing out why the market analogy is of limited use here.

  • Beowulf||

    yes and no.

    No market is perfect, but the healthcare market is certainly among the least perfect - mostly due to government interference and protection of providers/support for oligopolies - symptoms would be opacity and dedicated funding streams - impact would be reduced consumer choice.

    Too much money, overpriced and unnecessary are value judgements, not statements of fact per se.

    Purchasing food is not elective either - you have to eat.

  • KriegsEA||

    Your first point looks like a strawman - what interference and protection? I don't deny it could exist, but your flow of cause and effect is entirely too convenient.

    When a chest x-ray costs $35 in one place, and $225 a mile down the road (a real case), one is overpriced.

    When I purchase food, I can subsist equally well on beef, beans, or avocados. I can make informed choices on cost and what I perceive as fair. I could even drastically reduce how much I eat and be quite fine.

  • Libertymike||

    No, Beowulf's first point is not a strawman.

    Licensing, licensing, licensing.......

    Have you heard of the AMA? Have you heard of state sanctioned barriers to entry in numerous distinct health care fields? Do you think the existence of the same contributes to the price of goods / services delivered?

  • gaoxiaen||

    The AMA is the doctors' labor union.

  • Killazontherun||

    There is entirely too much money in health care, both public and private, chasing services. The result? Proliferation of unnecessary and overpriced service.

    Your thinking is more cultural normative than economic. Was there too much money in cathedral building in the 13th century? For those who don't value cathedrals and approach things from a central planning mentality, yes, but those who do, no. Even the economic factors of creating gluts, booms and bust in the related fields to that activity don't tell you whether there is too much or too little of that activity because those are mere hurdles for those who value that activity and not measures of whether they should or shouldn't engage in it.

    If people want to spend their money on their attempt at longevity and then as a result other people learn the skills to service that demand, than third parties who want to constrain that market with their own ideas of how money should be spent and resources allocated who are in the economic wrong because their choice of inputs and outputs will be a distortion of supply and demand, and that creates misallocation and the poor market signaling that results in long term recessions.

    -- continued --

  • Killazontherun||

    I can see the long term repercussions of such policy being to hamper innovation, as the next phase will be dramatic technological developments in cybernetics for commercial purposes, and without the spending that goes into medical technology that phase will be inhibited like the twenty year ban on commercial activity on the internet stifled growth in that market for a generation.

  • Killazontherun||

    Brrr. Wished there was an editing feature, as the text box will always be insufficient for larger posts. Three tiny errors niggle at me --

    yes, but those who do, no

    superfluous, cut it.

    'if, then' in a construction above not 'if, than.' No comparison made so wrong construction, and 'resources allocated who are in the economic wrong.'

  • Libertymike||

    Kriegs is right about there being too much money chasing health care services. In fact, he is absolutely right - because, in a free market, there would never be the amount of money allocated to health care services.

    Why? The state, of course. If the state subsidizes the delivery of health care services, guess what happens to the price? The same reasoing applies to education.

    Look at the average person in 1964. He or she could afford a whole lot more health care, out of their own pocket, than the average person today.

    Only a fool would not recognize in 1964 that the passage of Medicare would lead to dramatically higher prices of any health care service subsidized by the state.

  • Killazontherun||

    Considering the life style preferences that developed throughout the 70's into our current time in the baby boomer generation, around 13% of economic activity being related to health is not an unrealistic number in relation to their demand for those services. Their demand for it brought about the opportunity for government encroachment and the resulting missalocation through planning.

  • wareagle||

    out of their own pocket

    read and memorize that phrase. No one does anything out of their own pocket anymore; as it is, folks bitch about their co-pays. They have no clue what the actual bill for service is. The only time real paying occurs is if you go to a doc-in-a-box clinic which will file insurance for you or if you are wealthy enough to be totally self-insured against anything.

  • T o n y||

    So we should ban insurance because it distorts people's perception of their role in the market? Perhaps if your house burns you must feel the cost of every item lost so that you are a more perfectly rational consumer. Rational people should be able to predict lifetime healthcare costs and save appropriately, is that about right? And future house fires, of course.

  • wareagle||

    wow..the only thing burning are the straw men you keep erecting. You are the only talking about banning insurance. Treat it like every other commodity - open it to competition. Eliminate the silly ban on over-state-line purchases and drop the silly mandates on what every policy must cover.

    People bitch about the cost of their insurance coverage to a large degree because they pay so little out of pocket. They have no clue why that Tylenol was $8. Govt involvement has only served to distort the market.

  • Brutus||

    So we should ban insurance because it distorts people's perception of their role in the market?

    No, but we should stop subsidizing its purchase, a practice that leads to unnecessary inflation of medical care pricing through inefficiencies and overconsumption.

    Absent the subsidy, medical insurance would fairly quickly return to being actual insurance - hedging fairly large events - rather than a medical cost prepayment scheme.

  • Rasilio||

    UM tony we do not have unsurance today. In fact I suspect that it is illegal to sell an actual Health Insurance plan in many states (and will be so everywhere starting in 2014).

    What we have are Medical Payment plans called Medical Insurance.

    See actual insurance would have something like a $10,000 individual or $20,000 family deductible or possibly even higher with the idea being that you are protected from a major accident or illness but your routine predictible medical expenses (and yes that includes things like getting a case of pneumonia or having a baby) you pay for out of pocket.

  • Calidissident||

    A big reason why providers don't provide price information is because our system has encouraged 3rd party payment as much as possible

  • Rasilio||

    Actually the fact that you are unable to get price information regarding a service is very much a direct result of government policies. Specifically ones which made employer provided health insurance cheaper than private insurance.

    Further yes purchasing health care is nearly always elective. Sure, sometimes it may be the choice between dying and not dying but to argue that this is not making a choice is just foolishness.

