The Sucess of Socialized Medicine

[SJB]

http://www.theglobeandmail.com/servl...International/

[gojujay]

It's hard not to go up when you start so low. Still, it's nice to see childrens' lives being saved.

And I'm not sure this is really socialized medicine. Sounds more like public health.

[Inquartata]

And just adopting a new methodology in an already established public health system, at that. The results are from using resources differently, not from socializing medicine.

[SJB]

From my point of view a government using public funds to improve health care of every citizen, especially those in their infancy at that, is a socialst (or perhaps humanist) endevour.

[Inquartata]

But they aren't doing that. The program is (a) aimed only at children, and (b) only being employed in selected regions. Which doesn't really qualify on the "every citizen" front, does it?

[SJB]

But they aren't doing that. The program is (a) aimed only at children, and (b) only being employed in selected regions. Which doesn't really qualify on the "every citizen" front, does it?

From The Globe and Mail:

while the government of Tanzania has committed to at least $12-million to expand the health interventions acrossTanzania

"You could see from the results that it's possible to reach them. And if you see it's possible in two districts, it's normal to ask, 'Why don't you do it on a large scale?' . . . We would have got there eventually, but now with the help of our partners it will be easier."

Child mortalityfell in the two pilot districts by more than 40 per cent over the five years of implementation. Adult mortality dropped by about 20 per cent, even as AIDS was beginning to unleash its full force on the country. During this period, districts not using the TEHIP plan experienced virtually no change in their death rates.

[jeff]

Someone with a keen interest in economics surely can explain why this is not a "public good", and why the Canadian and Tanzanian governments should not have done this. Lots of kids can die while waiting for the invisible hand's miraculous effects...

[SJB]

Someone with a keen interest in economics surely can explain why this is not a "public good", and why the Canadian and Tanzanian governments should not have done this. Lots of kids can die while waiting for the invisible hand's miraculous effects...

Or why that extra $2 per year could have done more good as a corporate tax break.

[gojujay]

Someone with a keen interest in economics surely can explain why this is not a "public good", and why the Canadian and Tanzanian governments should not have done this. Lots of kids can die while waiting for the invisible hand's miraculous effects...

HERETIC!!!!

[jeff]

HERETIC!!!!

Hey, Lynne Truss, author of "Eats Shoots and Leaves" has a new book "Talk to the Hand: The Utter Bloody Rudeness of Everyday Life". You don't think she's talking about that hand, do ya?

[Inquartata]

the government of Tanzania has committed to at least $12-million to expand the health interventions across Tanzania

Is that in the same way that the Bush Administration has "committed" to deficit reduction and adherence to the Geneva Accords, do you think?

We should accept the promises of politicians as a "health plan"?

"You could see from the results that it's possible to reach them. And if you see it's possible in two districts, it's normal to ask, 'Why don't you do it on a large scale?' . . . We would have got there eventually, but now with the help of our partners it will be easier."

Or maybe the money will go into the pockets of corrupt officials instead. Again, are the promises of politicians tantamount to working government policies now?

Child mortalityfell in the two pilot districts by more than 40 per cent over the five years of implementation. Adult mortality dropped by about 20 per cent, even as AIDS was beginning to unleash its full force on the country. During this period, districts not using the TEHIP plan experienced virtually no change in their death rates.

Very well. But even measurement of overall adult mortality does not establish that "every citizen" has been helped, even in the selected regions.

BTW, have all other possible contributing factors to mortality eduction been controlled for in arriving at these attributions to the program?

[Inquartata]

Someone with a keen interest in economics surely can explain why this is not a "public good", and why the Canadian and Tanzanian governments should not have done this.

Two separate questions. The first is easiest to answer.

It's not a public good because from what little is said of the program ( I have not researched it further ) it is a constellation of services which are rival and exclusive. Lowering child mortality is being done by saving individual lives, from what I can see. This could be done just as easily by a private, or market, solution, if one existed. ( That none does is not a way around the public good definition, though it may be a justification for having someone else such as the state---or outside agencies---do it. )

There is no particular reason why a government ( or an NGO like the WHO, or a private charity like the Red Cross ) ought not do anything it pleases, other than the fact that they are taxing their citizens in order to pay for it. My essential point is that in the realm of economic policy governments ought to restrict themselves to public goods and leave nonpublic goods to the market. In this case I think it would be better to promote the latter, but there are cultural and institutional barriers to that, as well as economic barriers, which make that problematic.

There are as Gojujay pointed out differences between public health services and health care services. We in the US have the CDC, which is a public health agency which confines itself largely to activities with spillover effects for thegeneral society. It doesn't provide universal medical care to individuals in order to improve individual wellness, though. It is not a health care program. Spraying for mosquitoes and treating little Timmy's ear infection are worlds apart conceptually and practically...

[Inquartata]

Or why that extra $2 per year could have done more good as a corporate tax break.

Red herring, and fallacy of false dichotomy. Naughty!

[jeff]

Two separate questions. The first is easiest to answer.

It's not a public good because from what little is said of the program ( I have not researched it further ) it is a constellation of services which are rival and exclusive. Lowering child mortality is being done by saving individual lives, from what I can see. This could be done just as easily by a private, or market, solution, if one existed. ( That none does is not a way around the public good definition, though it may be a justification for having someone else such as the state---or outside agencies---do it. ) (Remainder snipped for brevity)

I don't doubt your analysis, which illustrates why the distinction of "public good" is of so little utility. If there was a private market solution, well, that would be nifty. But there's not. When private markets don't provide solutions, for the ample reason that not every problem's solution has a suitable ROI to motivate a for-profit institution, then it's good when the public sector steps in (regardless of which juxtapositions of "public" and "good" are prohibited). The extension to the US of rivalrous and exclusive services to supplement or supplant the private market ones here is clear. When the private market doesn't provide life-saving answers, it's apt for the public sector to do so.

