Philip Klein and my former colleague Greg Conko have
a new paper out making the case against the current batch of health-care reform proposals.
The criticisms of liberal reforms are sharp, but what really makes the paper worthwhile are two aspects. The first is that, contrary to
the president's accusation that those who oppose reform have no solutions of their own, they actually propose and detail a number of useful, specific reforms, including some that tend to get less attention, like curbing regulations on medical devices and new drugs that artificially increase scarcity (and, as a result, drive up costs).
The second is that they fully recognize that the current health-care system is a disaster, and that the reforms they propose wouldn't necessarily ensure that those with chronic preexisting conditions have access to health insurance. But, they say, the current patchwork of ill-thought-out government regulations of the health care market is so problematic—and, in fact, exacerbates our health care problems so much—that it must be fixed before addressing the few remaining problem cases.
It's too easy for reform skeptics to simply point out flaws and implicitly defend the status quo; Klein and Conko deserve credit for refusing to do so.
If I have a quibble with the paper, it's the suggestion that we cap punitive damages in medical malpractice cases. No doubt, there are excessive malpractice awards given out on occasion—they refer to these as "jackpots"—but I'm not convinced that the resulting savings from caps would be significant, and I think we ought to err on the side of giving wronged patients every opportunity for legal recourse.
That said, Conko and Klein have done some solid, capable work. More than that, they've proven, once again, that anyone who buys the president's argument that opponents of liberal reform don't have anything to offer just isn't listening.
“I think we ought to err on the side of giving wronged patients every opportunity for legal recourse.”
Makes sense, given that all payouts for medical malpractice come from the magical unicorn’s money tree.
But, they say, the current patchwork of ill-thought-out government regulations of the health care market is so problematic-and, in fact, exacerbates our health care problems-that it must be fixed before addressing the few remaining problem cases.
Yes. The problem with the health care system at the moment isn’t the inability to of poor people to get it. It is the cost escalation – caused by our efforts to ensure “universal” coverage that is making it unaffordable for everyone else.
The problem with attempting to make health care “universal” is that it essentially implies unlimited service to everyone. It implies you’ll never deny anyone anything, and in a world of finite resources, that is destined to result in skyrocketing prices.
Right now, the left is still pushing for that infinite, unlimited, universal, everything-is-covered, health care for all fantasy, while the rest of society is feeling the pain of the cost escalation. The middle class is not crying out for more free health care for the poor, they are screaming for relief from the skyrocketing prices.
and that the reforms they propose wouldn’t necessarily ensure that those with chronic preexisting conditions have access to health insurance. But, they say, the current patchwork of ill-thought-out government regulations of the health care market is so problematic-and, in fact, exacerbates our health care problems-that it must be fixed before addressing the few remaining problem cases.
So basically, fuck those people who have illnesses they can’t afford to pay for. They are just “a few problem cases” anyway.
Those people are one of the main reasons why American’s want to reform the system to begin with. At any given moment, if I don’t have insurance for whatever reason (lost job, can’t afford it) and I get diagnosed with a serious illness, I am fucked.
If I have a quibble with the paper, it’s the suggestion that we cap punitive damages in medical malpractice cases. No doubt, there are excessive malpractice awards given out on occasion-they refer to these as “jackpots”-but I’m not convinced that the resulting savings from caps would be significant
Insurance companies have to insure against all damages and charge for that risk….jackpots are a real risk and Doctors who work in jackpot prone fields must have the volume of work so they can pay those high premiums…doctors who don;t don’t have practices…this lowers the amount of competition and jacks up prices….you need to drop your quibble.
Tort reform will lower medical costs.
The problem with the health care system at the moment isn’t the inability to of poor people to get it. It is the cost escalation – caused by our efforts to ensure “universal” coverage that is making it unaffordable for everyone else.
And yet every other industrialized nation offers universal coverage at 40-60% less cost per capita.
Per OECD Data:
Total spending on health care, per person, 2007
United States: $7290
Norway: $4,763
Switzerland: $4,417
Luxembourg: $4,162
Canada: $3895
Austria: $3,761
France: $3,601
Germany: $3,588
Netherlands: $3,527
Belgium: $3,462
United Kingdom: $2992
Italy: $2686
Spain: $2671
Japan: $2581 (2006)
Peter: Conko and Klein write:
Few would suggest that injured patients be denied the opportunity to recover damages awards equal to the cost of their physical, mental, and economic injuries. But a surprisingly large amount of some malpractice awards is comprised of punitive damages, intended not to compensate the patient for injuries, but to punish medical providers for their negligence and deter future negligent acts by those providers and others. Although
the existence of punitive damage awards arguably does play an important role in improving the quality of health care services,
excessive punitive damage awards needlessly raise costs and incentivize health care providers to deliver unnecessary treatment.
At the margin, capping punitive damages may help in the broader effort to rein in health care costs.
I think that Conko and Klein are right in this case. If people harmed are fully compensated for their damages, then punitive damages amount to a very inefficient way to encourage other practitioners to avoid negligence. And trial lawyers just LOVE punitive damages!
So basically, fuck those people who have illnesses they can’t afford to pay for. They are just “a few problem cases” anyway.
We already have Medicare and Medicaid, either of which could be expanded to cover extreme cases that go outside conventional insurance. Most of us can agree on having an insurer of last resort for the outlier cases. Let’s just agree that it’s the guvmint in this case.
Unfortunately, that’s not what’s on the table. Obama’s proposals aren’t for the poor or outliers, it’s intended for everyone.
Can we stop the lie that it’s all about the poor now?
At any given moment, if I don’t have insurance for whatever reason (lost job, can’t afford it) and I get diagnosed with a serious illness, I am fucked.
We will all die and we are all fucked….free markets tend to extend the time we have and are far more efficient at allocating resources for the best results for the greatest number of people. Furthermore it is morally superior to put the responsibility of an individuals health on one’s own self.
Why should I be mandated to suffer because of your genes, eating habits or free base jumping hobby?
“So basically, fuck those people who have illnesses they can’t afford to pay for. They are just “a few problem cases” anyway.”
No Tom. Read the paper and stop assuming what it says. That passage goes on to read:
“But, if we reform the existing maze of federal and state regulation, we will then be able to address the problem of the truly chronically uninsured. Because they are a fraction of the 46 million individuals who now lack insurance or government health coverage, we would be able to create targeted programs to help subsidize their health insurance costs without breaking the bank and without distorting the rest of the health care and health insurance markets.”
If you make the system more responsive and stop letting the lawyers suck off the tit, you will then have the money to cover the people who truly need it. I don’t see why you couldn’t do the eight things these guys suggest and then set up a government run insurance plan that covers the most uninsurable at a loss.
Check out this POS article
“The latest proposal: a bipartisan compromise that Sen. Max Baucus, D-Mont., a moderate who heads the influential Finance Committee, was trying to broker…
…Just as auto coverage is now mandatory in most states, Baucus would a require that all Americans get health insurance once the system is overhauled. Penalties for failing to get insurance would start at $750 a year for individuals and $1,500 for families.”
As much as I despise mandatory regulations with fines for non-compliance, at least there is a semi-rational argument for mandatory auto liability insurance: It allows for a victim of someone else’s stupidity to recup personal and property losses when the instigator of the damages might not have the ability to compensate the victim. In this sense, it somewhat follows the libertarian philosophy.
But, exactly HOW does forcing someone to carry insurance on their OWN health make any sense?
There is also a moral hazzard issue. If I will get treatment no matter what, why ever buy insurance when I am well?
“But, exactly HOW does forcing someone to carry insurance on their OWN health make any sense?”
It is just a tax on healthy people. A lot of people forgo insurance when they are young and healthy and take the rational chance that they won’t get sick. This provision would keep them from doing that or tax them. Either way, it makes them kick in money to subsidize the treatment of the old and the sick.
I leave it to you to decide if that is such a good idea.
But, exactly HOW does forcing someone to carry insurance on their OWN health make any sense?
You’re looking at this all crabbed, that’s the problem.
What you need is a sweet, sweet corner office and some hella-big bonuses, a few comely assistants and an army of minions to command as you gaze upon your kingdom, being a captain of the health insurance industry.