    If you break your arm it may not heal right and may leave you crippled for life, or maybe it does, no real way to know for sure. Similarly with a heart attack, depending on the cause of it and the specifics of the situation it is possible that after a few minutes of your heart beat is regularized and you can go on for quite some time without issue (for example my father has had at least 7 heart attacks over the last 20 years but was never admitted to the hospital because by the time he got there his heartbeat had stabilized and he had no other symptoms, they were only recently discovered to have been heart attacks when he went in for a Diagnostic Imaging test and they saw the damage) so yes there is a choice, there is always a choice whether to get any given health care service or not.

  • Palin's Buttplug||

    Also, the private health insurers enjoy antitrust immunity.

    Any notion of a "free market" is ludicrous given that fact.

  • Fluffy||

    A literal free market would not have any antitrust law.

  • The Derider||

    If we take the argument Richman makes here to its logical conclusion, markets don't do anything whatsoever. If they don't "ration" goods, they also don't "efficiently allocate goods" or "promote innovation" or "react efficiently to changes in supply and demand," because they don't "do anything".

  • EDG reppin' LBC||

    Right. Markets don't do anything. Buyers and sellers of goods and services do things. The market only serves to bring buyers and sellers together, so they can compare prices.

  • The Derider||

    So do I now have your license to be a pedantic asshole in every thread about markets? When somebody says "markets are more efficient than government", I can respond "No, markets don't do anything."

    Because that's the same answer Sheldon Richman is giving to the statement "Markets ration goods".

  • EDG reppin' LBC||

    Sure, be an (pedantic) asshole.;-) But as Old Mexican explains below, "markets" is shorthand for the millions of transactions between buyers and sellers. It is the conceptual space where buyers and sellers exchange price signals. If you want to remind us of this every time there is an article about markets, by all means, do. It's always good to define terms.

  • T o n y||

    You can't escape ends-based claims. Having a laissez-faire market is a conscience choices. You guys promote it because it allegedly produces the best outcomes. If that's not the case, then what's the point?

  • Fluffy||

    You guys promote it because it allegedly produces the best outcomes.

    Not me.

    To me, it doesn't matter what the outcomes of the Canadian system are.

    The Canadian system says that if I take my money and give it to a doctor and he treats me, we have committed a criminal act.

    No one can satisfactorily identify for me the criminal element of that transaction.

    The Canadian government deserves destruction on that basis alone, and I heartily wish some Canadian libertarian could obtain the power to mete that destruction out.

    I don't care what the statistical outcomes are for that system.

  • T o n y||

    You still demand a certain outcome, namely maximum individual liberty. That doesn't happen in a vacuum, of course, and will present other outcomes. You don't have to care about them but you can hardly be shocked if others do, since maximum individual liberty at the expense of things like financial security is not necessarily valued by people.

  • Concerned Citizen||

    since maximum individual liberty at the expense of things like financial security is not necessarily valued by people.

    You can trade your freedom for alleged security, but you can't trade mine. IOW, fuck off, slaver.

  • General Butt Naked||

    You guys promote it because it allegedly produces the best outcomes.

    Sorry dumbass, that's called utilitarianism. Which is bad but nowhere near as evil as the blind majoritarianism that you espouse.

  • T o n y||

    So it doesn't matter what kind of society comes out of the system you prefer? Even a nightmarish darwinian hellscape is OK because we are adhering to the correct first principles? That's not only evil it's stupid.

    Everyone's a utilitarian. If you're not offering better outcomes then what exactly are you selling?

  • General Butt Naked||

    Shorter Tony:

    "What are these slaves bitching about? They get three hots and a cot!"

  • nicole||

    Everyone's a utilitarian.

    I can assure you that this is not the case.

  • Anonymous Coward||

    Everyone's a utilitarian. If you're not offering better outcomes then what exactly are you selling?

    Tony w/spaces, can you give me your address so I can rob you? That would result in a better outcome for me, therefore it is okay.

  • Mr. FIFY||

    Tony, your Team demands an outcome as well - equality of outcome.

    Deny it all you want, and dream all you want, but that is not obtainable and deep down, you know that. But you keep plodding away, nose held high in the air, demanding that everyone is guaranteed a slice of pie.

  • T o n y||

    That's just false FIFY. One among an infinite supply of examples of your total inability to see gray areas anywhere. You are a scientific wonder.

  • Old Mexican||

    Re: The Derider,

    If we take the argument Richman makes here to its logical conclusion, markets don't do anything whatsoever.


    Concepts don't do anything. It is people that act.

    If they don't "ration" goods, they also don't "efficiently allocate goods"


    Only people ration goods or allocate goods.

    What markets do is provide information that allows people to more efficiently allocate goods.

    or "promote innovation"


    Freedom to act promotes innovation. The profit motive promotes innovation. Markets only provide information regarding supply and demand.

    Again, concepts don't do anything. "Market" is just the label given to the network of millions of transactions between free individuals. It is individuals who act.

    So your "logical conclusion" ends up being fallacious. Sheldon already explains that market is used metaphorically. The reason we use words and concepts is to ease communication, so we don't have to waste time with constant clarifications and definitions. As always, you confuse the map with the territory - this is evidence of lazy thinking.

  • The Derider||

    Freedom to act and the profit motive are concepts. Concepts don't do anything. Therefore freedom to act and the profit motive cannot promote innovation.

  • Libertymike||

    How about necessity?

  • Old Mexican||

    Re: The Derider,

    Freedom to act and the profit motive are concepts.


    Yes. Nouns represent concepts.

    Therefore freedom to act and the profit motive cannot promote innovation.


    You're now committing the fallacy of equivocation. "Freedom to Act" is a concept, but letting people be free to act - an ACTION - and letting people seek profits - again, an ACTION - leads to those things.

    Therefore, you're making an ass of yourself. That's also an action.

  • The Derider||

    You mean using pedantic arguments that intentionally miss the point make you look like an ass?

    Don't tell Sheldon Richman

  • Sevo||

    The Derider|7.15.12 @ 1:36PM|#
    "You mean using pedantic arguments that intentionally miss the point make you look like an ass?"

