The Sucess of Socialized Medicine

[jeff]

Originally Posted by gojujay

Nope. That's why I have a PPO

Good move. Me too. Good thing we can both afford them. And for the others?

Originally Posted by gojujay

The market cannot provide things that are not profitable. Why should it? As to moral principles; If we follow the rest of the worlds' example we'll soon be in such a mess that Alfred Doolittle's words will make sense (Pygmalion Act II: PICKERING. Have you no morals, man? (Pygmalion snip)

Heh-heh Nice quote from that noted Socialist playwrite. What side do you think he would come down on wrt. healthcare? Once Mr. Doolittle became respectable, do you think he would be pleased to pay more and get less - as we do here?

Your first sentence agrees with my point: The market cannot provide things that are not profitable. Not all good things, even necessary things, are profitable. Why insist that we provision them through the market when we know the market will not and can not.

Originally Posted by gojujay

q.v. earlier post, different thread

I must have missed that thread!

Originally Posted by gojujay

In the Fifties and Sixties J. M. Keynes' theories were widely held as unassailable proof of the necessity and benefit of governmental control. They were the proof of the superiority of the European system. And then along came the Seventies with Stagflation, which was all but impossible under Keynesian economic theory. What got the world out of this miasma? A market not controlled by the government. Admittedly sometimes slow to respond, once shown that profit can be made in an enterprise , it is an unstoppable force. I, personnaly don't know how it can be done, but I have enough faith in the FREE-market system, that it will be possible.

All to prove that an economists' claim's that their over-arching system of economic theory leads to nirvana should be viewed with skepticism, no matter who they are or how prestigious their credentials. That's why I consider myself a pragmatist and refuse to subscribe wholly to any economic belief system, Keynesian or otherwise. Dogmatic adherence to any of those schools of thought is IMO foolish, and we have to continually look for the right modality for each problem. Something like healthcare clearly is one with both public and private aspects, and dithering about it on reasons of ideology or theoretical purity while people die is repugnant.

To Amadeus's observation: plenty here on the right opposed the school lunch programs (which have shown themselves to be extremely effective and valuable) for the same reasons given now against universal healthcare

[Inquartata]

Originally Posted by jeff

1) In other words, private market solutions are not the answer for every solution,

Right. Cases in point: Public goods, certain externalities, monopolies and collusion. "People are poor" isn't in there.

and we can always avail ourselves of the circular reasoning that private market solutions didn't work because circumstances were not right for private market solutions to work.

Exactly.

In less dire circumstances, why private market solutions never provided universal healthcare to everyone in the US (because private enterprises don't deliberately do things that are money losers, regardless of how it would be nice to reduce preventable deaths)

And more importantly, far more importantly, because it would not be an efficient allocation of scarce resources.

2) The fact that a market does not exist does is a good reason to provide a government substitute, since a private market solution may or may not materialize.

Well, you can keep saying so...I can keep saying "No it doesn't"...and where are we?

How many children should we let die

Argumentum ad misericordiam, the Appeal to Pity.

Thanks, it has been awhile since I had the chance to break out the Latin fallacies.

For that matter fact that a market does exist does not in itself preclude a government substitute.

No; but no more does it justify it.

I say that it might be the right answer.

Perhaps, but not on economic grounds.

Rather than dogmatically asserting that the private market is the answer for all questions, let's face the fact that people can wait a long time, or die waiting (that fits "somehow inadequate"), until the circumstances arise to provide a private solution. Preserving the textbook abstraction of "public good" is far less important than the public good.

They can wait a long time for that luxury yacht, too. It doesn't justify the government providing them with one at taxpayer expense.

This seems to be at the crux of our disagreement: you believe that "need", defined morally, is a higher economic law that supply and demand. I do not. Morality plays no part in economic determinations, or should not.

If society "votes" to ignore the economics on moral grounds--and it happens all the time---so be it. That doesn't make the vote any less foolish ( economically ).

I prefer private solutions to most things, but I don't delude myself that it is the job of the market, or of profit making institutions, to care for the needy sick.