THEN it will all begin to make sense.
@John: I was being facetious. I perfectly understood THEIR rationale, which you addressed:
And your previous comment is EXACTLY why they are making it mandatory:
JW, where exactly does I gets me onna dese Kingdoms?
TAO, ergo MANDATORY insurance…
no, you’re right, it would be better to build a ‘system’ that would shut down innovation and never give future sufferers of the same conditions the chance to have their conditions cured.
So all those countries that have universal coverage and better outcomes have shut down innovation ?? They don’t do any medical research in those countries?
This argument is a big load of bullshit.
People aren’t dying because of a lack of technology nor is there a shortage of medical research in countries with universal coverage so I don’t know why you keep insisting that somehow universal coverage will lead to a stifling of innovation.
Last I checked, private insurance doesn’t fund research for cures for anything, so I don’t know how your comment is even relevant.
More on limiting punitive damages – I argued some time ago that libertarians should not confuse market outcomes with common law court outcomes (which is not to say that my colleague Peter Suderman is doing that).
From my 2003 column on tort reform, “Ambulance Chasers II“:
… get to the chief objection to my column-daring to suggest that limits be set to the fees charged by trial lawyers. Advocating this is evidently an unconscionable interference with the right of private parties to contract between themselves. Why? Because the civil courts are evidently in some sense “markets.” Burch writes, “In a free market for legal services and claims, sellers and buyers will match themselves based on expected returns.” Or as another reader more succinctly stated in an email to me: “You want to limit the incentives for enterprising attorneys which are freely bargained for in negotiations with plaintiffs who are willing to pay the costs.” And yet another emailed me: “Explain to me how legal fees shouldn’t be set the same way fees for all other professional services in the free market are set; i.e., by agreement between the buyer and the seller?”
Let’s get this clear: Courts are not markets. They are government agencies. Lawyers are freelance bureaucrats. Keep in mind that in civil litigation one of the parties is generally in the courthouse under duress. Voluntary trucking and trading between plaintiff and defendant is not what is going on. The parties are in court often because some trucking or trading between them has already gone awry and they need the strong arm of the state to sort things out.
The only “sellers and buyers” over whom Burch is concerned are the plaintiffs and their lawyers. But they are not the ones paying the costs-defendants who are coerced into court are. In voluntary markets, one person exchanges something with another, say I give my grocer $10 and he gives me some bread, ham and jam. Courts are not in the business of voluntary exchanges; they are in the business of involuntary exchanges.
Burch suggests, “Plaintiff’s lawyers are, in essence, professional evaluators of claims.” Yes, indeed they are, and that’s exactly the problem. The current system of high contingency fees encourages enterprising trial lawyers to push dubious cases through the courts on the off chance that the payoff will be enormous. In other words, they take big risks for potentially big profits. However, whether their gamble pays off or not, we all still get stuck with the costs for such things as the ridiculous proliferation of scientifically tested warning labels, defensive medicine and higher building costs.
Limiting lawyers’ fees would encourage them to evaluate claims more closely and desist from using the civil court system as a kind of lottery…
*pssst* You com’a over hear. I gots lots dese kingdoms a’right hear. What? You no can see dem? You come’a closer….closer….closer….
ChiTom (aka Douchebag): If even more than 5% of the “innovations” were being produced by those lovely socialist states, you might have a stump to stand on.
The fact of the matter is, your lovely socialist states can offer universal coverage for the same reason that they can offer 32 hours work weeks and yummy retirement packages:
WE make it possible!!!
The vast majority of medical innovations come out of our “evil” capitalist system, just as your paradises have a big chunk of their GDP freed up by not defending themselves. They rely on OUR defense spending.
Say what you will about Rand’s stilted writing style, or her philosophy…she was remarkably prescient, wasn’t she?
If you make the system more responsive and stop letting the lawyers suck off the tit, you will then have the money to cover the people who truly need it.
The trial lawyers canard is so fucking tiresome.
Every state that capped jury awards has not seen any significant drop in malpractice premiums.
Spare me the tort reform bullshit. Suing incompetent doctors is not the problem.
I don’t see why you couldn’t do the eight things these guys suggest and then set up a government run insurance plan that covers the most uninsurable at a loss.
Why should the government only get the uninsurable — wouldn’t it make more sense to make the gov’t pool as big as possible to spread risk and try and not run at a loss. Cuz if the gov’t plan is running at a loss, the healthy will still be subsidizing the sick, and they will still have pay again for private insurance.
Tony: Do you happen to have a list of the no doubt myriad drugs and medical devices invented and brought to the bedsides of patients by government agencies since, say 1970, handy?
Because you do not understand that the profit motive drives innovation.
I understand that quite well. It just has nothing to do with universal coverage.
The innovators will still get paid whether the insurance comes from the government or the private sector. This whole stifling innovation argument is ridiculous.
If it were true than there would be no innovation happening in every industrialized nation that offers universal coverage.
Did I say any somewhere? It is certain that socializing health care costs will take the profit motive out of many sectors of innovation, and those sectors will be “shut down”.
No it isn’t certain. Hospitals will still buy new equipment, research will still go on. These things you state as a certainty are nothing of the sort.
That is a tough homework assignment there Ron; as they virtually don’t exist.
Cases are emerging across the UK: The mother of a 13-year-old girl who became partly paralysed after being given a cervical cancer vaccination says social workers have told her the child may be removed if she (the mother) continues to link her condition with the vaccination. A couple had all six of their children removed from their care after they disputed the necessity of an invasive medical test on their eldest daughter. Doctors, who suspected she might have had a blood disease, called for social services to obtain an emergency protection order, although it was subsequently confirmed that she was not suffering from the condition. The parents were still considered unstable, and all their children were taken from them. A single mother whose teenage son is terminally ill and confined to a wheelchair has been told he is to become the subject of a care order after she complained that her local authority’s failure to provide bathroom facilities for him has left her struggling to maintain sanitary standards
ChicagoTom: Indeed, “suing incompetent doctors is not the problem” — it is, however, PART of the problem. BTW, the reason medicine is cheaper in the countries you list can largely be summed up with one short phrase: “price controls.” That’s why Medicare is cheaper too.
In general, imposing price controls eventually ends up producing shortages, but perhaps you can show us that medical care is different.
Instead of putting a cap on punative damages I would think that tort reform should specify losing party pays all legal fees. This would reduce frivolous lawsuits.
Peter,
Thank you for the generally positive comments on my new paper with Phil Klein. I don’t disagree with what you wrote on tort reform per se. But I do think Ron Bailey’s 4:52 comment is right.
As we note in the paper, punitive damage awards do serve a purpose. And, while the “excessive” punitive damage awards (i.e. many multiples of the underlying economic damages) that make headlines tend to be exceptions, not the rule, I simply don’t believe they can be justified in most cases. Thus, I believe capping, rather than eliminating punitive damage awards — there are many different ways in which you could do this, and we don’t state a preference for any particular one — can be justified on principle.
Still, the estimates regarding the contribution of malpractice awards to health care costs are all over the map. Evidence strongly indicates that doctors do practice “defensive medicine” — ordering tests and providing care they believe is unnecessary — in order to protect themselves against malpractice liability. But, it’s not clear how much of this is due to fear of punitive damage awards per se, rather than fear of all malpractice damages. My best guess is that it’s more the latter than the former. Consequently, I suspect the health care cost savings to be had from capping punitive damages would be small, but not zero.
-Greg
Tony – you’re right, but none of the drugs those companies have come up with have increased lifespans AT ALL; right?
The increasing lifespans are all magic fairy dust and glitter.
I’ve a ton of pills in my cabinet that I say cure cancer. Funny how despite how profitable they’d be, I can’t sell a one of them.
WE make it possible!!!
American Exceptionalism — For the Win!
Obviously, it’s because of the USA that Europe enjoys a shorter work week and better vacation time.
The vast majority of medical innovations come out of our “evil” capitalist system, just as your paradises have a big chunk of their GDP freed up by not defending themselves. They rely on OUR defense spending.