[Inquartata]

If there was a private market solution, well, that would be nifty. But there's not. When private markets don't provide solutions, for the ample reason that not every problem's solution has a suitable ROI to motivate a for-profit institution, then it's good when the public sector steps in (regardless of which juxtapositions of "public" and "good" are prohibited).

Two flaws in this line of reasoning.

1) It's not that this problem cannot be solved by a market solution, it's that there is no market. We're probably talking about a country large parts of which are pre-capitalistic, subsistence agararian societies. This is not a state of affairs which is likely to lure investment in ANY market. There are probably few ( private ) physicians for the simple reason that none could make a living there.

2) The fact that a market doe not exist does not in itself justify a government substitute. ( It may justify government policies designed to promote the creation of a private market, in some cases. ) If that is the standard you're proposing for justifying government provision, then I guess the government should also provide cars ( no auto dealers ), clothing ( no Men's Wearhouses ), restaurants ( no Denny's ), consumer electronics ( no Circuit City ), etc....

The extension to the US of rivalrous and exclusive services to supplement or supplant the private market ones here is clear. When the private market doesn't provide life-saving answers, it's apt for the public sector to do so.

Not really. There is nothing in the nature of government or in the nature of a want that mandates the creation of a market in a nonpublic good, much less the extension of one deemed somehow inadequate. Still less the nationalization of an existing one on those grounds. I don't see the logic by which you conclude that it does...

[jeff]

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

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. How many children should we let die while waiting for the market to decide there's a profit in saving their lives? For that matter fact that a market does exist does not in itself preclude a government substitute.

Unnumbered) I don't say that it mandates, I say that it might be the right answer. 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.

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.

[gojujay]

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

The private market in healthcare insurance arose from the incentives to hire more qualified employees in the WWII era. Governmental wage and price controls percieved as necessary for the war effort pressured business to find a new way to attract/lure employees. Enter health insurance payed for by the employer. When government decided to get in the game, they brought a lot of money not subject to market forces. The healthcare industry took off and we made a lot of progress without proper market balance. IMNTBHO this is the reason for the healthcare "crisis" we now have. Like most things govt. gets into, there is a fantastic growth period followed by a period of realizing that the market is not really supporting the industry. I believe that this is where we are now, at a crossroads with the choice of free capitalist markets or command socialism. May God have mercy on our souls...

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. How many children should we let die while waiting for the market to decide there's a profit in saving their lives? For that matter fact that a market does exist does not in itself preclude a government substitute.

In answer to an earlier question/comment, maybe not from this thread, this is one of the reasons economics is called the dismal science.

Unnumbered) I don't say that it mandates, I say that it might be the right answer. 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.

And therein lies the temptation, to do the wrong thing for the right reason.

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.

And I can't trust the government to do it according to how it should be done on an individual basis.

[jeff]

I think that there is still a lot of confusion about what universal healthcare would entail. If you look at the other industrial nations, you can see different ways to provide it, and none of them are experiencing the Orwellian nightmare that people here fear. Just one of the alternatives is "single payer" (where everyone is covered by insurance), with private providers, so you get to choose the doctors and services you want. There's simply no need to get paranoid about "trusting the government", as they can be the insurer, not the provider. And, do you trust your HMO?

For the rest of it - I'll be convinced when someone shows me how and when private market solutions can be brought into play to provide universal coverage and prevent the preventable deaths that now happen, for market segments that are unprofitable. Either in 3rd world countries or in the USA. Until then, I'll take the choice - based on moral principles - that saves lives.

I hate to sounds like a broken record (a metaphor that probably makes no sense to anyone under 30. "What's a "broken record, Daddy?" "Well, we had these things made of vinyl with small grooves cut in them, to play music" "You're kidding!") but the "no" side of this debate on universal healthcare still hasn't confronted the contradiction that the countries with universal healthcare pay less and live longer. If the private market is always better, then how can this be true? I suggest people drop their emotional responses and consider this dispassionately. If our system cost less and we lived longer, I'm sure we would all be bragging about how we had the superior system. If we were more honest we would recognise when others do.

[Amadeus]

needless to say, a very poor country in africa is very different from the united states economically and in health care in general.

children in the united states already get most of the health care that would be provided by the $2. For example, we spend, IIRC, 7 billion dollars a year on the school lunch program simply to keep children fed.

[gojujay]

...And, do you trust your HMO?

Nope. That's why I have a PPO

For the rest of it - I'll be convinced when someone shows me how and when private market solutions can be brought into play to provide universal coverage and prevent the preventable deaths that now happen, for market segments that are unprofitable. Either in 3rd world countries or in the USA. Until then, I'll take the choice - based on moral principles - that saves lives.

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?
DOOLITTLE [unabashed] Cant afford them, Governor. Neither could you if you was as poor as me.

I hate to sounds like a broken record (a metaphor that probably makes no sense to anyone under 30. "What's a "broken record, Daddy?" "Well, we had these things made of vinyl with small grooves cut in them, to play music" "You're kidding!")

q.v. earlier post, different thread

but the "no" side of this debate on universal healthcare still hasn't confronted the contradiction that the countries with universal healthcare pay less and live longer. If the private market is always better, then how can this be true? I suggest people drop their emotional responses and consider this dispassionately. If our system cost less and we lived longer, I'm sure we would all be bragging about how we had the superior system. If we were more honest we would recognise when others do.

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.