    No, it means calling you on your bullshit when you post bullshit.

  • The Derider||

    You're a little late to this party, Sevo.

    Read the whole thread before you start shitting on it.

  • Old Mexican||

    Re: The Derider,

    You mean using pedantic arguments that intentionally miss the point make you look like an ass?


    Engaging in equivocation - like confusing the map for the territory, like you're doing - makes one look like an ass 7 ways to Sunday.

  • Fluffy||

    That section of the article is, in fact, the weakest part of it.

    In general, the anthropomorphization of abstractions while linguistically convenient is often obfuscatory and deceptive. (See concepts like "the public good".)

    That being said, there's no reason to invoke that here. It's quite sufficient to point out that the "rationing" I do when I drink half the orange juice in my refrigerator rather than all of it because I don't feel like going back to the store this morning is qualitatively and morally so different from state-enforced legal rationing schemes that we really need two different words for these two concepts. Using the same word for them obscures more than it illuminates.

  • Ted S.||

    Single payer legal care.

    There's not one lawyer out there who does anything worth more than minimum wage.

    (I'll let you all figure out how much of the above is serious.)

  • Libertymike||

    Roger Clemens would beg to differ.

  • JoshSN||

    How intellectually dishonest this feels to me.

    Humankind has chosen a system for deciding who gets health care. Following T. R. Reid, US Veterans, the Native Americans, and the UK have one system where patients never see a bill. The Canadians have another, Medicare for everyone, the French and Germans have another system, where heavily regulated, profit-capped private insurers manage to cover everyone, and India and Cambodia have the fourth major type of system, where if you have the cash, you get the treatment.

    America has moved from the Cambodian system to the Swiss/Dutch system (a lot like the French/German).

    Humankind chooses the system which determines how care is rationed. There is no reification in that formulation, and Sheldon Richman favors the Cambodian/Indian system, he who has the gold, lives.

  • Libertymike||

    What do you think happens in Maobamaland?

    He who has the gold and gives it to the right Maobamacrat, lives.

  • The Derider||

    I love libertarians.

    When confronted with situations where government intervention works, double down on stupid.

  • Sevo||

    The Derider|7.15.12 @ 1:48PM|#
    "I love libertarians.
    When confronted with situations where government intervention works, double down on stupid."

    I don't love Derider. When called on bullshit, he says 'stupid'.

  • The Derider||

    If you can explain what "Maobamaland" is to me, I'll try to respond to it with the respect you think it deserves.

  • Fluffy||

    The state-centric system in western healthcare was imposed on top of a system that grew up capitalistically.

    You may as well say that East Germany's high GDP proved that Communism worked.

    And the jury is still out on the major US health care state interventions. If Medicare ultimately turns into a demographic disaster that required the specific population distribution of the Baby Boom years to work, and it collapses later, can you really call the demographically-favored years a "success"? That would be like calling the farmer who eats all his seed corn over the winter and starves the next year a "success" because he ate well in January.

  • Old Mexican||

    Re: Fluffly,

    You may as well say that East Germany's high GDP proved that Communism worked.


    As a side comment, it is interesting that up to the very point before the collapse of the U.S.S.R., Paul Samuelson was making that very argument about the U.S.S.R., entirely based on the GDP reported by the Soviet government.

  • Old Mexican||

    Re: JoshSN,

    Humankind has chosen a system for deciding who gets health care.


    Power-seeking politicians are NOT the whole of Humanity.

    Besides, humanity chooses nothing - ONLY INDIVIDUALS CHOOSE.

    Following T. R. Reid, US Veterans, the Native Americans, and the UK have one system where patients never see a bill.


    Hence the overuse/declining quality and quantity. You cannot violate the Laws of Economics just like you cannot violate the Law of Gravity.

    Sheldon Richman favors the Cambodian/Indian system, he who has the gold, lives.


    Before the existence of antibiotics, even those that had the gold, died. What Having The Gold provides is an incentive to find cures and sell more of them. Instead, a system of free medical care will ration what already exists, with little to NO incentive for improvement.

    I prefer the Cambodia/Indian system - at least I will know there's someone looking for a cure for ME. Under the system YOU prefer, I will be able to look at calendars, counting the days to my appointment with my chiropractor.

  • The Derider||

    And yet the Cambodia/India systems have the worst health care outcomes for their citizens, and the "big government" systems have the best.

    I guess government isn't always bad, and markets aren't always the best.

  • Old Mexican||

    Re: The Derider,

    And yet the Cambodia/India systems have the worst health care outcomes for their citizens, and the "big government" systems have the best.


    You're quick to forget that for many decades, medical care in the US was like this Cambodia/Indian system (I'm using Josh's words, which were obviously meant as a put down, to mean free market care) and only recently has it been moving towards a more government-controlled system, progressively leading to higher costs, higher demand and lower supply.

    Instead, the British/French/Canadian system is so "good" that European and Canadian politicians and VIPs travel to the US for their medical care.

    I guess government isn't always bad, and markets aren't always the best.


    And that is what it is: A guess. The first true thing you've said so far. Congrats.

  • wareagle||

    Humankind has chosen a system for deciding who gets health care

    Uh, no. Humankind has not chosen anything; it has had various systems foisted upon by people who think they know better. If the same govt choosing that applies to healthcare was universal, the horse and buggy would still rein, the phone would be attached to your wall, and the Internet would be something the Defense Dept and some universities once used.

    Caps on insurance companies, by extension, also mean caps on services that will be covered. In the UK, in Canada, and in France and Germany, there are things for which the answer is 'no'.

  • Killazontherun||

    India and Cambodia have the fourth major type of system, where if you have the cash, you get the treatment.

    Funny that you mention Cambodia, though you you do so with disdain. I have been watching what is available in South East Asia for a few years now, with an eye on how it develops without interference from their governments, and whether this will continue. If Cambodia (and Indonesia, Thailand, Vietnam and the Philippines) continue along their path, and we continue along ours, people like you are going to be devastatingly shocked how they leap and they bound over us in terms of medical innovation available to their public verse that available to us. There already exist medical tourism where you can get first class care for much cheaper than here even with travel factored in. It will only improve and and, yes, as much as progressives despise the idea (poor babies), trickle down to the masses, so long as governments stay out of the way.

