RoR: Forum

David Kelley covers this issue in his book "A Life of One's Own - Individual Rights and the Welfare State". He refers to "increased demand on the part of people whose bills are being paid by someone else...a total of 75% of all medical bills is paid by third parties - either insurance companies or government." He advocates the idea of people buying insurance individually and carrying it with them from job to job. In Australia, private health insurance is usually paid for directly by individuals, rather than being associated with an employer. I think this is a much better arrangement.

Post 1

Monday, August 29, 2005 - 7:56am

"In other words, we need a truly free, laissez-faire market in medicine."

The implications of this happening are tremendous. Imagine being able to choose and purchase treatments, practitioners, drugs, alternatives, all without government interferrence. To some extent, you can do so now but not legally.

Good article Andrew.

Post 2

Monday, August 29, 2005 - 9:40am

You cover it simply and well. You have a crystaline style that is compelling.

Post 3

Monday, August 29, 2005 - 10:20am

Nice article, Andrew.

One point I'd like to make though, is that I think it likely that a fully privatised health system may actually lead to substantially higher costs overall - this is reflected already in the fact that USA spending on health is much higher than in countries with socialised medicine (eg UK, Canada, Spain, NZ).

BUT this is not a bad thing! It is a reflection of supply expanding to meet a more complete range of customer choices.

Another issue in USA is not "who pays", but the crazy regulatory system that distorts and controls where and on what patients spend their money. There is enormous bias built into the system for employers paying health costs when there is no rational reason for this to be part of a employer/employee relationship given the dynamic nature of the Americal labour market - tax policy has created enormous distortions in this area.

Post 4

Monday, August 29, 2005 - 12:21pm

Excellent, Andrew.

You're right on the money about what has to happen. And it's so far from happening. A trip to the doctor's office is like a trip through a Kafka story. There is an adversarial relationship between the receptionist and the desperate, and often unreasonable, patient. You have patients who appear to have no interest at all in taking care of themselves (ridiculously overweight, unclean, uneducated, rude and verbally abusive). And these foul souls bully the system and make demands without paying a dime. Not only do they exchange nothing for the service, they actually suck value from the good docs and nurses and receptionists by making their lives far more unpleasant that it otherwise might be.

Post 5

Monday, August 29, 2005 - 12:57pm

Almost makes you wish they'd put a hangman's post by the door, with realistic dummy, and sign saying - WARNING - BE CIVIL...
(Edited by robert malcom on 8/29, 12:58pm)

Maybe with empty noose next to it... :-)

(Edited by robert malcom on 8/29, 12:59pm)

Post 6

Monday, August 29, 2005 - 1:48pm

When Hillary was running amok, PJ O'Rourke suggested that "if
you think health care is expensive now, just wait until it's 'free.'"

Post 7

Monday, August 29, 2005 - 2:32pm

That is a beautifully written and highly effective article, Andrew. And you're right: our health care is inordinately expensive, not because of the profit motive, but because health care has been regulated nearly to death. These regulations choke back the supply of new drugs, practitioners, and innovations; while ballooning demand thru medical welfare programs.

Perhaps we'll all have to head to Thailand for expensive medical proceedures.

Post 8

Monday, August 29, 2005 - 4:10pm

Well said, Andrew.

Yep, public funding coupled with private provision is the worst of both worlds. There's an irony in the *efficient* disbursement of public monies. And, of course, the market gets the blame.

Ross

Post 9

Monday, August 29, 2005 - 9:22pm

Thanks everyone for the compliments.

PC, I had actually thought about including that clever P.J. O'Rourke quote in my column, but I had already quoted him in another one, so I thought it best to try and come up with my own turns of phrase.

David, I think it is very difficult to say whether costs will go up or down with fully privatized health care. As I write in the article, over 45 percent of American health care is already socialized, so the American system can't really be taken as an example of a true laissez-faire arrangment. As pointed out by other posters in this thread, we also have regulatory and litigation-related costs, which I think may not be as high in those countries with public health care.

Post 10

Monday, August 29, 2005 - 9:28pm

Andrew, I've always found it a good rule of thumb that if I can include a quip from either Mencken or O'Rourke and it wouldn't look out of place then I know I'm doing well. But as you say, not every day. :-)

Post 11

Monday, August 29, 2005 - 10:17pm

I have a bad feeling that we will get some kind of universal public health insurance system in the U.S. It will most likely be a compromise type of situation where there are some little pockets of market forces working here and there, but ultimately government controlled (sort of like Bush's social security proposal). Tragically, I think the measure will be supported by large companies who are looking to the government to offload their ever-rising health care costs. I hope I am wrong.

Beware of the different types of arguments for socialized medicine:

1. Annecdotal story of a blue collar worker who just lost his job to China and suddenly suffers a life threatening condition that costs hundreds of thousands dollars to treat. He is forced to spend his entire savings and live a financially strapped life from then on not able to send his kids to college as planned. It will be contrasted with a similar situation in (insert Scandanavian country here) where the government plan saves the day.

2. The "economic" case, wherein a moderate Leftist talks about the percentage of money "we" spend on health care compared to socialized medicine states, and says that eliminating the private insurance middle man will simply save "us" more money in the long term. Don't be surprised if the same article pretends to be looking out for businesses by talking about the crippling effects of rising health benefit costs (which is of course a real issue). I consider this type of argument to be more of an "it's the economy, stupid" approach.

3. And don't be surprised if comparative rates of infant mortality and other ailments are shown where the U.S. is below some socialized medicine country.

There is a bit of an uphill battle as well in that most citizens who live under a public health plan are vehemently against full health care privatization. Most of them will concede that their systems have some horrible flaws, but they wouldn't even think about trading them for a system where someone could potentially be denied services because they can't afford them. I've even read that many European countries view their nationalized health care plans as a source of great national pride. It would be great intellectual ammunition if libertarians could point to popular uprisings demaning full health care privatization in some European country, but as of yet I'm certainly not aware of any such developments. Can anyone living in Europe or Canada confirm (or challenge) that assessment?

(Edited by Pete on 8/29, 10:19pm)

Post 12

Wednesday, August 31, 2005 - 5:35pm

The whole premise of health "care" looks increasingly flawed. The empirical evidence (starting with the RAND Corporation's Health Insurance Experiment back in the 1970's) indicates that the quantity of medical resources a population consumes doesn't seem to make much difference in overall health outcomes. Refer to economist Robin Hanson's essay, "Fear of Death and Muddled Thinking – It Is So Much Worse Than You Think":

http://hanson.gmu.edu/feardie.pdf

Given the lack of real progress in fighting many chronic and developmental diseases, despite all the money we've thrown at them, I don't know why we even bother pretending that we can "treat" for example most forms of cancer.

Post 13

Wednesday, August 31, 2005 - 7:49pm