Innovation isn’t going to stop because the government is providing insurance rather than WellPoint or Blue Cross — last I checked they aren’t funding medical research. They are paying doctor bills and hospital bills and for equipment, just like a public insurance option would pay for. (Except the public option would probably have exceptions and out of pocket expenses)
Why should the government only get the uninsurable — wouldn’t it make more sense to make the gov’t pool as big as possible to spread risk and try and not run at a loss. Cuz if the gov’t plan is running at a loss, the healthy will still be subsidizing the sick, and they will still have pay again for private insurance.
Because we’re a nation founded with a work ethic and not a handout ethic?
Seriously, you are getting mendacious now. First the poor and outliers don’t have access to health care and that’s an outrage. Now, people offer ideas of how to cover these people and it’s an outrage that we only cover those people?
Really, what is your fucking point? That everyone should be getting a pony, well, just because, and it’s an grave injustice if they don’t?
Its still very, very odd to me that Medicare is 50% of all medical spending in this country, its costs are rising at dramatic rates and its on a path of financial ruin.
Yet this is the model we want to apply to the entire country.
How about Medicare get its funding right, and tamp down on costs WITHOUT simply mandating lower fees, BEFORE we go adopting it as our entire system.
ChiTom:
As a famous politician one uttered: “There you go again!”:
The innovators will soon find another area to go into, as Gov pays a discounted rate for innovation rather than the market rate.
Once again, innovation is NOT coming from countries with univeral coverage, they are “borrowing” from us.
And hospitals WILL NOT purchase new state of the art equipment, as the price will be prohibitive. They will cobble up their existing equipment, and when it is beyond repair, they will replace it with similar technology that just doesn’t have any wear and tear on it.
ChicagoTom: What effect do you think that government price controls on medical care will have on innovation?
In general, imposing price controls eventually ends up producing shortages, but perhaps you can show us that medical care is different.
Ron Bailey,
And what pray tell do insurance companies impose when they negotiate payout rates? Those aren’t price controls? My doctor isn’t allowed to bill me more than the contracted rate.
And don’t give me the “they can opt out” bullshit. When Blue Cross or United Healthcare control more than half the insurance market (and in many cases over 75% of the market) not too many doctors are going to opt-out.
Furthermore, I don’t see too many shortages in places like Japan, Italy, Greece, Switzerland, etc. And they have better outcomes in many instances. The people are happy with health care (happier than people in the USA)
If those systems were so terrible you’d think their people would be agitating for change — but they aren’t.
“Those people are one of the main reasons why American’s want to reform the system to begin with. At any given moment, if I don’t have insurance for whatever reason (lost job, can’t afford it) and I get diagnosed with a serious illness, I am fucked.”
So? I don’t give a shit. It’s called life moron and it comes with big risks and losses.
Then you die.
It kills me that people that make economic decisions every day in their regular lives (like, if this refi saves me $100/mo, I’ll make it up in 2 years, but I only plan to stay 1, so no go) can’t do the math when it comes to government spending/innovation impact.
Ron,
The first flu vaccine was developed by the U.S. military. Today, at the direction and cost of the government, the most current iterations of that vaccine, including one to deal with a new pandemic of H1N1, will be available for every American citizen. Even if the magical market had innovated the vaccine, there is not necessarily any incentive for it to be distributed universally and cheaply. This logic, I think, can be extended to most of healthcare. The problem isn’t that healthcare as a commodity isn’t producing market rewards, the problem is treating healthcare as a commodity at all.
all medical spending in this country, its costs are rising at dramatic rates and its on a path of financial ruin.
Maybe it has something to do with the fact that it’s limited to the oldest people which tend to be the sickest and require the most care?
Allowing people to buy into medicare would bring the per capita costs down.
So? I don’t give a shit. It’s called life moron and it comes with big risks and losses.
Then you die
Well hopefully death finds you first, so I can do a dance on your grave, prick.
Life has risks. There is nothing wrong with mitigating those risks. No one deserves to be ruined financially because life dealt them a shitty hand.
Yes, Tom (aka douchebag): American exceptionalism!
Does that mean that “real Americans” are smarter than the rest of the world? No, it means that our system attracts the best and brightest from around the world, as they can actually be rewarded for their brilliance.
We have 5% of the world’s population. And while it seems “evil” to many that we consume 25% of the World GDP, that is more than offset by the fact that we PRODUCE 50% of the WGDP.
With 5% of the world population, our science community produces more citations (read that scientific innovation) than the rest of the world put together.
Sounds pretty fucking exceptional to me.
Let’s take a hypothetical:
Under a free-market health care system, Insurance Company X, if they are rational, are likely to deny coverage for homeopathic remedies. Let’s say that you tried to make a 5,000 dollar claim for homeopathic remedies. That is 5,000 dollars of capital “saved” from inefficient calculation.
In government-run health care, all it takes is political influence, and homeopathic remedies are considered legit and get that 5,000. Loss of capital due to inefficient allocation: 5K
Over the long run, the market makes more efficient and better choices that spur innovation.
Over the long run, government health care encourages, not development, but political obsequiousness.
Not, they are not.
Listen to Mr. Obama’s report on the health care crisis September 9!
Mr. Obama will give you the answer!
Don’t forget Mr. Obama on September 9!
“So all those countries that have universal coverage and better outcomes”
Pure, unsubstantiated bullshit.
There are more anti-healthcare reform distortions on this thread than a half hour of Sean Hannity.
We do have excellent health care. For people who can afford it and aren’t screwed by insurance. Most people have access to mediocre care. Just because there’s a shiny new MRI machine in a upscale hospital doesn’t make our system the best in the world by a long shot.
Tort reform is a complete distraction. No state that has enacted it has seen an appreciable decrease in healthcare costs.
This:
Is the most honest thing I’ve heard from anti-reformers. The purity of the market is simply more important than people’s access to healthcare. That’s certainly an argument you can make.
ChicagoTom: The fact that the US pays more for health care is an interesting argument. Of course we’re a richer country than most of those on the list, so I’ll bet we also pay more for food, clothing cars, houses, vacations, etc.
Also, we’re spending health care money on illegal aliens, Canadians and others who come here for treatment, lots of elective cosmetic surgery, etc. I don’t think it’s fair that all that counts against our system.
Finally, medical tort reform seems to have been successful in Texas. See here and here.
ChicagoTom – if you think negotiating a price is a price control, then you are “price controlling” every time you bid for something on eBay.
Please stop trying to expand concepts to the point of meaninglessness.
From my column “2005 Medical Care Forever“:
[Harvard University economist Kenneth] Rogoff also observes, “[I]f all countries squeezed profits in the health sector the way Europe and Canada do, there would be much less global innovation in medical technology. Today, the whole world benefits freely from advances in health technology that are driven largely by the allure of the profitable U.S. market. If the United States joins other nations in having more socialized medicine, the current pace of technology improvements might well grind to a halt.”
Which suggests the following thought experiment-what if the United States had nationalized its health care system in 1960? That would be the moral equivalent of freezing (or at least drastically slowing) medical innovation at 1960 levels. The private sector and governments would not now be spending so much more money on health care. There might well have been no organ transplants, no MRIs, no laparoscopic surgery, no cholesterol lowering drugs, hepatitis C vaccine, no in vitro fertilization, no HIV treatments and so forth. Even Canadians and Britons would not be satisfied with receiving the same quality of medical care that they got 45 years ago.
Everybody pays more to obtain improved pharmaceuticals, imaging technologies, cancer therapies, and surgical techniques. The happy result is that average life expectancy has increased by about eight years since 1960.
Tony: Flu vaccine — that was back in 1944. As I asked, anything since 1970? As for “incentive to distribute,” that is called profit.
“Last I checked, private insurance doesn’t fund research for cures for anything, so I don’t know how your comment is even relevant.”
Are you really this stupid. Private insurance pays for medications which are purchased from pharmaceutical companies, which in turn, take a portion that revenue and invest it in research.
Really, you can’t be THAT stupid, can you?
Tony and ChiTom, as Pesci said in “My Cousin Vinny”, “I got no more use for this guy”.
Reasoned arguments have no power against Unicorns and fairy dust.
“And what pray tell do insurance companies impose when they negotiate payout rates? Those aren’t price controls? My doctor isn’t allowed to bill me more than the contracted rate. ”
Man up and die, ChicagoTom. Man up and die.
