And what about using sin taxes to pay for government health care that you couldn't receive. I realize this hasn't happened yet, but it would be unfortunate.
And what about using sin taxes to pay for government health care that you couldn't receive.
This gets floated around a lot, but its a red herring. Sin taxes are based on consumption, which is fluid, therefore a sin tax can never pay for any service with unlimited demand.
But wait a minute. If PRIVATE health companies decide to stop paying for certain conditions, charging extra for people who live a lifestyle they disapprove of, or when you get past a certain age, will that be all hunky dory?
But wait a minute. If PRIVATE health companies decide to stop paying for certain conditions, charging extra for people who live a lifestyle they disapprove of, or when you get past a certain age, will that be all hunky dory?
What's the difference, pray tell?
1) If my private health company doesn't meet my needs, I can hire another one. I can't hire another government.
2) If my health insurance denies my claim for life-saving treatment, I can hire the doctor directly. If the government denies my claim for life-saving treatment, I die.
3) Since there are many health care providers and many health insurance companies competing for my business, the price and coverance is highly likely to be at least approximately equal to the cost and risk (if not, see #1). Since there is only one government, they are a monopoly, and there is no market force driving price and coverage to parallel cost and risk. In fact, they can be completely arbitrary.
Actually, I've worked for one and am a p/t CSR for a gov't-sponsored one right now. The private ones are alot more flexible and tend to cover a great deal more.
don't fool yourself into thinking a purely private system has no rationing. There is still limited supply that's trying to satisfy a too-large demand. I think Dave S. has written about this before. But in our system the rationing is based on ability to pay. Is one really different than the other?
therefore a sin tax can never pay for any service with unlimited demand
You may want to let the government in on this, I just googled state health cigarette tax, and California and New York are about to make a huge mistake.
But in our system the rationing is based on ability to pay. Is one really different than the other?
Other points aside, I think that assertion requires stretching the definition of "rationing" beyond the breaking point. I'd love to have a world cruise, a bigger house, and a Canon 1Ds Mark III. I can't afford any of those things right now, but that doesn't mean that anyone has "rationed" the supply of those goods. It just means they cost more than I am able/willing to spend right now.
When applied to medical care that's not good, but it's not rationing. And, more to the point, the cure for that problem (to the extent that it requires curing) isn't the same as the cure for rationing would be.
I think that this is a slightly mistaken view on the problem.
If you have capacity for 100 life saving operations, and 1000 people that need them then obviously you will have to ration them in some way. You can either give them to the 100 people that will most likely recieve the most benefit (young people with a healthy lifestyle) or to the 100 people who will pay the most money for them (quite likely old people who have accumulated a lot of capital.)
The problem isn't that the first way is less 'fair' then the second way, indeed from many perspectives it a very fair way to do it. The problem is that their is no incentive in the first system for the capacity to be increase, while in the second system there is.
Of course a country with the incentive to increase their capacity in this manner will soon end up spending more on health care then anyone else, and it is quite likely that they will only have marginally better outcomes (some of the increase capacity, as well as some of the uses for the existing capacity will go to people who are old and unhealthy and thus die soon anyway.)
When applied to medical care that's not good, but it's not rationing.
Maybe you don't like the term "rationing". Healthcare is a produced commodity, which means that there is a finite amount of it available in any given year. It appears to me that people want to consume more than is available.
One way or another, supply and demand will be matched.
I think Dishman has got my meaning here. Even if you factor in charity care, there is still a finite amount of time spent working by a finite amount of doctors in a finite amount of hospital space. the supply side is still limiting the deal. So as Dave J says, you're still going to have to leave people out in the cold based on inability to pay, least likelihood to benefit, or some other metric.
Dave J makes another excellent point regarding growth of medical supply. I don't know if his intuition is right or wrong, though. I'd be interested in seeing the rates of growth of the medical infrastructure in the U.S. vs. France, UK, Canada, etc. Not sure what the normalization would be, though.
It appears to me that people want to consume more than is available.
One way or another, supply and demand will be matched.
Sure. Maybe I'm quibbling, but what I object to is government action to limit demand by restricting who is eligible for the limited supply. Yes, we have private entities limiting access now, but as Michael noted above it's a lot easier to switch your insurance than it is to switch your government.
The opposite approach, which seems to work pretty well for every other industry, is to increase the supply to match the demand. We apparently need more medical practitioners (not necessarily doctors) and more places to get medical care. Which is one reason why I hope Walmart and other retailers get their in-store clinics up and running quickly and without interference.
We already have health care rationing in the US, but the rationing is being done by insurance companies rather than directly by the government. Insurance companies sometimes have to justify their rationing decisions to state insurance regulators or in court, so indirectly, the government is in control of some of these rationing decisions already.
If PRIVATE health companies decide to stop paying for certain conditions
...
don't fool yourself into thinking a purely private system has no rationing.
Of course private health care has rationing; all private systems are inherently rationed according to who can afford to pay for the goods and services offered. That's the whole argument for state health care... but that also has rationing.
