The Most Assinine Platitude in America Today
And there are all alot of them, but here it is:
"People have a right to affordable healthcare."
Let's examine. What exactly is "healthcare"? I will start with the simplest input. It is the knowledge and experience of healthcare professionals - doctors, nurses, EMT technicians, etc. Where does this knowledge come from? Schooling. Lots of very expensive schooling. Granted medical school students are readily financed, but the ultimate financial obligation rests with them, they have invested in ("bought") the intellectual capital of a medical education. It also comes from rigorous on the job training. Internships are brutally intense and pay very little, so again there is a big personal investment in the hands-on training required to provide "healthcare." Then there are intangible, yet important, aspects of "healthcare" like a doctor's bedside manner, for lack of a better term. This is essentially a doctor's interpersonal skills, communication ability and so on, all things that are valuable and obtainable at cost as well (granted, to some it comes naturally, but mostly this too is acquired at a real cost). All of this is bought and paid for, it someone's property. Why do I have a right to any of this? Do I have a right to the benefits of an electrical engineer's training, in the form of subsidized consumer electronics, at below market value? How about a lawyer's advice or financial planner's expertise? No, I have to pay the going rate for these things. Why is a doctor's bought-and-sweated-for knowledge and experience mine to have by rights at anything less than the going rate?
You can extend the analysis to medical equipment - ultrasound imagers, MRIs, blood analyzers, etc. Someone invents these things and someone has to build them, from raw materials, in a factory where workers are paid and electrical bills are incurred, etc. Do I have a special right to the use of such equipment at a special rate that is deemed to be "affordable" yet may not cover the input resources?
Hospitals too. A building of steel and concrete, built on somebody's land, by a construction crew...you get the point.
How did we ever get to the point where we feel that the real cost of all of these inputs (education, land, labor, invention) must be ignored? We blithely bandy about the word "healthcare" with all of its connotations of life and the individual and we think nothing of advocating stealing what is somebody else's property, which is exactly what we do when we invoke the need for "healthcare" at anything less than the full market value of all that it takes to provide it?
And this is not to even contemplate the variations in quality of "healthcare." What should be affordable? A John Hopkins-educated doctor? A Central State-educated doctor? A 2006 model MRI or a 2002 model? But that is another post.
So there it is, in all its idiotic glory, the dumbest platitude in policy discussions today. Say it with gusto and look completely foolish.
"People have a right to affordable healthcare."
Let's examine. What exactly is "healthcare"? I will start with the simplest input. It is the knowledge and experience of healthcare professionals - doctors, nurses, EMT technicians, etc. Where does this knowledge come from? Schooling. Lots of very expensive schooling. Granted medical school students are readily financed, but the ultimate financial obligation rests with them, they have invested in ("bought") the intellectual capital of a medical education. It also comes from rigorous on the job training. Internships are brutally intense and pay very little, so again there is a big personal investment in the hands-on training required to provide "healthcare." Then there are intangible, yet important, aspects of "healthcare" like a doctor's bedside manner, for lack of a better term. This is essentially a doctor's interpersonal skills, communication ability and so on, all things that are valuable and obtainable at cost as well (granted, to some it comes naturally, but mostly this too is acquired at a real cost). All of this is bought and paid for, it someone's property. Why do I have a right to any of this? Do I have a right to the benefits of an electrical engineer's training, in the form of subsidized consumer electronics, at below market value? How about a lawyer's advice or financial planner's expertise? No, I have to pay the going rate for these things. Why is a doctor's bought-and-sweated-for knowledge and experience mine to have by rights at anything less than the going rate?
You can extend the analysis to medical equipment - ultrasound imagers, MRIs, blood analyzers, etc. Someone invents these things and someone has to build them, from raw materials, in a factory where workers are paid and electrical bills are incurred, etc. Do I have a special right to the use of such equipment at a special rate that is deemed to be "affordable" yet may not cover the input resources?
Hospitals too. A building of steel and concrete, built on somebody's land, by a construction crew...you get the point.
How did we ever get to the point where we feel that the real cost of all of these inputs (education, land, labor, invention) must be ignored? We blithely bandy about the word "healthcare" with all of its connotations of life and the individual and we think nothing of advocating stealing what is somebody else's property, which is exactly what we do when we invoke the need for "healthcare" at anything less than the full market value of all that it takes to provide it?
And this is not to even contemplate the variations in quality of "healthcare." What should be affordable? A John Hopkins-educated doctor? A Central State-educated doctor? A 2006 model MRI or a 2002 model? But that is another post.
