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HEALTH
June 18, 2007
(Perhaps part of a
'Tarian's Progress
series...)
Back in the mid-80s, at the
height of my "libertarian"
craze, I thought "socialized ("Socialized medicine" is what we
medicine" was a horrible idea. used to call it back then. Now
it's called "universal health
Back in those days I bought care", a sign that it may be
the libertarian arguments about to win in the great
against it: dumbed-down market place of ideas...
"universal" no doubt polls better
than "socialized".)
Expect long waiting
lines, because (At that point, Britain was famous
they're symptomatic for long delays: though Canada did
of government a bit better, presumably because
rationing systems, they spent more on it.)
Cutting the profit motive
out of the equation would R&D requires cash, and to pay for that
have a very bad impact on you need to be able to charge a lot
innovation. for new techniques... at least while
they're new.
Quality was claimed
to be better on the As time goes on you expect the
American side of the R&D to be paid off and mass
border with Canada. market efficiencies to kick-in,
and the price should come down
Presumably because to make the new technique
the best doctors available to everyone.
preferred living
with the least
government controls.
I talked to at least one guy
who thought that the fix for
So essentially I that problem was simple:
believed in a "free convert the whole world
market" for health over to government run systems
care on largely then they won't have any
theoretical grounds. choice in the matter.
RANDRHET
But the actual evidence This, needless to say,
of how it all worked is a great argument to
really did need to be adopt if you want to
explained, and I knew piss-off a libertarian.
that at the time...
You think you're
Canadians were happy going to chain And converting
about their doctors to their the entire
government health stethoscopes? world to one
care system, the system isn't
British seemed less You make it too a terribly
happy with theirs, annoying to be likely
what were the a doctor, you're scenario.
differences, what going to discover
were the odds an you've got a Recently I
American system would shortage of doctors. had some
end up with one or dental work
the other? done while
in Bali.
And if the entire world Even with
switched over to an employee
socialized medicine, dental plan,
what would the long term it wasn't
impact be on the state worth doing
of medical research? in the US.
And as for
There are a number of difficulties quality: it
with that line of argument, not the would've been
least of which is that the medical very easy
companies don't like to pay for their for me to
own research. In point of fact, they find worse
do things like get government funding dentists than
to develop techniques and then they the one's
demand (and typically get) ownership I went to
of the "intellectual property" that in Bali,
got developed with public money. and it would
be hard to
find better.
Further: the incentives are
perverted by the need to
develop *new* drugs that This is not just lefty
you can charge a lot of rhetoric: I've heard this
money for... a research complaint from people who
into a new use for an really do know something
existing drug is hard to about it, (I've heard it
get funded. from more than one person
on the PhD track in
bio-sciences).
Another problem that I
knew about, is that the (This is a thought
argument that government of which my libertarian
subsidies subvert sort-of-brethren seemed
incentives would also ignorant... I think I
seem to imply to saw it mentioned once in
insurance companies. passing and scuttled
away from quickly...)
The idea is that if you've
got the government watching
your back, you'll be more
inclined to do risky
things, and you'll need
even more health care, and Lefties like to sneer at this
government spending on it sort of thing as an absurdity:
will have to climb through who is going to go "Oh boy,
the roof to meet the we've got universal health
increased demand. care now, I'm going to run out
and break my leg! Or maybe
If insurance firms do I'll try to get *lung cancer*,
a good job of distributing it's *free* now!"
risk throughout the
population, they'll Obviously, that isn't
effectively shield quite the way it works,
individuals from the but human motivation
consequences of their is a strange subject,
actions, in much the same way and the case can be
as government intervention. made that when people
*feel* safer they get "Studies have
more reckless. shown" this,
if I remember
This is supposedly correctly. (But
one of the reasons how could they
SUVs have safety show it?)
problems. Despite
their larger
momentum, they
don't appear to be
any safer than
smaller vehicles.
Apparently when
drivers feel
invulnerable they
drive a lot worse.
It also can be famously difficult
to get insurance companies to pay
off on a claim... profit goes up
the *less* you help your customers. The way it seems to me
at present: trying to
In the mid-80s, I thought get ahead of the game
HMOs were a great idea: by buying health
they looked like a way insurance is like
around the perverse trying to beat the
incentives of the odds in a casino.
insurance industry: by
fusing together the You don't think the house
insuring agency and the understands the odds
health care services, you better than you do?
might eliminate that
conflict-of-interest. (There's a factoid
going around: two-
In practice, HMOs have thirds of all
the same, if not worse medical bankruptcies
problems. And while are people who had
Kaiser-Permanente does health insurance.)
indeed usually provide
decent health care -- at
the very least, they seem
to understand preventative
medicine, something the Michael Moore commented
rest of the US system in passing that in spite
doesn't seem to get -- of Kaiser being a "non-
they definitely make you profit", the execs make
pay for it. "obscene" amounts of money
in the form of salaries.
It is indeed a problem with
the "non-profit" as an
institution. They *may* be
more resistant to corruption
than a corporation, but
they're not immune.
There's another point
that can be made:
If you want to be Michael Moore mentions
healthy, the thing to this one, too:
do is to live in a
healthy way -- not to "... one way to beat the system,
try to patch up the at least this system, is that we
problem later with should all try to take a little
expensive medical better care of ourselves ...
proceedures. And so, I started eating fruits
and vegetables. I don't know if
American society doesn't you've heard of these things,
make it easy to do this. but they come in different
In principle, we have colors and they're crunchy, and,
access to all sorts of you know, they're very good for
great food and exercise, you... "
in practice the need to
"keep up/get ahead" keeps [ref]
people running back and
forth in cars,
perpetually too busy to
worry much about Despite various claims made
nutrition, and with about the "quality of life"
little time to use that and "standard of living" of
gym membership. the United States-- we don't,
in general live all that well.
One advantage the Cubans
have over us in health
care is that the people
there don't have any money.
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