  • JW||

    Following T. R. Reid, US Veterans, the Native Americans, and the UK have one system where patients never see a bill.

    It's hard to put a price on systemic incompetence.

    I'm guessing they get that bill every time the tax man cometh.

  • J Freeman||

    What is dishonest is saying that US Veterans never see a bill. They might never see a bill for an active duty related incident (as long as there is a mountain of paperwork backing that up), but outside of that you are misrepresenting the facts. And to me the inefficiency of the Baltimore VA has shown me that government run health care can be pretty atrocious.

  • T o n y||

    The market was never set up by people to achieve a purpose.

    True, yet people still need to achieve purposes. Some of those are common purposes.

    The distinction you're drawing is purely on the semantic level. The alleged negative consequences of rationing are present in both a free market and a government-run system. Healthcare consists of scarce resources, and the free market is just one way to allocate them.

    The market doesn't have a conscience will in the way you describe it regardless of government's involvement. People make a bunch of individual choices in a given environment, and that includes government subsidies and regulations. Still it's a policy choice to leave healthcare to the free market. It's every bit as much conscious rationing, as we can predict or observe the allocation outcome.

    The free market will never and has never delivered the purpose people all over the civilized world want to achieve: universal access to healthcare and healthcare cost controls. That's only been achieved by other means. This suggests that the free market is simply a particularly inefficient means of rationing.

  • wareagle||

    This suggests that the free market is simply a particularly inefficient means of rationing.

    so it's false flag argument day. The market is not a mechanism for rationing; to the contrary, it exists to expand choices. That is why virtually no product or service is only available through a single provider. Curiously, the ones that are - water, power, cable, maybe health care - are the ones govt has monopolized.

    As it is, health is not a true market. If it were, I could buy coverage from companies in ANY state, not just the one where I live or where an employer is based. My options are artificially limited by govt involvement.

  • T o n y||

    That is why virtually no product or service is only available through a single provider. Curiously, the ones that are - water, power, cable, maybe health care - are the ones govt has monopolized.

    That's not curious at all. Essential services that are meant to be available to all (you left off national defense and police among many others) tend to be single-payer. We provide police power completely apart from market demand because there is a social demand that supplants it, and a private market will produce very bad social outcomes. The free market allocates resources in a certain way. That way is not always optimal even when you don't have certain ends in mind.

    The across-state-lines thing is a talking point and a very bad idea. The reason this restriction exists is because states regulate health insurance in different ways. Allowing your plan means insurers cluster in the most favorable state and thus a national health insurance standard dictated by the government of one state. It happened with credit cards.

    The CBO estimated that such a policy would not change things much in the aggregate but would have the effect of making healthcare cheaper for the healthy and more expensive for the sick, an outcome opposite of the point of risk pooling in either insurance or a government system.

  • wareagle||

    national defense and police are Constitutionally-supported powers of govt. Supplying cable tv is not. This can be done privately and, in some cases is. However, places are limited to a single provider. Pissed at Comcast? Tough. Buy a dish.

    Across state lines is hardly a talking point; it exists in almost everything to include car insurance. Allowing my plan means removing the keystone of yours: "states regulate health insurance in different ways." They should not be regulating it at all beyond standard consumer protection as applies with car insurance.

    CBO estimates, by teh way, are based entirely on the information fed into the system. That same office has also put the lie to claims that Obamacare will cut costs, not impact choices, etc.

  • T o n y||

    The constitution's magical ability to grant exceptions to certain industries from supposedly superior market forces aside, the reason things like national defense are government-run and things like cable TV are not is because one is judged to be an essential need and the other is not. Most civilized human beings recognize healthcare as every bit an essential need.

    I offered up the CBO's estimates, so what's your evidence that eliminating state regulations and letting insurers sell across state lines would produce better healthcare outcomes?

  • ||

    this is not true. the reason national defense is govt. run is per our founding documents, it is necessarily a DUTY of government to provide for national defense.

    it may very well be an essential need, but that is not why govt. runs it. govt. runs it because that is the ROLE of govt. per the very documents and founders that themselves established what the role of govt. would be in our democratic republic.

    food is clearly an essential need. you die without it. however, food distribution, production etc. are not govt. run because it's not a ROLE , a DUTY of govt. to do so.

    contrast with national defense

    again, both are essential needs (food MORE obviously so than national defense) but only one is government-run

    the distinction is clear. one is a duty of govt; one is not

    so, you are wrong. it does not have to do with being an essential need

  • T o n y||

    Surely you realize all you've done is present a tautology. Defense is a duty of government because it's a duty of government.

    And you're seriously claiming government doesn't subsidize food production and consumption? Ever heard of farm subsidies or food stamps?

  • Old Mexican||

    Re: Tony,

    The distinction you're drawing is purely on the semantic level. The alleged negative consequences of rationing are present in both a free market and a government-run system.


    Oh, heck - another nitwit who confuses price allocation with rationing.

    Tony, dear, a free market does not ration. Rationing means progressively dividing a total of goods between an increasing number of individuals. This is not what people do when they engage in trade. Rationing is NOT the same as trading.

    The free market will never and has never delivered the purpose people all over the civilized world want to achieve: universal access to healthcare and healthcare cost controls.


    Now there's a red herring! You cannot know what people all over the civilized world want, unless you claim you can read minds.

  • T o n y||

    People collectively express their will via democratic government. You can say it's not legitimate but it's not a phantom. Governments do things and often those things are considered expressions of popular will. Most people also find having the means to accomplish things collectively rather useful, whether you like it or not.

    Would it make you happier if we said that insurance companies, care facilities, and patients ration? They make conscience decisions. They're also the constituents of the healthcare market. None of your semantic nitpicking supports the underlying claim that the free market allocates healthcare resources in the best possible way.

