No Such Thing As a Free MRI

The New York Times realizes there is a downside to socialized health care in Canada: long lines for testing and treatment. If you don't ration a product by price, it will be rationed some other way. This is a story Reason has been covering for many years, so it's nice to see the Times has finally caught on. The page 3 article relies heavily on the Fraser Institute, whose Michael Walker wrote a piece for Reason about the problem in 1989 (too long ago to be available online). The waits apparently have gotten worse since then. According to the Fraser Institute, "patients across Canada experienced average waiting times of 16.5 weeks between receiving a referral from a general practitioner and undergoing treatment in 2001-2002, a rate 77 percent longer than in 1993."

Comments

[Matt Welch]

Hey Jacob -- What, if any, are the preferred libertarian-bent strategies for making health insurance available to the 40 million people who don't have it now? You can send me to an old Reason story or something, if one applies. Thanks!

[Philip Elliott]

Wouldn't the libertarian strategy be for the uninsured to get-a-freakin-job, one that either provides health insurance or pays enough to buy it on your own.

[Lefty]

I don't buy it that folks go to the doctor just because they have some extra time on their hands and it's "free".

My guess is most of the posters here are either slackers, soon to be unemployed, or are already there. If you're like me and already there, you are one slip on the ice from banruptcy.

[Brad S]

"I don't buy it that folks go to the doctor just because they have some extra time on their hands and it's 'free'."

No, but when you artificially reduce the price of something below its market value, there naturally becomes an excess in demand for that thing, which is precisely what they're going through in Canada with their nationalized health care system. I guess the question is, is it better to have timely care and pay market value for it, or is it better to wait for care which is government-subsidized?

[Anonymous]

lefty:

if all the posters here were unemployed, wouldn't they probably want free health care?

of course, you could argue that libretarians (even unemployed ones) understand the reality of artifical controls in a free market.

[Left]

Please educate me. If some proper Libertarian would help me with a couple of questions.

Why does it take an insurance company for a person to obtain health care in the U.S.?

Why is it business' responsibility to provide health insurance for workers?

[Jacob]

Matt, you might want to take a look at Ron's recent column on this topic (at http://www.reason.com/rb/rb021203.shtml), which suggests how health coverage can be made affordable to people of modest means. In general, there needs to be more flexibility, variety, and competition, which can be accomplished through deregulation (eliminating minimum coverage requirements and allowing non-M.D.s to do more, for example) and changes in tax law--in particular, the treatment of health insurance as a fringe benefit, which encourages companies to offer one-size-fits-all plans rather than pay employees extra and let them buy the coverage that's right for them.

[Anonymous]

1. It doesn't... most people want insurance because of the extraordinary cost of providing care. It?s a prudent investment for an individual. However, if you can't afford it, you can?t afford it.

2. it is in NO way a business' responsibility to provide an employee with insurance. The government has made it a responsibility, and wrongfully so.

In a free market it would be an expected method of compensation. if an employer did not provide insurance, an employee could expect other compensation (i.e. monetary, or stock options). if the employee did not like this situation, he could take his labor elsewhere.

It?s so simple really, too bad the government is run by morons.

[Anonymous]

1. It doesn't... most people want insurance because of the extraordinary cost of providing care. It?s a prudent investment for an individual. However, if you can't afford it, you can?t afford it.

2. it is in NO way a business' responsibility to provide an employee with insurance. The government has made it a responsibility, and wrongfully so.

In a free market it would be an expected method of compensation. if an employer did not provide insurance, an employee could expect other compensation (i.e. monetary, or stock options). if the employee did not like this situation, he could take his labor elsewhere.

It?s so simple really, too bad the government is run by morons.

[Brad S]

"Why does it take an insurance company to obtain health care..." - because most (not all) people who can afford health care would rather have health insurance than bear the risks associated with not having insurance. There may be some risk-neutral or risk-seeking people out there who would rather take their chances and be self-insured, but I suspect there are not many.

"Why is it business' responsibility to provide health insurance for workers..." - this was not always the case, but workers have come to expect their employers to provide some form of group insurance. I think Labor Unions were a big driving force behind this. There is a benefit to the worker - generally, workers can get cheaper insurance through their employers (due to their employers' purchasing power) than they could get if they were to purchase insurance on their own. And there is some benefit to the company - generally, a company has a vested interest in seeing to it that its workforce stays healthy.

[Sebastian]

No matter what you may think about socialized medicine, it's hard to argue that our current third-party-payer health care system isn't horribly broken. If we insured our cars like we insure our health, you'd file a claim every time you filled up the gas tank or changed the oil.