Of course it isn't. It also isn't the government's job to force me to do it, IMO. Economics aside, that's as unjust in my eyes as letting the poor go without free health care seems to be in yours.

[Inquartata]

Originally Posted by jeff

All to prove that an economists' claim's that their over-arching system of economic theory leads to nirvana should be viewed with skepticism, no matter who they are or how prestigious their credentials.

Straw man, my friend. No economist claims anything like that. ( "Dismal" science, remember? ) The economist's claim is more like Churchill's characterization of democracy: it's the worst system there is, except for all the others. The best that humanity has been able to muster. We would like to know why we ought to exchange it for one which doesn't work as well, though.

To Amadeus's observation: plenty here on the right opposed the school lunch programs (which have shown themselves to be extremely effective and valuable) for the same reasons given now against universal healthcare

"Effective" in doing what? "Valuable" by whose calculations?

The proper economic measure is efficiency, not effectiveness, and not an abstruse concept like value...

[jeff]

As part of your response is that supply and demand always produces the most efficient solution, perhaps you can address the open question posed to you for a few weeks, as to how you explain why our peer industrialised nations have better health care at lower cost? That's been pending for long enough, I think. If market efficiency is your proof of economic wisdom, the other way is visibly wiser, proven for decades and for millions of people.

Also, and this bears repeating: only part of the argument for universal healthcare (this thread is an offshoot of that one) is coverage for those not covered by private schemes - your worry about being forced to pay for the healthcare of others. Healthcare in those systems also provides better care at lower cost for those who are not indigent.

And, for those the private market does not cover, discussions of "efficiency" are rubbish: they are besides the point and don't apply at all. Where the private market doesn't participate, it's output is "zero". I can claim infinite efficiency for market segments I don't act in. It's a meaningless expression.

You seem to agree with my comment about circular reasoning. You can use it to justify any bad policy - it's the same as the Communist excuse for governments not withering away because the right circumstances haven't arisen. Well, private enterprise can't solve everything because the right circumstances havent arisen there either. I wouldn't hold my breath either, but true believers of whatever dogmatism will always make an excuse.

[Inquartata]

Originally Posted by jeff

As part of your response is that supply and demand always produces the most efficient solution, perhaps you can address the open question posed to you for a few weeks, as to how you explain why our peer industrialised nations have better health care at lower cost? That's been pending for long enough, I think.

You are right. I have just spent a couple of hours of my scarce internet time reading dull papers and looking at charts and graphs. So my research ducks are pretty much in a row. I hope to get to the actual argument part this week. If not, then Sunday. Barring intervening exigencies.

As a prelude, I will just say that in perusing the country data from the CIA World Fact Book, notice that the US death rate per 1,000 is lower than those in most of those industrialised OECD countries I checked. In some cases, markedly so. I didn't expect that, but it would seem at least tangentially relevant to the issue of health. Not perfectly so, of course: my criticism of methodology and statistics use will apply as well to my own as to others'.

Healthcare in those systems also provides better care at lower cost for those who are not indigent.

This has not been demonstrated. Some health indicators have been cited, as have cost measures. "Better" has not been shown.

And, for those the private market does not cover, discussions of "efficiency" are rubbish: they are besides the point and don't apply at all. Where the private market doesn't participate, it's output is "zero".

Actually, they do: even in the most impoverished third-world backwaters, there is usually SOME semblance of a market---even if it's only for herbalists and witch-doctors.

[jBirch]

Originally Posted by Inquartata

As a prelude, I will just say that in perusing the country data from the CIA World Fact Book, notice that the US death rate per 1,000 is lower than those in most of those industrialised OECD countries I checked. In some cases, markedly so. I didn't expect that, but it would seem at least tangentially relevant to the issue of health. Not perfectly so, of course: my criticism of methodology and statistics use will apply as well to my own as to others'.

Comparing against UK:
- Lower Death Rate
- Higher Infant Mortality Rate
- Lower Life Expectency

Comparing against Canada:
- Higher Death Rate
- Higher Infant Mortality Rate
- Lower Life Expectency

Comparing against France:
- Lower Death Rate
- Higher Infant Mortality Rate
- Lower Life Expectency

All of whom have "socialised health care".