So there it is, in all its idiotic glory, the dumbest platitude in policy discussions today. Say it with gusto and look completely foolish.
posted by Donny Baseball at 12:09 PM
9 Comments:
So I'm a little confused, are you saying that only the rich are entitled to health care, and if you can't afford it, you should just expect to die?
Or are you trying to say that health care providers shouldn't continually be squeezed by health insurance companies to provide care at lower costs, for the sake of health insurance company profits?
I am saying neither. Your first question begins with the assumption that a healthcare system based on free market principles would inevitably result in a hard class-based dichotomy - that rich folks could afford healthcare and poorer folks could not. This is a false assumption. There is every reason to believe that healthcare costs would fall under free market competitive conditions and that only the most complex, innovative treatments would be beyond the means of the poor. And even then there is the virtual certainty that true insurance products would emerge to make such treatments available to everyone.
As to your second assertion, there would be no cause for insurance providers to squeeze providers because there wouldn't necessarily be a third party payer relationship. Consumers and insurance companies alike would be the payers and providers would not have to deal with monopsonistic conditions.
The tradeoffs implicit in your questions reflect the terrible bargains that the current system shackles us into. It should be obvious that the system we have is deficient by you even having to ask these questions.
Yes the health care system in the US is extremely flawed. The question is how do we fix it.
Switching to a totally free market system will "result in a hard class-based dichotomy - that rich folks could afford healthcare and poorer folks could not."
It is not a false assumption.
To think the poor could afford such things as open heart surgery, chemotherapy and bone marrow transplants, which could run into the hundreds of thousands of dollars is pure fantasy.
We could easily have a system where everyone paid for routine care, such as medical check ups, lab tests, etc. without much problem, but when it comes to the big ticket items, it is (and I hate repeating myself) pure fantasy to think everyone could afford such expenses.
That is why we have insurance. Unfortunately everyone doesn't have to purchase insurance, yet everyone is entitled to care for those big ticket items. And that is the major problem with healthcare in the US, in addition to the fact that the supply of doctors is artificially limited in the US.
Health care costs are going up, not because somebody else is paying, and we don't care what it costs, health care costs are going up, because the population is aging, i.e. demand is increasing.
We do need to add more supply to keep price increases in check, but in the interim, we need to make the purchase of health insurance mandatory, and spread the risk evenly throughout the population.
It isn't fair that only those who have health insurance, or are otherwise able to afford health care on their own, should have to pay for the health care of others.
Marc-
I wholeheartedly agree with some of your points and likewise disagree with other points. I never said that sophisticated medical treatments will be affordable to the poor. I said that insurance products, true insurance products, would emerge to make such treatments available. Like life insurance, insuring for heart bypasses, bone-marrow transplants and the like would be a straight-forward affair for an actuary and, like life insurance, it would probably cost about as much as a Starbucks latte per day. Cars are expensive too but we have financing and leasing and many low to middle income people have cars. So I still reject the notion that a free market system would leave the poor without access to the basic types of care that rich folks have.
Costs are rising because of demographics, but not only for that reason. They are also rising due to the 3rd party payer system, tort law abuse, state mandates, and the simple fact that medicines and procedures are better than they were in the past and thus of higher value. We should fix the policy measures that are driving up prices artificially and let the price mechanism handle the demographic issues which is a basic problem of supply and demand as you point out.
I do not believe in coerced purchase of health insurance on personal freedom grounds and I don't believe in allowing rampant free-ridership, so that is why I would like to see policy that opens up more options and makes access better rather than having to resort to coersion. With more open markets and true, risk-based insurance products we can 1)insulate the majority of us from free-riders, 2)entice many free-riders to give up and enter the risk-sharing pool, and 3) save our resources to help the truly needy rather than subsidize a mediocre system for all.
We coerce people to purchas and pay for many things without complaints, i.e. auto insurance, police and fire protection to name three.
Take police and fire protection, like health care, everyone needs both, the difference between the two, is we don't require people to purchase health insurance, yet we do require them to contribute to a pool to cover police and fire departments.
Tying health care to employment is unfair, especially to business in this global economy.
Then to make someone who isn't employed, pay more for health care than those that are employed is unfair. To deny someone coverage, because they are sick, and have lost their job is equally unfair.
Unfortunately all those inequities exist in our current system, and would persist in a free an open market as I expect you envision.
Just to add one point. I agree that while we may not use the police department everyday, just having a police department can act as a deterent to crime, so I can understand not objecting to paying for a police department.