I think removing responsibility on heath care from the employer would allow people to choose their own level of care at a price level they felt comfortable with. As for the current government health bureaucracy? I'd be in favor of tearing it down and replacing it with vouchers.

[Michael Duff]

Matt,

Whenever I want to know the Libertarian strategy for something, I start with the Cato Institute Handbook for Congress.

I think this brief primer on Health Care would be an excellent place to start.

[Michael Duff]

Matt,

Whenever I want to know the Libertarian strategy for something, I start with the Cato Institute Handbook for Congress.

I think this brief primer on Health Care would be an excellent place to start.

[Steve]

Lefty clearly hasn't been to a doctor in a while. Or even paid attention. 30 and 40 years ago, people handled their kids sniffle or flu or whatever at home. Now, they go to the doctor, or worse yet, the emergency room. There's no incentive not to. There's little incentive for the doctor not prescribe a drug or some expensive test. Mom and dad demand it and he runs the risk of being sued if he doesn't do everything possible. The insured never sees the money he is REALLY spending because it comes out of his paycheck before it gets to him.

The result is what we got.

[NineNine]

I just wanna say that I was unemployed for 6 months. Then, I started my own business. Before that, I was a hired gun, a "contractor" for the IT industry before it all left the US. For the past god knows how many years, I bought my own health insurance. I have full coverage for $70/month. My wife has several health problems, and for her it's $110/month. That's not at all cost-prohibitive for anybody. I'd love to see people take responsibility for their own health and just do what I do: buy their own health insurance. And yes, I'll hear people whining, "But I have 3 kids". Yeah, so? How's that my problem? That's something that responsible people need to take into account before they have kids. They're *expensive*. If you can't afford health insurance and everything else that comes with kids, don't have 'em. It's that simple. Nowhere is it written that people have a right to have kids and to be able to afford health insurance. Nowhere.

[James]

Here's the perfect example: Last July I hurt my knee playing basketball. When it didn't get better after a couple of months, I went to a doctor, who sent me to a physical pherapist. I've been going once a week to PT for the last 4 months at a cost to my employer provided insurance of about $150 a visit. If I had to bear the cost myself, I would have told the PT to give me a home exercise program, and I'd be checking in with them about once a month.

Given a choice I would take the cash my employer pays to the insurance plan, and pay out less for a less comprehensive program.

No sane person could think that hiding the costs of health care and limiting consumer choice doesn't cause people to use it more.

[Jon H]

NineNine wrote:" If you can't afford health insurance and everything else that comes with kids, don't have 'em."

And what if you have em already, and everything goes pear-shaped?

Nah, never happens. Have you lived a peculiarly sheltered life? It seems like you must have a poor ability to conceive of bad scenarios.

[NineNine]

No, I know that happens occasionally. But more times then not, it's a matter of "Got a condom?" "Nope." "Screw it! Fuck me, big boy" And thus begins a 10 seconds that will change both of their lives forever. So what? How's that my problem? Why should I, as a taxpayer, be forced to pay for that?

[Lefty]

Good points.

Is the gummint's role then, in "taking care" of its citizens, only a regulating body? And if so, when it is taken over by the corporations it is regulating, where do we turn?

[Gary Farber]

"Wouldn't the libertarian strategy be for the uninsured to get-a-freakin-job, one that either provides health insurance or pays enough to buy it on your own."

What's the libertarian strategy for those with fucked up lives? People who are disabled, people with mental disease, people with criminal records, people who are illiterate, people who have been mentally crippled in one or another, people whose abused lives leave them with great problems getting a job?

Most jobs that pay, say, under $16/hr tend to come without any health insurance? What's the libertarian answer to that, beyond "choose between food, rent, and health insurance"?

Note: I'm somewhat libertarian, but the lack of such libertarian answers keeps me from going any further.

"Get rich, so you can be a libertarian" seems an inadequate answer for the many who can't. "Get well off, so you can be a libertarian" works no better. Many people can't work, or can only work inadquately, or at McJobs. Surely libertarianisnism should have a better answer for them than "too bad." Else it fails as a political philosophy.

(Mind, I've always been fond of the negative income tax.)

[Gary Farber]

"I have full coverage for $70/month. My wife has several health problems, and for her it's $110/month. That's not at all cost-prohibitive for anybody."

This turns out not to be true. If you make $7/hr -- a common wage -- at a 35/hr week job, you make $265 a week, $1060/month. And if you pay, say, $900/month, and actually eat and pay utility bills, but don't own a car....

Heavens, what's cost-prohibitive about that? Apparently millions of Americans don't exist! How convenient to define millions of people as not "anybody."