But under a private system, you can either pay yourself, or go with another company that will insure you. If you want a new government -- well, that's a little harder to change.
Even high-risk people can be covered by insurance; it just costs more. When the government is paying, there is no "costs more," it's either free or nothing.
Of course private insurance is also fundamentally flawed; patients and doctors are almost totally insulated from cost decisions, which just begs for inefficiencies. That's why Wal-Mart is moving into the healthcare space - those kind of massive inefficiencies mean there are fat profit margins for more rational providers.
There are other problems too, also stemming from illiberal statist policies of a different kind. Another reason that healthcare is too expensive is that the annual salaries of doctors are inflated because the supply is artificially limited by the AMA. By making medicine a cartel, they've done for medical costs what OPEC does for oil prices. And the all-powerful State enforces their cartel for them via the use of violence, arresting anyone who practices medicine without their say-so.
It's tragic that some people can't afford health care (though the problem is generally overstated). Capitalism is cruel -- but that's why it works. If you want to be able to buy things, you need to make decisions that will put you in a position to be able to.
Socialism will be just as cruel, just in different ways, and at the cost of significant freedoms and efficiencies. And the more freedoms we give up, the crueler life will become.
The advantage of socialized national Euro healthcare is that it promotes the tourist industry to Lourdes with its some 5 million pilgrims every year.
I even know a few irish grannies that have gone there while awaiting the many, many months, the (Eire) NHS imposed prior to their hip replacement surgery.
For doctors to demand the right to make decisions like these strikes me as being like airline pilots demanding the right to tell people what their destinations should be.
We already have health care rationing in the US, but the rationing is being done by insurance companies rather than directly by the government.
Sort of. HMOs do 'ration' in the sense of treatments - like going for cheaper alternatives [dialysis rather than transplants, for example], but rarely in the sense of turning away one of their clients. It happens, its just rare in the larger scheme of things.
Bear in mind, too, that this UK NHS measure is largely in response to lurid news stories about youthful boozers that get livers and refuse to stop drinking heavily, etc. Its become a public outrage so of course they're suggesting it. One needs to keep in mind why its a public outrage, though: It isn't because Joe the drunk gets a liver [which, if everyone could get one, wouldn't matter] but that everyone must wait so goddamned long for a liver and why the Hell did Joe the drunk get one before me?! Its not the rationing but the overall frustration with the bureaucracy. Picture the DMV as your local hospital and you've pretty much got the idea.
Last: "Rationing" is a kind of misnomer in that healthcare is always rationed. What do any of you think 'triage' is all about? Its in the nature of the thing.
Wait just a minute, you're giving George Best, one of the greatest futballers of all time, and one of the worst livers of all time, the impression he wasn't a worthy human being for a liver transplant, which he was.
On the other hand, guess who also got a liver transplant in USA that seemed chosen well ahead of many others on a list ? His name was Mickey Mantle.
And I suspect that HMO's don't go for dialysis as the cheaper modality, merely that the supply of advailable kidneys doesn't meet demand. Like four years of dialysis is cheaper than one successful kidney transplant ?
Next up: miners and minors, fire forces. Then armed forces, nurses, archeologists, geologists and spelunkers, skin divers, general practioners and surgeons, ...
1.29.2008 8:17pm
Commenting on Dean's World is a privilege, not a right. Dean is your host, you are his guest, and you should behave in that fashion. Dean is not your babysitter, nor is he your punching bag. Please remember this. In general, you are free to disagree with anyone on any subject you wish, but abusive behavior will not be tolerated.
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.
I mean, why wouldn't it? It makes perfect sense.
But this isn't public health.
This gets floated around a lot, but its a red herring. Sin taxes are based on consumption, which is fluid, therefore a sin tax can never pay for any service with unlimited demand.
What's the difference, pray tell?
1) If my private health company doesn't meet my needs, I can hire another one. I can't hire another government.
2) If my health insurance denies my claim for life-saving treatment, I can hire the doctor directly. If the government denies my claim for life-saving treatment, I die.
3) Since there are many health care providers and many health insurance companies competing for my business, the price and coverance is highly likely to be at least approximately equal to the cost and risk (if not, see #1). Since there is only one government, they are a monopoly, and there is no market force driving price and coverage to parallel cost and risk. In fact, they can be completely arbitrary.
Mike
don't fool yourself into thinking a purely private system has no rationing. There is still limited supply that's trying to satisfy a too-large demand. I think Dave S. has written about this before. But in our system the rationing is based on ability to pay. Is one really different than the other?
Many hospitals have charity care options.
therefore a sin tax can never pay for any service with unlimited demand
You may want to let the government in on this, I just googled state health cigarette tax, and California and New York are about to make a huge mistake.
Other points aside, I think that assertion requires stretching the definition of "rationing" beyond the breaking point. I'd love to have a world cruise, a bigger house, and a Canon 1Ds Mark III. I can't afford any of those things right now, but that doesn't mean that anyone has "rationed" the supply of those goods. It just means they cost more than I am able/willing to spend right now.