Ron,
Why would a corporation whose main motivation is profit even invest in flu vaccine at all rather than spend its time selling expensive erectile dysfunction pills or anti-depressants that people have to continually buy? If we want a cure for cancer I’d trust a government agency with the goal of finding a cure for cancer over a corporation whose goal is maximizing its bottom line. Hypothetically speaking, what incentive is there for such a corporation to find a cure rather than just produce drugs that people need to take continually?
My point about NASA is that it’s just false that the government can’t innovate. Innovation is not the sole province of the magical marketplace. And it’s not clear that innovation in the service of a company’s profits is the same thing as innovation in the service of greater access to healthcare, which hasn’t happened yet in this country despite its relatively free healthcare market.
“Well hopefully death finds you first, so I can do a dance on your grave, prick.”
I’ll make certain to provide snacks.
If I have a quibble with the paper, it’s the suggestion that we cap punitive damages in medical malpractice cases.
We should eliminate punitive damages, period.
The purpose of a civil case is restitution, not punishment.
A punitive damage is a fine, and no fine should be imposed without full, criminal due process, for violation of a criminal law.
Punitive damages were originally instituted as a form of social engineering, to try to give defendants “incentives” to not be negligent, etc. Screw that. The purpose, again, of civil justice is restitution, not punishment, not social engineering.
If you want to punish someone, take them to criminal court. If your want social engineering, go find a country that isn’t a constitutional republic of limited state powers.
Every state that capped jury awards has not seen any significant drop in malpractice premiums.
Well, except Texas. That I know of.
“No one deserves to be ruined financially because life dealt them a shitty hand.”
[citation needed]
Plus, if you can’t afford a flu vaccine or otherwise don’t get one, you risk spreading it to other people. That makes it a social problem. You don’t get vaccinated because you are choosing a product among alternatives, you do it because you don’t want to get sick, and you’re likely to choose the CDC-approved vaccine since it’s the only one out there. That is not the normal calculation that drives market innovation.
What effect do you think that government price controls on medical care will have on innovation?
Not a very big one. The profit margins may be less, it wouldn’t be a losing endeavor.
In fact I think innovation could get better.
For example, most drug “innovators” are only studying for patentable solutions. DMSO is a good example. It has a lot of medical uses, but since it’s been around forever, and there is no money (un-patentable) in it for pharma companies, they don’t study it, and without that research, the FDA limits/blocks it’s use.
I would argue that the profit motive is in fact stifling innovation in many instances because the private sector isn’t interested in studying off label uses of existing products.
And if we see innovation stifled (which I doubt will happen) there is always government funding available and research from universities.
I hereby nominate “BeatADeadHorse.com” as the new name for ReasonOnline. How many more times to we need this debate anyway? The Liberals here say Universal Coverage is wonderful – with piles of statistics to back it up – and they would want it even if it weren’t functional. The Libertarians say Universal Coverage is awful – with more piles of statistics to back it up – and wouldn’t want it even if it was functional. And around and around we go.
It’s pretty funny that Tony points to NASA as a bastion of innovation. What’s NASA’s budget every year, Tony? And what was Burt Rutan’s budget for Spaceship One?
Those people are one of the main reasons why American’s want to reform the system to begin with. At any given moment, if I don’t have insurance for whatever reason (lost job, can’t afford it) and I get diagnosed with a serious illness, I am fucked.
Then don’t get employer-based insurance and pay for your own instead. Or get an HSA. Plus, there are all sorts of payment plans that could allow you to keep your insurance over a period of unemployment. You don’t necessarily have to set yourself up to lose your insurance after one month.
“Is the most honest thing I’ve heard from anti-reformers.”
I’m not an anti-reformer you knee-jerk cunt. I am opposed to government run healthcare. Nothing scares me more than turning 65 and being forced on to Medicare.
R C Dean,
Without punitive damages corporations can often make the calculation that breaking a law and paying restitution is simply cheaper than complying with it. That’s what punitive damages are for, and I really don’t see what’s libertarian about opposing them except its traditional habit of defending corporate welfare.
if you think negotiating a price is a price control, then you are “price controlling” every time you bid for something on eBay
If you think that an insurance company that controls a majority of the market setting rates a “negotiation” then I have a bridge to sell you in the Brooklyn area.
When one party has much more power than the other it isn’t really a negotiation.
Tony: NASA? Seriously?
Please, I beg of you, please read Joel Mokyr’s The Gifts of Athena: Historical Origins the Knowledge Economy. See my column on Accelerating Change for a short intro.
ChicagoTom: You are right about insurance company oligopolies. But imposing a government insurance monopoly will only make things worse. The solution is more competition, not less.
ChicagoTom: What effect do you think that government price controls on medical care will have on innovation?
Well, price controls on oil brought the price down so that everyone could afford it, and there was no rationing whatsoever. It was so plentiful that the oil companies soon started paying people to take it.
You are right about insurance company oligopolies. But imposing a government insurance monopoly will only make things worse. The solution is more competition, not less.
I agree Ron, that’s why a PUBLIC OPTION that competes with insurers is necessary — to provide necessary competition and drive insurance prices down.
ChicagoTom, I just want to thank you for shoving it again and again to these knucklehead true-believers who think that every societal problem can be reduced to the economics of a lemonade stand. You really expose them by forcing them back onto their same stupid “ipse dixit canards” over and over.
These Libertards don’t even want to talk about the core issues of American health insurance –the free-riders, the pre-existing conditions, the cherry-picking, and the hair-trigger recissions of coverage that deprive us all of the security and peace of mind in health care protections that every other citizen of the First World takes for granted.
These clowns talk like they all live in log cabins that they built will trees that they cut down with axes that they forged with iron that they dug out of the ground and smelted. Interdependence defines modern life, and I have no more fear of government health care than I have of government subways, government colleges or government building inspectors. With an elected government, whatever is lost in market checks can be made up in democratic checks. And anybody who thinks most of us are going to have an qualms about “enslaving” our fellow taxpayers to get an orderly, coherent and transparent national risk pool for health insurance, is bound for further disappointments real soon.
Elections have consequences. We won. You lost. Bend over.
Maybe it has something to do with the fact that it’s limited to the oldest people which tend to be the sickest and require the most care?
Allowing people to buy into medicare would bring the per capita costs down.
Are you a complete moron? You are ALREADY buying into Medicare, it’s right there on your pay stub. They are called “payroll taxes”, idiot.
We are all, ALREADY, being forced to subsidize Medicare costs for the elderly at a rate of 2.9%. What you are asking for is for Medicare is to start paying for more than just the elderly. Which would inevitably make the tax burden rise substantially.
I can’t see how guarenteeing free medical care to more people is going to bring down “per capita” costs either.
These clowns talk like they all live in log cabins that they built will trees that they cut down with axes that they forged with iron that they dug out of the ground and smelted.
Prove that I didn’t.
Or rather, that I don’t.
My point about NASA is that it’s just false that the government can’t innovate. Innovation is not the sole province of the magical marketplace.
NASA has not done any significant innovating in over 40 years.
They have rules in place today that effectively prohibit them from flying any technology that isn’t at least 10 years out of date.
The most significant recent innovations in the space industry have come from private sources – Spaceship One, satellite radio and telephones.
Moreover, the space industry has been burdened for 40 years with expensive inefficient technology precisely because the government didn’t care about costs when it was trying to get to the moon. So we have a technological legacy established that is now difficult to overcome. If the commercialization of space is ever to occur, private industry is going to have to redesign everything to make it cheaper to build and operate. But right now transition costs make that difficult, so we’re stuck on a cost plateau. If anything, the government has hampered the space industry by giving us this technological legacy.
Well, price controls on oil brought the price down so that everyone could afford it, and there was no rationing whatsoever. It was so plentiful that the oil companies soon started paying people to take it
We all know the refineries already have price controls over oil. They are to POWERFUL!! Simply shifting price controls from refineries to government will not effect prices.
So they’ll start producing a vaccine as soon as it’s expensive enough to be profitable? Fantabulous. You don’t see why free market dogmatism isn’t appealing to more people?