  • Old Mexican||

    Re: Tony,

    People collectively express their will via democratic government.


    Another red-herring. Just because people vote for something does not mean they express THEIR will, people simply chose between two alternatives given to them by politicians.

    Governments do things and often those things are considered expressions of popular will.


    The fact that they're considered expression of popular will does not mean they're really expressions of popular will.

    Most people also find having the means to accomplish things collectively rather useful, whether you like it or not.


    Oh, I agree - especially when they have those that did not have the vote to pay for those things. After all, democracy is two wolves and a sheep voting on what to have for dinner.

  • Old Mexican||

    Re: Tony (Cont'nd)

    Would it make you happier if we said that insurance companies, care facilities, and patients ration?


    I don't understand why would saying such a thing would make me happier. It sounds like a prayer.

    None of your semantic nitpicking supports the underlying claim that the free market allocates healthcare resources in the best possible way.


    Despite the fact that medical care services are scarce resources, just like landscaping services. Yet the market works for one and not the other.

    The problem is not with any semantic nitpicking, is with your selective thinking and how you put a moral spin on medical services. I wonder if you would believe that a doctor that decides to retire is committing mass murder, because that is the logical conclusion of your overall argument.

  • T o n y||

    Yes I explicitly claim that the healthcare market is different from other markets because it provides essential services. If someone wants to argue for lawncare to be an essential service, he can knock himself out. Right now this country is unique in the developed world in not recognizing healthcare as such. Beyond that, it doesn't work like other markets because consumers don't really get a choice in participating in it. They either participate or they die. That doesn't lead to a market-rational system. People need what they need whether they can afford it or not. Having universal healthcare only takes the insurance concept and makes it most efficient, spreading the risk and cost to all, since all participate anyway.

  • Old Mexican||

    Re: Tony,

    Yes I explicitly claim that the healthcare market is different from other markets because it provides essential services.


    Again with the red herrings. They may seem essential to YOU, but that does not mean they're essential per se.

    If someone wants to argue for lawncare to be an essential service, he can knock himself out.


    Just like you're doing right now. You think that the epithet "essential" is self-evident.

    Right now this country is unique in the developed world in not recognizing healthcare as such.


    Maybe that's a blessing - people are not insane.

    Having universal healthcare only takes the insurance concept and makes it most efficient, spreading the risk and cost to all,


    How is socializing the risk make insurance more "efficient" escapes me. It certainly obviates the cost.

  • Sevo||

    T o n y|7.15.12 @ 2:45PM|#
    "Yes I explicitly claim that the healthcare market is different from other markets because it provides essential services"

    Right, shithead. Like, oh, providing food? That sort of "essential service", shithead?

  • ||

    And the FACT remains that you do not have claim on another person's mind, body, or talent. NO MATTER WHAT FIELD THEY CHOOSE TO SEEK EMPLOYMENT IN.

    Fuck off slaver.

  • Generic Stranger||

    People collectively express their will via democratic government.

    The majority of people in the United States did not, and still do not, want Obamacare. It was passed with absolutely no bipartisanship, and only was able to do so because several Democratic congressmen were literally bribed to go against their constituents. And even with the bribes it was only able to be passed through several borderline unconstitutional procedural tricks.

    Saying that Obamacare is the will of the people is dishonest and flagrantly false. And that ignores the fact that even if it WAS supported by a majority, that doesn't necessarily mean the majority has the right to force it on the minority who doesn't want it, any more than it'd be allowable for the majority to decide to enslave anyone named Steve.

  • Calidissident||

    I love how Tony's "the people collectively express their democratic will and it's too bad if you're on the losing side" arguments suddenly stops when the subject turns to gay marriage

  • Old Mexican||

    Re: Calidissident,

    For Tony and those of his ilk, is "why bother with principles?"

  • T o n y||

    Minority civil rights are afforded special protections in our constitution, and I'm just fine with that. I'm not for unchecked majority tyranny, as I've explained countless times. The only thing going on here is your guys' inability to see the world in a slightly more complex way than "freedum is guud, der."

  • ||

    Fuck you Tony. Just because 50% plus 1 decide they want something doesn't mean they can demand it from the rest.

  • Sevo||

    T o n y|7.15.12 @ 1:44PM|#
    '*Nothing* will ever or has ever delivered the purpose people all over the civilized world want to achieve: universal access to healthcare and healthcare cost controls.'

    FIFY, shithead.

  • Old Mexican||

    This required its special little thread because of how it illustrates the classic case of "missing the point"

    Re: Tony:

    So we should ban insurance because it distorts people's perception of their role in the market?


    No, insurance per se does not distort people's perception of costs. Pseudo-insurance that works like a paying system or a sugar-daddy distorts people's perception of the true cost of services.

    Perhaps if your house burns you must feel the cost of every item lost so that you are a more perfectly rational consumer.


    Or I can anticipate the cost of a fire and buy my own fire insurance.

    What Progressives want is to make insurance companies insure my house when it already burned down.

    Rational people should be able to predict lifetime healthcare costs and save appropriately, is that about right? And future house fires, of course.


    That is what savings are for. This is what catastrophic medical insurance is for. We save and insure for unforeseeables. But this is not what many Progressives are calling for - they want a guarantee. They want to violate the laws of economics and conjure goods and services out of thin air, gratis.

  • T o n y||

    The complaint above was about people's not appreciating their true costs. I agree with you that insurance is a perfectly legitimate product in the market that people buy in order to reduce the risk of large costs in the future.

    You still have not demonstrated how the market most effectively allocates healthcare resources, you're just presenting it as an axiom. And it is in fact possible to conjure goods and services out of thin air--government subsidy. It's not free, but evidence suggests that taxpayers paying the cost tend to get a better deal than private consumers doing it.

  • Old Mexican||

    Re: Tony,

    You still have not demonstrated how the market most effectively allocates healthcare resources, you're just presenting it as an axiom.