Much better data then the factbook:
http://www.oecd.org/document/46/0,23..._1_1_1,00.html

Seems to imply that the US spends way more on health care then any other nation (by far) and has below average health indicators.

James.

[gojujay]

Originally Posted by jeff

Good move. Me too. Good thing we can both afford them. And for the others?

The temptation to quote Marie is soooo strong... However, I made a choice to pay extra for my PPO. I know plenty of others who made a different choice.

Originally Posted by jeff

Heh-heh Nice quote from that noted Socialist playwrite. What side do you think he would come down on wrt. healthcare? Once Mr. Doolittle became respectable, do you think he would be pleased to pay more and get less - as we do here?

Oh come on, you know where GBS stands on that. As to A. Doolittle (what a name! Shaw was an excellent playwright no matter his political leanings), of course he wouldn't be pleased, but he'd chalk it up to being "respectable".

Originally Posted by jeff

Your first sentence agrees with my point: The market cannot provide things that are not profitable. Not all good things, even necessary things, are profitable. Why insist that we provision them through the market when we know the market will not and can not.

We'll have to agree to disagree on this.

Originally Posted by jeff

I must have missed that thread!

And I forgot where the ref. is. q.v. Old Age

Originally Posted by jeff

All to prove that an economists' claim's that their over-arching system of economic theory leads to nirvana should be viewed with skepticism, no matter who they are or how prestigious their credentials. That's why I consider myself a pragmatist and refuse to subscribe wholly to any economic belief system, Keynesian or otherwise. Dogmatic adherence to any of those schools of thought is IMO foolish, and we have to continually look for the right modality for each problem. Something like healthcare clearly is one with both public and private aspects, and dithering about it on reasons of ideology or theoretical purity while people die is repugnant.

The greatest temptation, to do the right thing for the wrong reason. I cannot condone replacing an admittedly imperfect system that has capitalism at its' heart, with another imperfect system that has socialism as its' core belief.

[Inquartata]

Originally Posted by jBirch

All of whom have "socialised health care".

Seems to imply that the US spends way more on health care then any other nation (by far) and has below average health indicators.

Yes. But this is not necessarily all of the story. Raw statistics can mask significant differences in experiences.

Just one example: indicators such as infant mortality and life expectancy are almost always found to be significantly lower for populations of African descent. Which country has the higher number of citizens of African descent, both in gross and percentage terms, the UK or the US? Canada or the US? France or the US? Germany, or the US? Japan, or the US? Whichever has the larger segment of its population composed of such higher-risk groups ( American Indians are another such ) will have its overall averages dragged downward. ( Check the rates for Cuba, with its significant black population, for instance: universal health care, but numbers for child mortality and life expectancy very close to those of the US. )

And do be careful with that "any other nation". If you check beyond major industrialized countries, you will find that many which offer universal free health coverage yield the opposite result. Check Brunei and Saudi Arabia, for instance. Or South Korea. ( Or North Korea, for that matter. ) Or Greece. And why are Hong Kong's numbers so dramatically better than those of any Western democracy, without universal free coverage? ( Don't say "it's China", either; China's numbers are much worse than those of Hong Kong. ) Why are industrialized Russia's so much worse, if the presence of free health care alone matters?

Could it be that as I said there may be other factors involved? That health care alone is not necessarily the sole controlling factor?

This is a tremendously complex question, with hundreds, if not thousands, of variables. To assert that all differences can be explained by a single variable---presence of a NHS---is breathtakingly reductionistic, IMO.

[Amadeus]

Originally Posted by jeff

To Amadeus's observation: plenty here on the right opposed the school lunch programs (which have shown themselves to be extremely effective and valuable) for the same reasons given now against universal healthcare

i don't doubt it.

i was just pointing out that the $2 a head spent in tanzania and much more is already being spent on our children.

therefore, i deny that the article that started this thread shows clear support for univeral healthcare in the united states.

[jBirch]

Originally Posted by Inquartata

Yes. But this is not necessarily all of the story. Raw statistics can mask significant differences in experiences.