Meanwhile, the magical omniscient government knows in advance which vaccines are going to be in demand in the future, while no private company could ever predict such things.
Fuck!!
That last post was wrong…Lets try it again :
Pathetic that losers have to spoof in order to attack anyone who deviates from your pathetic dogma.
Losers
What you are asking for is for Medicare is to start paying for more than just the elderly. Which would inevitably make the tax burden rise substantially.
I’d be happy to pay more in taxes to get insurance that covers me even if I were to lose my job or start my own business. And my salary would go up since my employer no longer has to pay for health insurance.
I think it would be a net positive.
Elections have consequences. We won. You lost. Bend over.
This guy isn’t serious, right? Its so hard to tell the difference between good satire and the real thing these days.
WHAAAAAA!!!!
Satire of my ideas is not fair.
I’m as serious as a heart attack Brian.
If I have to deal with a pointy-headed bureaucrat rationing my health care, I at least want to be able to fire him at the ballot box. The government can’t screw this field up much worse than the corporations, at this point. And even if it can, I want to see it, just out of morbid curiousity.
Now, with a rubber, or without?
Proposals are grand, but without good sources for research demonstrating that government solutions are worse, we are selling the same opinion-heavy snake oil that the public option folk are. The pragmatic argument is easier to make than the philosophical one, but only if you can find the facts.
I have repeatedly looked for sources on the inefficiency/inefficacy of government solutions as compared to public solutions to no avail. The straws of opinion make the needles of fact effectively impossible to find.
Any chance that Reason might create a section with a clearinghouse of sourceable facts?
Dan,
Ok, thank god you’re joking. That is wasn’t immediately obvious is a testament to how crazy some people have gotten.
The idea of firing a bureaucrat is absolutely priceless. I’ll be chuckling at that for a while.
Or once a drug is profitable the company making it will fight tooth and nail against anyone else who tries to produce it. It can go both ways.
Without punitive damages corporations can often make the calculation that breaking a law and paying restitution is simply cheaper than complying with it. That’s what punitive damages are for, and I really don’t see what’s libertarian about opposing them except its traditional habit of defending corporate welfare.
You misunderstand, Tony. I’ve got absolutely no problem with levying fines on corporations or anyone else who breaks the law.
I’ve got a real problem with taking the civil justice system, designed for restitution under relaxed due process, and turning into a quasi-criminal lottery that pays off bounty hunters on an ad hoc basis.
If I have to deal with a pointy-headed bureaucrat rationing my health care, I at least want to be able to fire him at the ballot box.
I’m convinced Dan is performance art. Unless he gets a different ballot than I do, because I’ve never seen a line on my ballot that says “Vote to fire pointy-headed bureaucrat”.
We are firing thousands of bureaucrats even as we speak. California is trying to delay the inevitable with furloughs, but that is futile. The tiniest state, Rhode Island, is poised to fire 1,0000 workers.
Anyway, I have a better chance — however small — of getting a government employee fired than of getting a corporate executive fired. I have one vote in government, but none at Blue Cross.
Shorter Dan: “I have a right to the village, and the village is goin to pay for this idiot.”
Why not just pay more directly to an insurance company that provides that? Detaching insurance from employment is something a lot of people are in favor of.
IIRC, that was the main goal of HIPAA: to extricate policies from employers if an employee changed or lost a job. Instead, it was bastardized into (massive) privacy prection rackets.
“protection” = H1NoSpell fail.
Which is part of the reason you won’t see government getting out of the way anytime soon. Even without cronies in D.C. there are plenty of things that large companies can do to stifle and eliminate competition. The Anaconda copper mine and Standard Oil are two great examples.
Well, a big obstacle is the fact that people get to pay pre-tax income for healthcare if they get it through their employer. They should make a tax credit/deduction for all health care costs people incur, including insurance costs. That way private, non employer provided insurance would be on a level playing field.
Nice try Dan. You are pretty good but not good enough. If you had left off the bend over part of your first post, you would have fooled me. Still, I applaud your attempted performance.
Rimfax: Do I ever hear you! The problem is that there are not even close to free market examples of health care systems in developed countries. Of course, advocates of government solutions will say that’s because none would work and therefore all have evolved in direction of ever greater government control.
Advocates of freer market medicine (like me) would reply that what has actually happened is that government began intervening long ago and continues to intervene each time the unintended negative consequences of its previous interventions manifest themselves and so on arriving at the dysfunctional over-regulated third party system we suffer under today. Free markets were never tried.
I have been involved in reporting on health care for nearly a decade now and the fact is that research on health care economics is so thoroughly politicized that I despair at ever finding any “objective” research on the issue.
That being said, we do know for a fact that competitive markets in other areas of our economy lower costs and improve products and services – so why wouldn’t that be the case in medical care?
ChicagoTom: About those “per capita costs” see Regina Herzlinger and Robert Book’s column on Medicare’s alleged lower overhead:
Medicare’s cost advantages are dubious in other ways. Advocates assert that Medicare’s administrative costs are 3 percent (or 6 – 8 percent with support from other government agencies included), compared to 14 to 22 percent for private employer-sponsored health insurance (depending on the study cited), or even more for individually purchased insurance. On a per-person basis, however, Medicare’s administrative costs are higher than those of private insurance, although private plans have additional administrative expenses, such as state premium taxes, marketing, and returns for stockholders. Medicare administrative expenses appear lower as a percentage of total costs only because enrollees need, on average, more health care services than those privately insured. Expressing them as a percentage makes Medicare’s administrative costs appear lower because they are spread over a larger base of health care costs. To be sure, the average general and administrative expenses of US private insurers are far higher than those in Switzerland, where expenses average 5%; but the public plan is even worse.
“Prove that they don’t then. What you really mean is that nobody values a trip to the moon enough to pay for it. You of course have no problem spending other peoples’ money on it. If somebody values pictures of distant galaxies enough, they can fund a venture to launch a satellite to take said pictures; there are plenty of private satellites in space.”
There are a great number of things that we will not pay for individually, because of free-riders, that we will pay for collectively, because of shared benefits. No one is going to pay individually to build a road that everyone else can drive on for free. Ditto for the gains from space research. The benefits are long-term and widely diffuse. Again, your lemonade-stand economics just don’t apply.
Once upon a time, only the super rich had computers. Yet, somehow, they are cheap and ubiquitous today.
And vastly more powerful, I neglected to add.
Once upon a time, only the super rich had computers. Yet, somehow, they are cheap and ubiquitous today.
We all know it was the vast talent of government employees that accomplished that.
If I have a quibble with the paper, it’s the suggestion that we cap punitive damages in medical malpractice cases. No doubt, there are excessive malpractice awards given out on occasion-they refer to these as “jackpots”-but I’m not convinced that the resulting savings from caps would be significant, and I think we ought to err on the side of giving wronged patients every opportunity for legal recourse.
Just because the Doctor no longer pays $100,000+ per year in Malpractice insurance DOES NOT mean that the Doctors Fee will go down.
Interesting Factoid regarding innovation:
VIAGRA was originally designed and tested as a blood thinner to help prevent strokes…
It was dumb luck that they hit the JACKPOT as a male enhancement drug.
Does anything exist that’s good for its own sake beyond any consideration of profit it provides?
You are a fucking idiot.
People don’t spend their own private money and time and talent on things they enjoy or out of curiosity or in pursuit of knowledge…only government does?
Go kill yourself moron.
What I don’t understand is why you people find this world appealing at all. Should we leave all of science up to market calculations?
no we should definitely leave them up to bully democratic calculations.
Dan & Tony: Well, at least some studies don’t find much in the way of government R&D spillovers. I cite a couple of recent OECD studies to that effect in my column The Failure of Centralized Scientific Planning:
The issue is complicated, but what evidence is available is damning. In particular, Kealey cites a 2003 Organization for Economic Cooperation and Development (OECD) report, The Sources of Economic Growth, which finds “a marked positive effect of business-sector R&D, while the analysis could find no clear-cut relationship between public R&D activities and growth, at least in the short term.” This finding mirrored a 2001 OECD working paper which showed that higher spending by industry on R&D correlates well with higher economic growth rates. In contrast to the academic truisms about the need for federal funding, the study found that “business-performed R&D…drives the positive association between total R&D intensity and output growth.” The OECD researchers noted that publicly funded defense research crowded out private research, “while civilian public research is neutral with respect to business-performed R&D.”