When applied to medical care that's not good, but it's not rationing. And, more to the point, the cure for that problem (to the extent that it requires curing) isn't the same as the cure for rationing would be.
If you have capacity for 100 life saving operations, and 1000 people that need them then obviously you will have to ration them in some way. You can either give them to the 100 people that will most likely recieve the most benefit (young people with a healthy lifestyle) or to the 100 people who will pay the most money for them (quite likely old people who have accumulated a lot of capital.)
The problem isn't that the first way is less 'fair' then the second way, indeed from many perspectives it a very fair way to do it. The problem is that their is no incentive in the first system for the capacity to be increase, while in the second system there is.
Of course a country with the incentive to increase their capacity in this manner will soon end up spending more on health care then anyone else, and it is quite likely that they will only have marginally better outcomes (some of the increase capacity, as well as some of the uses for the existing capacity will go to people who are old and unhealthy and thus die soon anyway.)
Maybe you don't like the term "rationing". Healthcare is a produced commodity, which means that there is a finite amount of it available in any given year. It appears to me that people want to consume more than is available.
One way or another, supply and demand will be matched.
I think Dishman has got my meaning here. Even if you factor in charity care, there is still a finite amount of time spent working by a finite amount of doctors in a finite amount of hospital space. the supply side is still limiting the deal. So as Dave J says, you're still going to have to leave people out in the cold based on inability to pay, least likelihood to benefit, or some other metric.
Dave J makes another excellent point regarding growth of medical supply. I don't know if his intuition is right or wrong, though. I'd be interested in seeing the rates of growth of the medical infrastructure in the U.S. vs. France, UK, Canada, etc. Not sure what the normalization would be, though.
One way or another, supply and demand will be matched.
Sure. Maybe I'm quibbling, but what I object to is government action to limit demand by restricting who is eligible for the limited supply. Yes, we have private entities limiting access now, but as Michael noted above it's a lot easier to switch your insurance than it is to switch your government.
The opposite approach, which seems to work pretty well for every other industry, is to increase the supply to match the demand. We apparently need more medical practitioners (not necessarily doctors) and more places to get medical care. Which is one reason why I hope Walmart and other retailers get their in-store clinics up and running quickly and without interference.
...
don't fool yourself into thinking a purely private system has no rationing.
Of course private health care has rationing; all private systems are inherently rationed according to who can afford to pay for the goods and services offered. That's the whole argument for state health care... but that also has rationing.
But under a private system, you can either pay yourself, or go with another company that will insure you. If you want a new government -- well, that's a little harder to change.
Even high-risk people can be covered by insurance; it just costs more. When the government is paying, there is no "costs more," it's either free or nothing.
Of course private insurance is also fundamentally flawed; patients and doctors are almost totally insulated from cost decisions, which just begs for inefficiencies. That's why Wal-Mart is moving into the healthcare space - those kind of massive inefficiencies mean there are fat profit margins for more rational providers.
There are other problems too, also stemming from illiberal statist policies of a different kind. Another reason that healthcare is too expensive is that the annual salaries of doctors are inflated because the supply is artificially limited by the AMA. By making medicine a cartel, they've done for medical costs what OPEC does for oil prices. And the all-powerful State enforces their cartel for them via the use of violence, arresting anyone who practices medicine without their say-so.
Socialism will be just as cruel, just in different ways, and at the cost of significant freedoms and efficiencies. And the more freedoms we give up, the crueler life will become.
socializednational Euro healthcare is that it promotes the tourist industry to Lourdes with its some 5 million pilgrims every year.I even know a few irish grannies that have gone there while awaiting the many, many months, the (Eire) NHS imposed prior to their hip replacement surgery.
Bear in mind, too, that this UK NHS measure is largely in response to lurid news stories about youthful boozers that get livers and refuse to stop drinking heavily, etc. Its become a public outrage so of course they're suggesting it. One needs to keep in mind why its a public outrage, though: It isn't because Joe the drunk gets a liver [which, if everyone could get one, wouldn't matter] but that everyone must wait so goddamned long for a liver and why the Hell did Joe the drunk get one before me?! Its not the rationing but the overall frustration with the bureaucracy. Picture the DMV as your local hospital and you've pretty much got the idea.
On the other hand, guess who also got a liver transplant in USA that seemed chosen well ahead of many others on a list ? His name was Mickey Mantle.
And I suspect that HMO's don't go for dialysis as the cheaper modality, merely that the supply of advailable kidneys doesn't meet demand. Like four years of dialysis is cheaper than one successful kidney transplant ?
Oh, I know its always the bureaucracy.
Of course I have. Why would you assume otherwise?
Mike
Next up: miners and minors, fire forces. Then armed forces, nurses, archeologists, geologists and spelunkers, skin divers, general practioners and surgeons, ...
Of course we all lose our tempers now and then. Dean freely admits to being imperfect in this regard, which is why regulars to this establishment will generally be cut more slack than people who we don't know very well.
Still: behave like an adult, or go find somewhere else to play. Thanks.