Absolutely.

Just one example: indicators such as infant mortality and life expectancy are almost always found to be significantly lower for populations of African descent. Which country has the higher number of citizens of African descent, both in gross and percentage terms, the UK or the US? Canada or the US? France or the US? Germany, or the US? Japan, or the US? Whichever has the larger segment of its population composed of such higher-risk groups ( American Indians are another such ) will have its overall averages dragged downward. ( Check the rates for Cuba, with its significant black population, for instance: universal health care, but numbers for child mortality and life expectancy very close to those of the US. )

Actually, to talk about your own statistics here, it's the rate of poverty that is strongly correlated with infant mortality and the segments you cite have stronger trends of poverty then us white guys. It really has nothing to do with race and everything to do with economics. In fact, I suspect that the Universal Health Care system in Cuba is what makes up for the economic gap between the US when it comes to life expectency, infant mortality and death rate, not the fact that there are roughly the same proportion of black people there.

Did I just tell Inq that it WAS all economics??? Weird. Must be the Big Mac talking...

And do be careful with that "any other nation". If you check beyond major industrialized countries, you will find that many which offer universal free health coverage yield the opposite result. Check Brunei and Saudi Arabia, for instance. Or South Korea. ( Or North Korea, for that matter. ) Or Greece. And why are Hong Kong's numbers so dramatically better than those of any Western democracy, without universal free coverage? ( Don't say "it's China", either; China's numbers are much worse than those of Hong Kong. ) Why are industrialized Russia's so much worse, if the presence of free health care alone matters?

None of whom spend as much % of GDP on health care. The US indisputably leads the world on that figure.

Could it be that as I said there may be other factors involved? That health care alone is not necessarily the sole controlling factor?

Absolutely. Culture, geography, demographics, climate, imigration nuances (to name just a few) have HUGE effects on a population's health.

This is a tremendously complex question, with hundreds, if not thousands, of variables. To assert that all differences can be explained by a single variable---presence of a NHS---is breathtakingly reductionistic, IMO.

Never said that. I'm not the one arguing that all healthcare inadequecies are a result of market forces. *grin* I'm merely rejecting your notion that universal healthcare defacto provides lesser healthcare and higher cost.

James.

[jeff]

In brief, as only have a few minutes:

Amadeus: No argument on my part

gojujay: We'll have to disagree. IMO there exist things that are good, valuable, and even necessary, which are not going to be capable of being profitable. (When did we start claiming a profit on the Navy? )

Inq, jBirch: I think I go with Inq's remark that the statistics he quotes are tangential to the question. Many other factors come in, including those already noted. I'll add that Europe in general has an older population than the US, and overall, older populations have higher mortality figures, dontcha know? I would prefer to stick to primary metrics for healthcare. The cost question seems beyond dispute. We certainly pay more.

Later, Jeff

[Inquartata]

Originally Posted by jBirch

Actually, to talk about your own statistics here, it's the rate of poverty that is strongly correlated with infant mortality and the segments you cite have stronger trends of poverty then us white guys.

Not entirely. Persons of African descent are also at much higher risk for a number of diseases and conditions than are other racial groups. But I take your point, though it really makes no difference if you substitute "poor" for "black" in my last post. The outcome is the same: a segment, X, of a population, Y, has markedly lower life expectancies and higher infant mortalities than other segments of that population. This will drag the averages for those figures downward for Y, and the larger the segment X the greater will be that downward drag. If the US has a larger X than that of other countries, its figures for Y will be skewed from those of the other countries. And the US does have a larger X, I think.

In fact, I suspect that the Universal Health Care system in Cuba is what makes up for the economic gap between the US when it comes to life expectency, infant mortality and death rate, not the fact that there are roughly the same proportion of black people there.

It may be a valid suspicion, but we simply do not know. Nor am I necessarily asserting the contrary, merely pointing out that it is not as simple as "universal health care=better results". There are too many other factors which might be relevant to accept that position unless the other factors have been controlled for...and AFAIK they haven't been yet.