In other words, government funded civilian research didn’t appear to hurt the private sector but there was not much evidence that it helped, at least in the short term. The report concluded, “Research and development (R&D) activities undertaken by the business sector seem to have high social returns, while no clear-cut relationship could be established between non-business-oriented R&D activities and growth.” Economic growth associated with R&D was linked almost entirely to private sector research funding. The OECD report did allow that perhaps publicly funded research might eventually result in long-term technology spillovers, but that contention was hard to evaluate. The 2003 OECD study also noted, “Taken at face value they suggest publicly-performed R&D crowds out resources that could be alternatively used by the private sector, including private R&D.”
A 1995 analysis done by American University economist Walter Parker also finds that government funding crowds out private research. “Once private research is explicitly controlled for, the direct effect of public research is weakly negative, as might be the case if public research has crowding-out effects which adversely affect private output growth,” concludes Parker. Weakly negative? Government funding may retard technological progress? Is it possible that the funding for NASA has crowded out private space transport research and development? Or more currently, that private companies are not investing in carbon capture and sequestration research as a way to mitigate man-made global warming because they are waiting for the federal government to fund such research?
If you’re interested, click through to the studies themselves.
“I have one vote in government, but none at Blue Cross.”
Buy some shares and you’ll have lots of votes.
Tony: Flu vaccine — that was back in 1944. As I asked, anything since 1970? As for “incentive to distribute,” that is called profit.
Ron, are you arguing that since 1970, NIH funding had not led to any new drugs or medical devices?
Wow, Tony’s sockpuppet master sure has some time on his hands this afternoon/evening.
“They’re innovating because of prior innovations made by NASA”
I credit the inventor of the wheel. Or maybe fire even.
Single Payer is the way to go.
The REST of the world is doing it.
The ONLY disadvantage is concerning Single Payer is the LOSS of many many jobs…But, they’ll have healthcare coverage.
“Just because the Doctor no longer pays $100,000+ per year in Malpractice insurance DOES NOT mean that the Doctors Fee will go down.”
You’re right Alice, their prices will only go down if there is actual competition as well. If doctors aren’t actually competing for customers than there’s no real need for them to lower their prices.
Anyway………. After reading most all this thread… I have to say, I think SusanM said one thing I have to quibble with:
I think she said that the leftists cite statistics proving their case.
Really? When?
Tony has never ONCE in my entire experience dealing with him provided a link to anything. Not ever.
ChiTom isn’t as consistently retarded as Tony, but he certainly doesn’t have much data to back up his positions here… Believing that Europe is getting better quality care or is in any way cheaper without the massive subsidies the US provides directly from paying higher health care prices, from US military protection & from US medical innovation requires jamming your head straight up your ass pretty far.
Tony: No, I am not arguing “NIH funding had not led to any new drugs or medical devices” but I will point out that NIH has never made so much as a pill for a patient.
Now back to my original question, please.
You’re right Alice, their prices will only go down if there is actual competition as well. If doctors aren’t actually competing for customers than there’s no real need for them to lower their prices.
Why would it go down?
Because someone can charge just a little less and get more customers, thus, more total profits. And then someone else decides to charge just a little less than the first person, etc.
alice, your lemming attitude will be the death of this country.
The whole point behind social insurance is to make risk diffuse. All pay a little so that nobody is forced to go bankrupt for something beyond their control. It can be done and therefore it should, in my opinion, and we should thank God or the market or whatever you worship that we live in a time where such a thing is possible and your access to life, liberty, and the pursuit of happiness is not dependent on the happenstances of your health.
Very well Said Tony.
Too bad that we live in a World were sloagans like:
“SAY NO TO HEALTHCARE”
and
“LET’s Give WAR a Change”
and
“Healthcare is Not a right…if u got cancer and can’t pay for it…then go DROP dead”
are in fashion.
Advocates of freer market medicine (like me)
You would abolish Medicaid, Medicare, licensing restrictions, subsidies to medical education, prescription-only access, drug scheduling, immigration restrictions on medical professionals, trade restrictions on drugs and medical equipment, government ownership of hospitals & medical centers & schools, HMOs, insurance boards, disparate tax treatment of health insurance, and FDA approval for drugs & medical equipment?
I would, of course, but I’m wondering if you understand just how deep this rabbit hole goes.
alice screw you. name the person you want to work for your well being. name that person. is it me? your neighbor? who?
Tony: It’s been said before, but here goes again — food and shelter are also things to which people have to have access to live and live well. All the evidence points to the plain fact that markets provide much better and more food and shelter than do governments,e.g., see the Cabrini-Green Projects in Chicago for an excellent example of government supplied housing. Let’s try markets for health care instead of government monopolies.
I agree with Peter Suderman: The paper is excellent.
However, I too have a quibble. After reading a paragraph in the Executive Summary regarding the maze of state and federal regulations that restrict who may provide medical services and who may sell and provide medical devices, I was hopeful that the authors would examine the horrors of licensing and its burdens on the system.
Nope. Sure, they note that state licensing laws do drive up costs by requiring physicians to supervise physician assistants in the delivery of routine services. They did acknowledge that the AMA has worked to limit the number of medical school slots open. But they barely scratched the surface.
Licensing of health care occupations has been a colossal disaster. The elimination of licensure for health care occupations would yield tremendous downward pressure on health care costs. In addition, the quality of health care would dramatically improve.
Joe, I have many Doctor friends here in NYC.
NONE OF THEM TAKE INSURANCE. And, there is NO Shortage of Patients willing to pay them in cash or with a credit card. My Psych doctor friends charges $600 for the initial evaluation and $450 for 45min of therapy.
Yes, people can go to a collection of doctors in NYC that take insurance and charge less.
Don’t think for one minute that they will lower their fees.
Remember, no matter what we do, public option, single payer, free market insurance with no gov restrictions, or leave the system the way it is…WE WILL ALWAYS have a MULTI-TIER system were the wealthy will PAY and the BEST DOCTORS that offer the BEST service WILL ALWAYS choose to service them.
joshua:
i would absolutely abolish those things. that does not mean they go away, but that they are replaced.
Joshua-
What you describe is not a rabbit’s hole. Its an awesome thing. Its better than a Thorton Mellon party.
ransom147 … you’re just a mean-spirited selfish person and a subscriber to Ronald Reagan’s ‘Rugged Individualism’.
Joshua Holmes: Yes. I do understand how deep this rabbit hole goes. See my column “Markets, Not Mandates” and my earlier (and somewhat flawed) article “Mandatory Health Insurance Now!”
The basic idea is to unravel the entire third party payor system and take all Medicaid, Medicare, and SCHIP funds and hand them out as vouchers for people to buy private health insurance.
Ron,
I don’t see how public housing–whatever its problems–interferes with the marketplace for people who can afford their own housing. Are the problems with public housing caused by its relationship with government, or because of its relationship with poverty? Would those problems go away if we simply sent those people to the streets instead?
alice: you’re correct. we will always have multi tier systems. so what’s your point? you want to drag the majority down rather than strive to bring the minority up.
Tony: You ask: Are the problems with public housing caused by its relationship with government, or because of its relationship with poverty?
Answer: Its relationship with government.
Alice, who pays the doctors bills for the most part?
Do you shop around for doctors to find the best price? Does anyone?
Ostensibly your insurance provider might do that… But in general it doesn’t work like that at all – instead it functions like a cartel where there are a few hundred members in the “network”, who all get paid the same. The doctors aren’t competing for your business, they aren’t really even competing for quality. They’re just *there*. You pick one, and your insurance (or government if that’s your deal) pays them whatever they charge.
If the bulk of your medical treatment was paid out of pocket, they would be competing for price. I know this gets used a lot – but again; see prices charged for the very few non-insurance or gov’t paid procedures like Lasik or various cosmetic or “alternative” treatments.