    It is axiomatic that when people show their preferences through trade, the result will be more efficient allocation of resources, for a very simple and logical reason: People do not trade for things they don't want. Ergo, they only trade for things they want. This has to result on an EFFECTIVE allocation of goods and services as people trade for those goods and services THEY want, not those they DON'T want.

    The problem with your thinking is that you're conceptualizing the action of allocation based entirely on things YOU value - YOU, Tony. Not what OTHERS value. OTHERS, not Tony. YOU can trade for things YOU want because your wants are known to YOU, since it is YOUR mind; but you cannot presume to know what OTHERS want, precisely because you cannot read other people's minds (not unless you happen to be the first person in the Universe to have this gift.)

    So you're committing a fallacy by thinking that the market cannot allocate those goods YOU value to certain people, because you cannot know how THOSE people value those same goods. The presumption of knowing better than others is called arrogance.

  • Old Mexican||

    Re: The Derider,

    Not having the means is not just TEMPORARY to many,


    You cannot know this.

    you can't pull yourself up by your bootstraps and buy health insurance next year because you're dead.


    That's a possibility, even if true. So? Catering for every possible scenario truly increases the cost for everybody else, and all just so you do not have to worry at night about that hypothetical who could've fallen through the cracks.

  • 0x90||

    "Health care reformers say they have two objectives: to enable the uninsured and under-insured to consume more medical services than they consume now, and to keep the prices of those services from rising, as they have been, faster than the prices of other goods and services."

    By turning free riders into purchasers, the "consume more services" bit should be covered. The "keep prices from rising" part can be achieved by manipulating quantity, quality, or price, and by means of the improved efficiency of an extended market.

    Regarding the latter: how many free riders will actually become purchasers? Depending whether one receives a refund, one should either not pay, or pay the penaltax. In any case, consumption should be expected to increase, on the strength that service is now "owed" -- and the system will take a net loss. Or put the other way around: the efficiency argument rests on the creation of newly-insured persons, for whom contribution outpaces consumption; these will be found to have been largely imaginary.

    And beyond this, we find a third objective:

    "The Affordable Care Act [requires] younger and healthier people to buy insurance that will help pay for the healthcare needs of older and sicker people." - Robert Reich, July 4, 2012

    The math doesn't work, Bob -- and not in spite of the mandate, but because of it.

  • wareagle||

    Reich spoke a malicious truth in calling ACA a wealth transfer and/or generational welfare and was not called on that. A smaller, poorer pool of givers cannot sustain a larger, richer pool of takers, not for long.

  • DarrenM||

    This sounds like it's just semantics. The bottom line is that a restricted amount of goods (health care) make their way to various individuals. These goods will naturally make their way to those with more ability to pay for them, all else being equal. Health care is viewed by some as being an essential good, a little like food though not to the same degree of course. Government rationing may make the distribution of these goods more equitable. However, I also believe it will also make these goods more scarce overall. This means more expensive (supply/demand) and harder to obtain. If you are one of those less able to procure health care than most, you might find this to be acceptable as long as someone else is forced to pay for it.

    The incentives and disincentives can get very complicated very fast. We'll shoot ourselves in the collective foot because of our inability or lack of desire to think through or care about, in many cases, the consequences.

  • Old Mexican||

    Re: DarrenM,

    Health care is viewed by some as being an essential good, a little like food though not to the same degree of course.


    Like I said to Tony above, they apply their own value judgment when arguing that those goods are essential. I am a healthy 43 year old, and for me, right now, medical services are NOT essential.

    Government rationing may make the distribution of these goods more equitable. However, I also believe it will also make these goods more scarce overall.


    The main reason for this potential artificial scarcity is because of one fact that the Progressives are quick to forget: Labor is property. The services provided by a doctor are all from his own labor. His labor belongs to him, he's the only steward of this labor, no one else. When the government imposes itself on the decisions of the owner of the labor on how to allocate it, the owner has then less incentive to exploit and profit from his labor, leading to either withholding of that labor or producing less of it. This is EXACTLY what happens in many of these "Western" countries where medical services are controlled by the government: There's LESS of it, because the owners of the labor have less incentive to exploit it.

  • Old Mexican||

    "The services provided by a doctor are all from his own labor. His labor belongs to him, he's the only steward of this labor[...]"

    As corollary to this, what Progressives are talking about is Stealing this labor.

    The whole ethic of Progressives is based on thievery. Just look at the arguments from Tony, The Derider, etc: They talk about receiving services paid, through force, by someone else.

  • ||

    fwiw, just as an anecdote (oh noes!) as to how ANYBODY can suddenly need very expensive medical care...

    i'm a pretty healthy guy - eat well, train with weights 4-8 times a week, etc. rarely even get a cold

    not too long ago, i woke up in insane pain (in the membrane... literally) and vomiting intensely. to make a long story short - intubated by medics, driven code to harborview (not the nearest hospital by a longshot but where you want to go with major trauma/disease), spent 8 hrs in ER and 3 days in ICU.

    most of the time in ICU i was unconscious/sedated, etc. and apparently, i was exceptionally combative, they had to use 4 point restraints etc. i was out of my gourd.

    diagnosis? encephalitis.

    COST??? well over 40k for the ER and the 3 days in ICU. the pharmacy costs alone were 10k (which is insane. )

    ANYBODY can get encephalitis (or any # of serious conditions, even if perfectly healthy) and 40 k is a lot of money for many people

    it cost me NOTHING because i have bitchen insurance (literally zero dollars) but it's a good example of how some condition can come on quickly and proper fuck you in regards to medical costs if you don't have insurance.

  • Robert||

    Don't you just love equivocation, Sheldon? Reinhardt's not alone in saying the market is a rationing system, and as long as people use the words consistently I don't mind. But obviously what he's trying to do is paper over the difference for those who use "rationing" to mean something in distinction to the market by pointing out that some people use the term to include all means of allocation. It would be like saying to someone who complains of having "a temperature" (meaning fever) that everyone has a temperature of some degree, and that therefore the person is not sick!

