The Market for Peformance Enhancement

In yesterday's New York Times, bioethicist Carl Elliott suggests that the public has been too quick to condemn baseball players for taking steroids, given how eagerly Americans use all manner of performance-enhancing drugs. Fair enough. As I've said, I really don't understand the fuss about steroids, provided everyone plays by the same rules.

But then Elliott adds, "Perhaps this is the inevitable result of turning our medical system over to the market, where making sick people well is often less profitable than making well people better than well." He talks about letting people buy and sell health products and services as if it were some radical policy experiment, a strange way to look at it, especially since "our medical system" has never been fully socialized. And he does not pause to consider why it is that the areas of health care that are most socialized, most dominated by third-party coverage, and most subject to bureaucratic control—the ones that involve "making sick people well," as opposed to "making well people better than well"—are also the most dysfunctional.

Comments

[James Anderson Merritt]

Jacob says, "And he does not pause to consider why it is that the areas of health care that are most socialized, most dominated by third-party coverage, and most subject to bureaucratic control?the ones that involve 'making sick people well,' as opposed to 'making well people better than well'?are also the most dysfunctional."

If you like that kind of tunnel vision, then you owe it to yourself to check out the Commonwealth Club of California's recent panel discussion on "American Health Care in Crisis." The audio is at http://www.commonwealthclub.org/archive/04/04-11healthcrisis-audio.html. You'll get an hour of "profit-driven markets fail to deliver effective, preventive health care, much less excellent health care to most people." I have listened in vain for economically astute explanations for this so-called market failure. Instead, just when it looks like they can't dodge the question any further, the panelists change the subject! Yet, the view that markets are failing in the healthcare arena seems to be on the rise.

In my Libertarian fantasies, I would love to see a counter-panel, including people like Thomas Szasz, Jacob Sullum, Mary Ruwart, and a few others, go after the allegations made in the Commonwealth Club discussion, point by point, and refute them. We Libertarians need that kind of source material to inform our own discussions with friends, family, and neighbors, who seem ever more susceptible to the fuzzy propaganda that -- if followed -- will take us down the road to more systemic dysfunction, not less.

And yes, I work in the healthcare field, so I am personally familiar with the distortions caused by regulation and government's direct participation in the sector, not to mention the related distortions that occur when private-sector health carriers and providers seek to fit into the government-influenced environment. The folks on the Commonwealth panel inveighed against greedy, for-profit healthcare companies, but they actively avoided talking talk about why non-profits seem to become more and more like the so-called greedy villains with the passage of time; the panelists dodged the direct question when it was put to them!

I had to switch off the program when they, conceding that government-based solutions to the healthcare crisis probably "wouldn't fly" with politicians and voters, instead proposed a sort of "Federal Reserve Bank" setup for healthcare -- openly admitting that this was an end-run around resistance to government participation in the sector, just as the Fed itself had been an end-run around strong resistance to a government- run central bank.

Astounding. Simply astounding.

[Pavel]

"Making sick people well," as opposed to "making well people better than well" seems like a completely fabricated distinction at this point.

The only acceptable way to get "better than well" is to this of some condition completely commensurable with wellness as a disease. I'm not sure how much longer the lie can possibly progress, even among the thickest drug policy wonks.

Until then we'll just have to agree that we have Andropause, fibromyalgia and social anxiety disorder.

[Lowdog]

I wonder what is wrong with being better than well?? We, as a species, have been trying to attain better than wellness since we first started walking, if not before. Wait, isn't that evolution of a sort? Being better than well?

Someone mentioned collective guilt about being wealthy in one of the "fat police" threads, and now we have folks feeling guilty for being healthy.

It all goes hand in hand, though, doesn't it? A lot of guilt, and wanting other people to pay for it instead of dealing with their own insecurities and taking some fucking responsibility for their own actions.

[Ironchef]

Blame Bush.
If that doesn't stick,
Blame the free market.

[BladeDoc]

I know this is off the main point of the discussion but the reason I can see to object to the free market take on steroid use is that they have significant side effects -- brain and liver tumors, early heart disease, and etc. If you allow unrestricted use of these drugs you would essentially "force" people to use them if they wanted to stay competitive. Yes, I realize they would have a choice whether or not to take the risk of these side effects but the choice may boil down to "take these drugs and be a pro athelete or don't and sell insurance" as opposed to "take these drugs and be a Hall-of-Famer or don't and be just a pro athelete" as it seems to be now. Personally I don't care but I can see the argument.

[James Anderson Merritt]

BladeDoc says, "If you allow unrestricted use of these drugs you would essentially 'force' people to use them if they wanted to stay competitive. Yes, I realize they would have a choice whether or not to take the risk of these side effects but the choice may boil down to 'take these drugs and be a pro athelete or don't and sell insurance'..."

We haven't banned professional boxing yet (and the voluntary audience is far from abandoning it), so there is certainly precedence for a sport, in which mere participation entails great bodily abuse. If physical abuse is OK, why not chemical?