They all compete for price and price comes down – because profit margins move towards equilibrium. You know Alice – I once wrote out a nice little explanatory model about this… You might find reading it valuable: A tale of two burgers… Yes, the subject is silly, but it may help you understand this stuff a bit better. Also I’d recommend How an Economy Works (and why it doesn’t) by Erwin Schiff.
Ramson147,
“There you go again ” with the Reagan quotes.
“You can’t help the weak by punishing the strong”
You would not be punishing the strong by merely asking them to contribute to public healthcare…especially contagious diseases.
I’m OK with a multi-tier system. I do believe in free markets.
I’ve debated this issues with people here. And I keep changing my opinion a lot.
However, lately, i just think that the only thing that would work is a Single Payer…FOR healthcare and pension ONLY. We can have a free market for everything else.
It’s easy for charities to have soup kitchens and tents for the homeless. You can’t expect charities to carry the burden of the poor (and those that become poor due to high med bills). It cost too much.
Sean,
we talk a lot about this. And you are right about the following:
If the bulk of your medical treatment was paid out of pocket, they would be competing for price. I know this gets used a lot – but again; see prices charged for the very few non-insurance or gov’t paid procedures like Lasik or various cosmetic or “alternative” treatments.
With out a doubt. If we had NO insurance and we did pay out of pocket then this would be true.
However, for good or for bad, we are here now…and I doubt that we can make such a revolutionary change.
Going with my route with single payer system: many people loose their jobs…but they will be covered by the national plan.
Going your route by eliminating insurance and making people compete with the people that WILL pay: many people (i think) will die.
I wish we can meet somewhere in the middle somewhere.
That’s a great article Sean.
I’m so glad we didn’t have a third-party payer for my BigMac.
Sean:
search costs!?! the audacity! we’re talkin bout life or death not quality and thrift!
[Health Care]’s something people have to have access to in order to live and live well,…
So is food, yet a relatively free market provides us with that. How is it any different? Do we need a single payer system for food? Perhaps we need to nationalize the farms.
Alice:
“Going your route by eliminating insurance”
I didn’t say that. I’m talking about mobilizing productive forces to the extent that insurance is only there for truly catastrophic problems and everything else can be paid out of pocket – but that requires a cadre of reforms, as often expressed on this website.
Sean Malone-
I took up the offer you made to Alice.
And…
Love your hamburger piece and promise to check out your blog. Do you have room for anarcho-free enterprise-individualists?
Also, kudos for citing and linking to Irwin Schiff. Better watch out, Brandybuck is going to call you a wingnut for citing Schiff.
Alice: it only costs too much because we subsidize it silly.
Hey Ron – this isn’t intended to be a threadjack, but if you’re still here, my roommate is working on a ridiculous documentary (as an editor, not producing it… he’s not a fan actually) about some asinine anti-GE crops thing. I don’t know all the details but it makes the claim, as they often do, that the food we eat is evil and would be way better if we all went 100% organic, blah blah blah… But he was wondering how many acres/square meters, etc. it would take an individual to be entirely self-sustaining.
That is, how many acres would it take me to feed myself for a year if I grew all my own fruits & vegetables and raised my own livestock. Do you know?
Schiff for Senate, the younger that is…
I am probably a “wingnut”, assuming there’s a “wing” I actually belonged to. I’m not sure which that would be – is there a pro-freedom “wing” somewhere?
You would not be punishing the strong by merely asking them to contribute to public healthcare…
Alice, thank you for comparing my thought to mr. reagan, despite his faults it is truly a compliment.
beyond that, you are incorrect. first, we are already punishing the strong in this country and to tax them further could have disastrous consequences. further i despise the notion that the wealthy owe a debt to the poor.
so please answer my question, who would you rob to pay for your well being?
*points gunflashes badge at ransom*
IRS. Gimme.
that’s the ticket Sean.
Why is Ron Bailey talking to trolls?
“I wonder what percentage of Americans who believe this arrived at the conclusion because their own health care sucks or because they’ve heard stories about how health care sucks. Frankly I don’t know anybody whose health care is broken.”
I agree and will take it even further. I spent years working with the homeless. By any measure, they received adequate health care.
There are free health care clinics in every major city. I know a guy who got a free circumcision just because he wanted to impress a tranny he had a crush on. The real world is fascinating..
Frankly, the whole “helping the poor” healthcare claim is BS.
PS I am listening to Obama’s speech right now and any health care insurance company Board of Directors that doesn’t move to liquidate its assets tomorrow is setting itself up for a shareholders law suit down the road.
The insurance companies are evil; we shall give them more customers.
“Very well Said Tony.”
I just shit my deacades dead great grandmother.
decades
Schiff the elder is a genuine american hero.
All The President’s Czars | September 9, 2009, 8:40pm | #
Why is Ron Bailey talking to trolls?
Slumming?
no argument from me Liberty Mike
Just to address a point brought up a bit earlier, re: NASA putting a man on the moon: much of the basic science that led to that achievement was done at RAND, back when RAND was still wholly a part of McDonnell-Douglas. Evil, society-destroying capitalism strikes again, I guess.
They don’t do any medical research in those countries?
Not really. Go do some actual research. The US accounts for a huge chunk of medical innovation (from drugs to devices to practices, etc.). I wouldn’t be surprised if it wasn’t 60%.
We don’t spend 60% of worldwide expenditures on health care. Every single one of those systems is a free rider in some way.
“I am not the first President to take up this cause, but I am determined to be the last.”
I wonder how many guns and how much ammo Obama sold with that line.
Who could have foreseen that two “scholars” who work for the Competitive Enterprise Institute would come to this stunning conclusion. I’m sure it was disinterested research all the way, just following the data where it led (of course knowing that any other result reported would mean the loss of their fucking jobs)!
This is the kind of work that if submitted to a top notch academic/research journal with blind peer review would not qualify as fucking toilet paper.
Sean W. Malone: Now I don’t just do this for everybody (I have to spend a lot of time explaining markets and economics to trolls after all), but with regard to your room-mate’s question how about this:
450 pounds of corn provide enough calories to feed one person for one year (or fill a 25 gallon gas tank). A bushel of corn weighs 70 pounds, so 450 pounds is about 6.5 bushels of corn. In 2009, corn yields are projected to average about 164 bushels. So dividing 164 bushels per 6.5 bushels means that enough calories to feed a person could grow on 1/25th of an acre or about 1800 square feet, i.e., a plot that measures 18 feet by 10 feet. Of course, the calculated yields are for biotech corn produced using modern methods. Of course, organically corn grown in Africa yields about 15 bushels per acre.
Let me know if this works for your room mate.
@ SWMalone Okay I should have said anecdotes. The point I was trying to make is that this argument revolves around fundamental philosophies about the role of Government that are at odds with one another. After a while these threads lapse into Godwins and other personal abuse (not that it isn’t fun to read but still…)
MNG: I take it then that you fully endorse the “scientific consensus” that government supplied universal health insurance is the only solution to the health care problem. I’m not surprised.
Sean W Malone: Err. Too late and too many trolls. The area is correct at 1800 square feet, but the dimensions are off 90 percent. So try this:
So dividing 164 bushels per 6.5 bushels means that enough calories to feed a person could grow on 1/25th of an acre or about 1800 square feet, i.e., a plot that measures about 42 feet by 42 feet.
Ron Bailey,
MNG: I take it then that you fully endorse the “scientific consensus” that government supplied universal health insurance is the only solution to the health care problem. I’m not surprised.
I have to say that I think “government supplied universal health insurance ” … the same thing that works all over the modern world would be best.
But that is merely my opinion.
I base that opinion on that if we include the 300 million people in one single plan and eliminate the:
– judification process
– eligibility process
– icd9 codes
– premium verfication
– determining if treatment is covered
– determining if treatment is approved
– finding ways to weasal out of paying
– and let’s not forget, the 80 other people involved when one person goes to one doctor
…This will do far better than the free market we have with health insurance today. That’s just an opinion.
I think that out of the 300million people we have in america…if we simply tax those that work and make at/above a living a FLAT rate (rich will pay same as middle class), the cost of offering medical benefits to the sick and the masses would NOT cost more than the revenue generated by tax.