  • ||

    that's a good point. so many of these issues/artcles (while i think this article makes good points) come down wanking over meanings of a word.

    what's more important is getting to the essence of the issue, and the distinctions, problems, suggested solutions etc. vs. arguing what i refer to as "semantical wanks".

    granted, i admit i fall prey to this myself.

  • Sevo||

    "But obviously what he's trying to do is paper over the difference for those who use "rationing" to mean something in distinction to the market by pointing out that some people use the term to include all means of allocation."

    You need to be a bit taller so the point doesn't go right over your head.
    The "market" is simply an expression of those who vote with their resources; hence the "market" is no more than the messenger of those revealed preferences.
    So, no, the "market" makes no choices at all; individuals do.

  • Robert||

    Whether the market can be said to be choosing (even metaphorically) or not is separate from the point that people (incluing Sheldon) do commonly use "rationing" to mean something other than a market process.

  • Robert||

    Do you get the point that Reinhardt is saying something like, "Stop complaining. Everybody/b has a temperature."?

  • JeremyR||

    The problem is, you already have rationing. If you can't pay for health care, you don't get it, unless you go to an emergency room.

    The other problem is, due to the nature of medicine, you can't have a free market. For instance, in a free market, people would be able to go out and buy antibiotics. But that would end up in antibiotic resistant strains.

    In the last 5 years of my mother's life, I saw way too much of the health care system in this country. She had decent life insurance yet she had horrible experiences.

    I don't know what the solution is (certainly not Obamacare) but the status quo is terrible.

  • Sevo||

    JeremyR|7.15.12 @ 6:01PM|#
    "The other problem is, due to the nature of medicine, you can't have a free market. For instance, in a free market, people would be able to go out and buy antibiotics. But that would end up in antibiotic resistant strains."

    Sort of like now? When there is no "market" for medical care?

  • Robert||

    You're trying to make an exception illustrate the rule. Outside of antibiotics, how much of health care is necessarily or even arguably subject to that kind of problem?

  • ||

    just got to work. one my(favorite) sgt's was hit and injured by a drunk driver last night. that is the second officer hit and injured by a drunk driver THIS week from my agency

    FUCK DRUNK DRIVERS.

    and just arrested a dumbass kid for shooting up a bunch of signs at a public park with people all around, and causing substantial damage and affront and alarm to the public.

    he was still holding the air rifle IN HIS HAND when he arrested him

    this is referred to as a "slam dunk".

    some people just plead out "arrest me plz mr officer!"

    love my job

  • Emperor Wears No Clothes||

    I'd say I feel sorry for your fellow pigs.
    But I'd be lying.

  • ||

    i like posts like this because it just confirms the hateful bigotry present here amongst so many.

    i mean i deal with people victimized by scumbag burglars and thieves every day.

    but i would (and do) still feel sorry when a burglar is victimized, or anybody else for that matter, for a drunk driver.

    but that's the difference between compassionate human beings and bigots.

  • ||

    It's not bigotry. I've been watching these threads for years, but with barely enough time to read them and hardly time to comment. The anti-cop stance so prevalent here caught my attention and helped bolster my disdain of your profession.

    But there is cause and this is it in a nutshell. The state as it currently exists is a ruthless, mindless, unjust, and immoral institution. It authorizes it's agents to break into homes and kill any perceived threat over the alleged existence of certain plants and chemicals (and this is just one instance in many of the atrocities maintained as "legal").

    Anyone who would willingly work for such an agency is no better than a member of an organized crime syndicate. Godwin-ing is so gauche, but even law enforcement in Nazi Germany investigated and administered justice to real criminals as they captured and sent other human beings their deaths. The one does not allow the other to be forgiven.

  • Fluffy||

    Everyone's a utilitarian.

    No, Tony.

    Let's say a group of 50 people (me and 49 others) are dropped on a desert island.

    15 of those people are pedophile murderers.

    The first day, they gang rape and murder the only child on the island.

    Utilitarianism tells us that we should just let the matter slide. There are no more kids for them to hurt, after all, and we're talking about more than 30% of our total population here. There's no calculation of maximum aggregate utility you can make that doesn't dictate that we just shrug and say, "No problem, dudes, we're square."

    But because I am not a utilitarian, I would say to the rest of the population, "Let's kill these motherfuckers dead and burn their fucking remains."

    If we proceeded to do that, by every statistical measure we'd have terrible "social outcomes". Hell, our death rate is over 30%! And our GDP for the next year will be much lower without all that labor! And I bet a bunch of the dead, burned-up pedos would have had useful skills!

    But all of that would be irrelevant. The most important thing, the FIRST thing, our little desert island society needs is justice. And it wouldn't matter if there were 40 pedos and not 15. Killing those fuckers dead (if we could manage it) would still be the right thing to do. If there were 48 pedos and I had to kill them all personally and then live on the island Forever Alone, that would also be the right thing to do, if I could manage it.

  • ||

    I agree wholeheartedly. justice matters. i don't arrest people (when it's a discretionary arrest) because it's a "win" from the utilitarian standpoint. i do it because justice demands it.

  • Sevo||

    Dunphy (the real one)|7.15.12 @ 7:36PM|#
    "I agree wholeheartedly. justice matters."

    Justice does, but more importantly, "principles" do. They do, because in the long term, good principles have been shown to benefit mankind.
    "Utility" means eating your seed corn; full belly now, screw tomorrow.
    Shithead has none; shithead only cares if emotions tell him something 'feels good'; he'll eat his seed corn in a minute, presuming mommy will save him next year. Analytic thinking is not one of shithead's abilities.

  • Whahappan?||

    Sorry, as a kingsman, justice is not in your purview.

  • ||

    i beg to differ. i have done my best in my shift today to see it done, done rightly, swift, sure, and with fairness towards all!

    and stuf...

  • Emperor Wears No Clothes||

    Dunphy,
    I assumed you just pepper-sprayed their asses and then bragged about it in the bath-houses when you shot the steroids into each other.