But there is no such deterent in the case of fire protection. With exceptions, fires are not set purposely, but are typically caused by faulty electrical wiring, lightning strikes, and other acts of nature etc. So why should anyone be forced to pay for the mistakes of a neighbor who may have wired his home incorrectly, or installed his heater too close to flammable materials?
Healthcare is much like fire protection, except we can actually go through our entire life never needing fire protection. That is not the case with health care. At some point in our lives we will need the benefit of a health care infrastructure, so why shouldn't everyone have to pay for it?
So unless you are also against paying for fire protection, also then being against mandated health insurance is contradictory.
Marc-
We coerce people to pay taxes to receive certain goods that are somehow deemed better provided by government. I don't believe that these things are necessarily best provided by government but that is the way it is. I am absolutely certain that government is NOT the best way to provide healthcare. I lived in the UK and the system is awful.
I think we have lost focus on what my point is - I am not arguing for a complete lack of government involvement in healthcare. I am arguing for a free and open market in healthcare services and a free and open market in healthcare insurance for those that want to specialize their risks regardless of their employment status. I am fine with government filling in the gaps for the poor and sick with certain programs. But I don't want the entire system strangled by a collectivist mentality.
Back to fire protection - I don't think it is like healthcare at all - that was my initial argument, it is not a public good. I think fire protection is sensible, but I would have no problem not paying for fire protection and forgoing the right to have the fire truck show up at my house. I say this because I can buy fire insurance and outfit my house with sprinker systems and other safety devices of my own choosing. Likewise I would like to buy health insurance that fits my needs. No one in my family has ever had cancer, so I would like my insurance to reflect that in its cost and I'll accept the risk. And I eat right, exercise, son't smoke and wear my seatbelt, so I want my insurance to reflect that too. I don't want the costs of free riders imbeded in my rates. And if I need a procedure I want to be able to contract on my own with a doctor rather than take a menu option from a managed care entity. That is the free market I am talking about.
If we got rid of the employer tax break for healthcare insurance the costs of insurance would be more in line with that of term life and losing your job wouldn't leave you in the lurch like today. Any gaps could be filled in by the government like we do today with unemployment benefits. And if you wait until you are sick to buy insurance, you should pay more, and again the gov't can help out, but the incentives should be setup so that people don't do this.
Then we seem to be arguing for the same thing.
Health care is just too important to the well being of society to leave to free market forces, where you can be denied care because you are sick.
No one should have to be concerned about how they are going to pay for health care, when they get old, or lose their jobs. And they shouldn't have to worry about losing their life savings simply because they get sick. I too have never smoked or taken illegal drugs, I eat a healthy diet, and exercise a great deal, but it didn't keep me from getting sick. (See my blog - http://mlkashinsky.com)
I just want to see everyone contribute their fair share for health care, and not freeload off the system. The only way to do that is to mandate the purchase of health care.
And as for fire protection, certainly you can purchase fire insurance, which I have also, but rates would be considerably higher if we didn't have the infrastructure in place to fight those fires. That is what you are paying for, not the fire protection itself, but the maintenance of the infrastructure to fight those fires, when the time comes.
Marc-
I'm lost again. You don't want free-riders but you don't want free markets. We have massive free-ridership because we don't have a free market. The only way to prevent free-ridership is to force those that attempt to free ride to go without benefits. This forces people into the system.
Healthcare is just too important to leave to markets? Again you make the assumption that people will be denied in a freer market. Again I state, wrong assumption. We have a free market for food, are people denied food? Food is pretty important to society. It seems to work pretty well.
I would say that healthcare is too important NOT to leave to free markets. Every field of human endeavor has advanced under free markets. Government control yields the opposite.
Everyone is concerned about how they will pay their rent, food and utility bills when they retire. It's called planning for retirement. People ensure that there will be a roof over their heads in retirement in a variety of ways. Healthcare is no different, why do people have a right to be worry free over this element of expenditure? they should have the opportunity to be worry free, but there is nothing so special about it, it is falsely benighted category of expenditure because it is an emotional subject. No one wants to see people get sick or die prematurely, but no one wants to see people starve or get thrown out of their home. These things happen to a negligle extent in our society.
Finally, I would like to say that your suggestion of mandated healthcare insurance is not a non-starter but it must be accompanied with the freedom to tailor policies to people's needs. Force people to buy it fine, but don't make me pay for things I don't need or for the free-riders who smoke, eat poorly, drive fast w/o seatbelts, and have histories of major illnesses. And if some genius invents a miracle cure, let that person charge what they want and let insurance actuaries figure out how to spread the risk to make it affordable to everybody.
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