None of whom spend as much % of GDP on health care. The US indisputably leads the world on that figure.

Wait, I thought the hypothesis was that your picked set of countries had better results despite that they too do not "spend as much % of GDP on health care"?

If that principle applies, you cannot exclude other sets of countries based ONLY on that measure. You cannot say "X spends less and gets better results, Y spends less and gets worse results, so Y gets worse results because it spends less while X gets BETTER results DESPITE also spending less". There must be some other cause...

Absolutely. Culture, geography, demographics, climate, imigration nuances (to name just a few) have HUGE effects on a population's health.

...like those.

I'm merely rejecting your notion that universal healthcare defacto provides lesser healthcare and higher cost.

But you are doing so based on flawed premises, ie that those nations which seem to contradict my "notion" ( actually economists' notion ) are close enough in all other respects to the US to draw the conclusion that their healthcare is not in fact "less". It might well BE less, and the health indicators be explained by other things than universal healthcare. And the costs might actually be higher as well, due to differences in measurement methodologies. ( I noticed this problem when I tried to do a direct comparison of US and UK statistics on violent crime. The two countries don't even gather the same figures, much less compile and present them the same ways. Eventually I was forced to throw up my hands and admit defeat. The same problem almost certainly arises in health statistics. For example, infant mortality: how is this measured? Do all countries use the identical definition of "infant"? Do they include stillbirths, or is there a minimum life outside the womb? What about late-term abortions? Are ALL infant deaths measured, including those to foreign visitors, or only those of citizens? And is infancy considered to end at age 1? 2? 3? 4? 5? )

[jeff]

Got a few minutes more now, so an addendum to prior post:

gojujay: Surely "Not all good things, even necessary things, are profitable": that's the basis of the "public good"distinction Inq and I argued about interminably. We never came to agreement on that, but I think we both agreed that there are good things, etc, that are not in the sphere of private economies, and Inq even suggested instances of public health. I hope to not misrepresent him, of course. I think it as dogmatic to insist that everything of value can be only be provided by the private markets (therefore requiring a profit), as to insist that the opposite is true, as a socialist would.

Inq, James: higher mortality rates for black and American Indians substantiate the claim that universal healthcare improves population healthcare, rather than being a factor that must be factored in. It's not that those two ethnicities are innately less healthy (bizarre exception for the Tono Odham tribe, formerly known as Papago, but that's another story), but that they are poorly served by healthcare due to their societal situation. Rather than being a factor that drags down our averages due to genetics, they illustrate how inferior healthcare in our private system increases mortality. The contrast with societies that provide healthcare to poor populations is clear. This is in agreement with what James said, including his reference to Cuba.

[Inquartata]

Originally Posted by jeff

The cost question seems beyond dispute. We certainly pay more.

We do. But it does not necessarily follow that we have pinpointed the reason for this in "the US lacks state-provided free healthcare for all".

The US and the other nations compared are different in as many ways as they are alike. Neither similarities or disparities are wholly wholly explanatory, IMO.

BTW, if you look for the figures you will also find that while the US spends more per capita on health care than other first-rank industrialized nations, with the possible exception of Russia, the expenditures for those other nations are also growing at a faster rate than expenditures in the US. I know that's difficult to believe considering the high rate of growth in the cost of health care in the US, but it seems to be the case. ( Probably due to the demographics of aging you mentioned, IMO. )

[gojujay]

Originally Posted by jeff

gojujay: Surely "Not all good things, even necessary things, are profitable": that's the basis of the "public good"distinction Inq and I argued about interminably. We never came to agreement on that, but I think we both agreed that there are good things, etc, that are not in the sphere of private economies, and Inq even suggested instances of public health. I hope to not misrepresent him, of course. I think it as dogmatic to insist that everything of value can be only be provided by the private markets (therefore requiring a profit), as to insist that the opposite is true, as a socialist would.

Ah, the pitfalls of posting with little sleep. I would clarify my position: An expanded definition of "profitable"; Good corporate citizenship leading to a more positive customer perception or even viewing expenditures as a long term investment in customer service. A stretch to be sure, q.v. sleep.