  • ||

    i actually think it's been at least 3-4 yrs since i pepper sprayed somebody. there's spider who has spun a web next to my pepper spray trigger and he's been there so long he has hash marks on his sleeves.

  • T o n y||

    Why is it the right thing to do? Who says? Your emotions? Horrific as the rape of one child is, it's at least arguable that brutally killing 15 people is worse.

    In this highly specific situation it's not clear at all that the extreme utilitarian action you describe is any worse on any grounds than what you call "justice."

    Besides a society of 50 people poor of resources in a desperate situation will never act like either utilitarians or practitioners of justice.

  • T o n y||

    But in support of my point, you at least feel that there is some purpose to administering justice. That it serves some useful social end. I'd argue that even if the thing you're serving is a god or other abstract principle, it's still a practical matter at heart. But I'll assume you can do better than that.

  • Robert||

    Then count me as utilitarian. I don't believe in "justice" as some abstract good of its own. I would say to let it slide, for all the reasons the utilitarians would. What good does it do now to kill people over a situation that could never come up again?

    You who I would kill in a situation like that? A fanatic like you. Who knows what mayhem they might cause?

  • ||

    , free markets are not an alternative to rationing. They are just one http://www.ceinturesfr.com/cei.....-c-17.html particular form of rationing. Ever since the Fall from Grace, human beings have had to ration everything not available in unlimited quantities, and market forces do most of the rati

  • Don79513||

    Of course the market doesn't actually ration. However, it doesn't reason either. Having money will let a rich person get their third set of breast implants and let poor people with organ failure die. Private industry has its place, the health and safety of society isn't one of those places. It is the same reason the government runs the military as opposed to having thousands of private militaries spread throughout the country, only helping those that can pay for it. Cancer will kill a citizen just as dead as a foreign bullet or bomb. The military is expensive, but we accept the necessity of spending the money [maybe not quite in the amount we are spending now].

  • ||

    Trying to OWN doctors is just as morally evil as trying to OWN 18 y/o and shipping them off to Da Nang.

  • Angus MacAskill||

    It is the same reason the government runs the military as opposed to having thousands of private militaries spread throughout the country, only helping those that can pay for it.

    Private militaries: only those willing to pay would get to enjoy the benefits of dead Iraqis, Afghans, Pakistanis, etc. Boy, what a nightmare.

  • widget||

    I am late to the party. I do remember the gas rationing in 1979. Odd and even license plates were matched with odd and even days in the calendar month, or something like that. You could only buy gas every other day, based on the last digit of your license plate.

    This resulted in a siphoning epidemic. People purchased siphons to take gas from one car to put in another. Holy fuck, that wasn't part of the plan. Gas station attendants were expected to enforce federal law. They did and didn't. Fist fights broke out over line-forming protocols.

    There's some quibbling above over the exact definition of rationing. You'll know rationing when you see it, and you will see it.

  • ||

    lol "i am not resisting, but i refuse to comply"

    nice tasing

    also, note his dipshit friend videos the whole thing and it clearly supports the officer's actions.

    a video you won't see on reason.com

    but VERY typical

    http://www.policeone.com/polic.....y-the-book

    btw, turns out the guy had a concealed weapon on him, which thankfully did not come into play

    what's your name "miss price". you can legally address me as "miss price"

    what's your date of birth "i'm not sure right now"

    jesus christ.

    the stupid. it burns

  • ||

    nice tasing. saved the guy from maybe having to get shot.

    note, only 6 yrs on, but totally calm and collected.

    http://www.policeone.com/polic.....ad-camera/

  • widget||

    Dunphy,

    'A bloody and suicidal man'. I'll just assume tasering was warranted.

    But.

    How did the news crew come up with the report that he was bloody? The video is too scratchy to show that. It's not their cameras and they weren't first-hand witnesses.

    How did the news crew come up with the fact that the man was suicidal? Are they mind-readers with PhD's in psychology?

    I doubt I'd be treated so well if I poked a burglar in the eye with a sharp stick as he tried to climb in my bedroom window.

  • ||

    you don't have to have a doctorate in psychology to conclude that somebody is suicidal.

    fwiw, i went to grad school for psychology, but i and many other officers routinely involuntary commit people (i'd say i do one a week or so on average) for being imminent dangers to themselves or others. sometimes, for attempted suicide.

    this is the pac NW, the epicenter of teh crazy.

    usually, the best indicators that somebody are suicidal are 1) they make a suicide atttempt 2) they say they want to kill themselves

    the news crew probably spoke to the cop spokesman as to him being bloody. i doubt the medics would speak to the media (HPAA) about his bloodiness, and ditto the hospital.

    i have no idea how they came up with the fact he was suicidal. probably a totality of the circs thing along with statements he made to cops, etc.

    this isn't rocket science, but i don't know any more about the incident than you do. i just know that's how these things usually play out

    i invlol'd some woman just a few days ago for imminent danger to self or others. very common call for us.

  • jason||

    President is making real statements to its health policies.

  • ||

    The government might be able to distribute health care resources more equitably - but it might not. The political process is not an unbiased system of equal justice. It is a system where majority rules. Or, more likely, where a few key voters in a swing state rule. You end up with a distribution of resources that is not equal, but is distributed according to what is politically expedient, or what is rewarding to client constituencies.
    Resources will be directed to thoe groups that have the most political influence, instead of those with the most money.

  • Nike air max womens||

    some defenders of government control acknowledge that rationing is the logical consequence of their ambition. They parry objections by saying in effect: “So we’ll have to ration. Big deal. We already have rationing—by the market.”

  • Registration At Last!||

    Boring semantics rant is boring.

    Number of minds changed by this article: 0.00

  • ||

    Of course it does....how stupid. Also, Von Mises and Hayek wrote fiction, they didn't live in the real world, they manufactured facts to fit their conclusions, they really don't support any argument. No matter who runs our healthcare we will have rationing...

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