[Steve]

Jon and Lefty miss the big picture. that is, we are responsible for ourselves. Once we have ourselves under control, we can (IF WE SO CHOOSE) be responsible for others. There's a moral imperative in that, but not to the point where the overnment takes our labor at the point of a gun.

And besides, through the semi-socialized system we currently have, I've been paying for others for a long time. I'm pretty sure I haven't used 23 years worth of premiums. And I need an all-encompassing HMO like I need another hole in the head. I'm divorced, the kids are grown and I have no serious health problems. Why can't I get major medical and and maybe a long-term care option, just in case? Hell, I could get it in a system that was apparently so "broken" 25 years ago that it needed "fixing".

[Anonymous]

im fat and i smoke

gimme free health care!

[Marca]

NineNine: amen

[Commie]

you libertarians make me sick! all you want is corporate rule of healthcare!!!!

"Fascism may as well be called corporatism because it represents the merger of state and corporate power" --Benito Mussolini

[Lefty]

Attaboy, Commie. A little shrill, even for my taste, but a fair argument.

Is citizen health care as much a State interest as, say, water supply, roads and schools? Does it rise to the "promote the general welfare" responsibility of the State? I think it does. Further, turning over these types of responsibilities to private corporations (think private prisons) is chickenshit.

[Righty]

Is citizen food supply as much a State interest as, say, water supply, roads and schools? Does it rise to the "promote the general welfare" responsibility of the State? I think it does. Further, turning over these types of responsibilities to private corporations (think private prisons) is chickenshit.

Nationalize all Grocery Stores! The State can feed us better than Corporations!

[Steve]

I'd say housing, electricity, oil, manufacturing are all in the national interest and rise to the level of promote the general welfare as well. why not nationalize those, too?

[Michael Farris]

"Nationalize all Grocery Stores! The State can feed us better than Corporations!"

The supermarket analagy doesn't hold for healthcare: You don't need a license to go to a supermarket or to cook.

Libertarians lose me on healthcare (among other places) because of what I perceive as a basic denial of reality.

Yes, free market solutions could work in healthcare, but only with free market solutions in training and quality control for healthcare providers. There's no free market rationale for the tiny amount of doctors trained every year and the straightjacketing of nurses' responsibilities. There's no free market rationale for almost any part of doctor or nurse training or subsequent practice.

In other words, freeing up the market on the consumer side of healthcare won't work unless the producer side is also freed up. The chances of that happening are approximately close to less than zero, so let's move back to the real world.

[Robert Speirs]

People go to doctors far too much as it is and rely far too much on a semi-socialized health care system that makes people sick as much as it cures them. Just think of the "disorders" that have been added to the medical sphere in the last thirty years. That said, I agree that corporations have far too much power. Let's abolish the idea of incorporation itself, which is only a way of spreading risk to people who didn't incur it by limiting the personal liability of those who will get the benefit of the business. Somehow, I don't think the "lefties" will like that, but it makes sense. Also, for single 25-year olds to pay huge health insurance costs, or have their employers pay them, is simply another transfer of wealth to those who don't take care of their bodies or their finances properly. The free market in health care WOULD work, if it were ever given a chance.

[Dianne]

Am I correct that a good Libertarian would
disagree with the Republicans at least on the
following: that the solution to the problem
is NOT to take away the rights and freedoms
of those with limitted resources to pursue
redress of injury in the court system?

I once heard the Libertarian author of "The
Bell Curve", whose name escapes me at the
moment, assert that instead of having
government regulations on consumer products,
including inspections of the food supply,
the correct approach to redress any injuries
would be the civil courts. IF he correctly
stated the libertarian view (of which I am
by no means certain), then it would be a
contradiction to then attempt to limit the
right to pursue such redress.

[Leonard]

There are two things people are talking about here and they should be kept apart conceptually.

One is wealth transfer. One current function of health care, especially socialized systems like Canada's, is as a means of expropriation and redistribution. Basically the idea is, as Gary would say, that poor people simply can't afford health care - so they need to take money from rich people.

Note that this is a very separate thing from the need for health care, per se. It is about money generally. People want health care, but they also want to pay for rent, food, etc. Money is fungible and will buy anything. The fact that some people are social deadweight is a real problem. But that problem should not be associated with health care or the system for providing it.

The second thing that is being talked about is actually tinkering with the health care system to make it more efficient. Nationalized health care is said to do this by means of the maximum size risk pooling. But libertarian sorts of reforms are also said to do this, by means of market-based competition.

The NYTimes article is, primarily, about the second aspect of health care. Socialized health care is inefficient in certain ways. The problem of "how to cover" people that will not pay for health insurance voluntarily is not the focus of the article.