Basically, I’m proposing that the entire country be part of ONE pyramid. I propose this over the free market allowing an infinite number of small pyramids…which just doesn’t seem to be working. Especially when the insurance companies can merely weasal out of paying benefits and dump the sick on us (the tax payer).
Please, don’t be too hard on me. Don’t call me stupid. I don’t think u people are stupid. This is my current opinion.
Thanks Ron! It’s appreciated.
alice bowie –
TANSTAAFL
TANSTAAFL,
It would NOT be free. Healthcare cost are real. It cost REAL money. I’m proposing that the TAX payer pay (via a tax like FICA or medicare) in leu of healthcare premiums.
This is how it is done all over the modern world. And, for a good reason. The bigger the pyramid (tax payers vs benefactors) the better.
Alice – I don’t accuse you of being a troll, or ever call you stupid… But after all this time, you need to realize that what we have now is not “free market”. It’s easily as socialized as France with the only exception that Medicaid/Care doesn’t cover 100% of the population and instead covers about 30%.
But in terms of the system, it’s really not all that dissimilar.
Or perhaps I should say, the way health care in the US works has a lot more in common with how European systems work than it does with “unfettered” industries like software or electronics. If you want a model of “free market” in economic policy in the US (or anywhere) – the health care sector ain’t it. We’ve been over this dozens of times and you know I’m right about this – so it’s just not acceptable to keep making that claim.
Cartels, government granted monopolies & oligarchies, impenetrable & indefinite patents, price and wage controls, restricted and unionized licensing, not to mention 50% of it being paid for by government is about as opposite of “free market” as you could get in America.
I know what you say Sean. The current system is not a free market and should not be judged as such.
There is more government involvement in the way health care is distributed, paid for, produced, administered and more controls on the consumer options than in virtually any other industry in the US.
If it counts as “free market” then most other industries are outright no-hold’s barred anarchy.
“But, exactly HOW does forcing someone to carry insurance on their OWN health make any sense?”
In part, it’s because for some on the left have an odd form of obsessive-compulsive disorder about these sorts of issues. If the little people refuse to buy health insurance because they don’t see the benefit being worth the cost, then the left will put them in their boxes whether they want to go not. The left knows best, they are the intellectuals, right?
…If the little people refuse to buy health insurance because they don’t see the benefit being worth the cost…
Forget about the ‘little people’ MJ, I think if you have NO assets or if you have $300,000 in the bank and a $500,000 home, I wouldn’t blame anyone for NOT BUYING insurance. There is not benefit worth the cost.
I paid about $150,000 over a period of 10 years for healthcare. And, I used about $60,000. That just goes to show you how dumb I really am. The savy people didn’t pay shit. And, in the event that something like cancer/stroke happens, these people merely declare bankrupcty and move their assets and go on medicaid. Who’s the fool, I’m the fool for paying for insurance.
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alice –
you’re presuming that the system is so totally fucked that we have wrest control from the eeeevel corparashunz to fix it. when it is in fact most of the problems are caused by government intervention and could be remedied by repealing already existing laws.
repeal a law? why not just write a newer more gooder one instead?
“…unless the government has infinite resources, the government is going to have to say the same thing.”
But TAO, the government will only deny the unnecessary, wasteful procedures and tests that drive up costs! It would never deny a medical procedure that someone actually needs to be healthy!
Furthermore, we’ve always been at war with East Asia.
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“I wonder how many guns and how much ammo Obama sold with that line.”
I wondered the same thing.
“If we want a cure for cancer I’d trust a government agency with the goal of finding a cure for cancer over a corporation whose goal is maximizing its bottom line. Hypothetically speaking, what incentive is there for such a corporation to find a cure rather than just produce drugs that people need to take continually?” – Tony
What’s the incentive for the government agency to come up with a cure that works? If anything their incentive is to perpetually promise they are on the verge of amazing discoveries and never deliver anything substantial, because that’ll keep their funding going.
Your example of NASA is telling. The moon shots came about as an aspect of the Cold War, and once the propaganda value wore off, the whole thing was scrapped. Since then, NASA’s manned program has been directionless, flailing about to find a purpose with some spectacular and tragic failures thrown in. Government is most innovative in war and warlike activities, without that kind of pressure you get make work projects of dubious value.
Nipplemancer,
I’m a support for free markets…but I’m by no means a puritan. The regulations came to be because the insurance companies (participating in an unregulated free market) dumped their customers on US (the tax payer).
You can go ahead and repeal ALL of those pesty protectionist laws written to protect consumers from a profit-driven health insurance company. And, we can go to a 100% unregulated free insurance market. However, when they don’t make good on claims, we’ll be stuck with the tab…and the insurance companies (and their stock holders) will enjoy the benefits of high profits and not having to make good on very expensive claims.
As much as I like Obama, I must say, that speech was something else. He promised EVERYTHING. And I mean EVERYTHING. I just don’t think that even if he did get the votes and passed all of that, he wouldn’t be able to deliver.
For one thing, you can’t have an insurance company with ONLY sick people and old people…it just doesn’t work. That’s why there is NOT A SINGLE carrier that exclusively insures senior citizens and the sick.
alice, there is no resource limit for medicaid.
alice, there is no resource limit for medicaid.
Actually, there is. Medicaid people can ONLY go to Doctors that take Medicaid.
It’s somewhat strange that those who argue for universal healthcare have not yet set their sights on food. After all, if it’s a travesty that individuals can be denied access to quality healthcare because they can’t afford it, it’s also a travesty that individuals can be denied access to something far more basic – quality food.
As of June 2009, there were 35 million people in the United States receiving food stamps. And according to USDA data, 12.4 million children were at risk of hunger in the United States at some point last year. More generally, many argue that obesity in the United States is due, in part, to the fact that many individuals and families can’t afford “good” food.
All told, it’s clear that the number of people in this country who can’t afford enough food and who can’t afford “good” food is at least equal to the number of people who are uninsured or underinsured.
So why aren’t advocates of all-you-can-eat government calling for some sort of universal food program? A public option would be perfect – a government supermarket chain where consumers have plentiful access to fruits, vegetables, dairy, meat, etc. (all organic, of course) at “affordable” prices? No bread lines here – if you want the best organic strawberries, CapitolMart will have them in abundance at a price you can afford, regardless of the season. Eat that, Wal-Mart.
Universal food should be an easy sell. After all, people who eat well, live well. It’s the purest form of preventative care your Benjamins can buy.
The basic idea is to unravel the entire third party payor system and take all Medicaid, Medicare, and SCHIP funds and hand them out as vouchers for people to buy private health insurance.
IOW, you don’t support free markets.
alice:
w/ regard to eligibility. there are only income limits.
either way, you’ve pointed out a flaw that makes a govt. option a trojan horse for single payer.
so please answer my question, who would you rob to pay for your well being?
A government employee or member of a public employees union. A politician such as a Kennedy or a Rangel, a McCaine or a Baucus. Ain’t a crime to steal from a thief, is it?
At any given moment, if I don’t have insurance for whatever reason (lost job, can’t afford it) and I get diagnosed with a serious illness, I am fucked.
At any given moment, if I don’t have fire insurance for my house for whatever reason (lost job, can’t afford it) and it burns down, I am fucked.
At any given moment, if I don’t have food for whatever reason (lost job, can’t afford it) and I get hungry, I am fucked.
See now how your failure to be responsible should not be made into our fucking problem?
Because when someone says “they can’t afford it”, yet the cost is substantially less than their monthly income or current assets, what they really mean is “I have other, higher priorities.”
For one thing, you can’t have an insurance company with ONLY sick people and old people…it just doesn’t work. That’s why there is NOT A SINGLE carrier that exclusively insures senior citizens and the sick.
It’s called Medicare — albeit run by one of the most irresponsible insurers imaginable, the feds.
And there is no such thing as an unrateable risk. There are risks that, correctly priced, hardly any one will purchase the insurance.
Joshua Holmes: Yes, I do support free markets. But assuming that no move in the direction of free market reforms will occur unless a majority of Americans feel that they can count on obtaining some form of health insurance (which, no matter how you like it, I think is a safe assumption nowadays), then turning existing federal health care schemes into voucher programs for poor people to buy private health insurance is much better than the process of ever increasing direct government takeover of health care we are currently experiencing.
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