Jason Soon defends John Lott

Jason Soon is very angry that I dared to criticize John Lott in this post. I wrote about Freedomnomics (where Lott claims that women’s suffrage caused a massive increase in the size of the government):

Lott doesn’t like women’s suffrage

Soon writes:


His basic thesis is that the size of government expanded after women’s suffrage. It’s an interesting thesis. It may be right or wrong. But it does not follow from it that Lott is advocating that women be deprived of the vote since there are far more systemic and less illiberal views of checking the growth of government than arbitrarily limiting voting rights based on dissatisfaction with its outcomes.

Soon seems to accept that Lott would prefer a much smaller government and hence that Lott would think that women’s suffrage has had a bad result. As for other ways of “checking the growth of government”, this is not an argument that Lott makes, and Soon does not tell us what they are. Presumably these involve libertarians uniting and using their mighty political power or something.

To repeat – the proposition that women’s suffrage led to bigger government is a positive statement, not a normative statement. It is either true or false and the belief that it’s true is separate from the belief that women should therefore be deprived of the vote. Lambert decides to elide the two to smear Lott.

Hmmm, what did Lott’s sock puppet, Mary Rosh, write at FreeRepublic?

You have got to download this paper. Lott has done an amazing piece here. Fits in perfectly with Rush Limbaugh’s program today. Click on source URL above to get the paper.

How Dramatically Did Women’s Suffrage Change the Size and Scope of Government?

John R. Lott, Jr.

Abstract:

This paper examines the growth of government during this century as a result of giving women the right to vote. …

Lott does it again.

It’s pretty obvious that Rush Limbaugh was arguing that women’s suffrage was a bad idea.

Soon continues:

Yet, Lambert has been overwhelmingly positive about Freakonomics despite the fact that its most famous thesis is that legalised abortion led to lower crime rates. But if Lambert were to apply the same treatment to Levitt that he applied to Lott (i.e. mixing positive and normative conclusions) given the obvious racial bias in the US crime statistics and the rate of black illegitimate births compared to white illegitimate births, Lambert should be characterising Levitt’s argument as the argument that ‘we should pre-emptively kill black babies before they get born and become criminals’ . Yet I don’t see him huffing and puffing about Levitt’s alleged racism as he has been doing about Lott’s alleged sexism (of course just to clarify I believe that these ways of characterising BOTH Levitt’s and Lott’s arguments are silly and a distortion of their original intent).

Anyone who has read Freakonomics would know that Levitt argues that his thesis has no normative implications because other considerations trump the abortion/crime link. Lott makes no such argument.

Notice the hypocrisy and inconsistency. I used to think Lambert was a class act but since my recent run-in I’ve concluded that he is in fact a dishonest egotistical prick.

Charming. It seems that Soon doesn’t think it possible for anyone to honestly disagree with him. (My previous post on Soon’s conduct is here.)

Comments

  1. #1 dhogaza
    July 20, 2007

    Screw regulation. Long live thalidomide. Let those affected wallow in luxury upon winning their lawsuits in true libertarian “don’t prevent harm, just pay for the results afterwards” style.

  2. #2 jc
    July 20, 2007

    Oconnelc asks:
    “I’m curious about how someone can opt out of the Australian national health care system. If I were to choose to ‘opt out’, do my taxes decrease?”

    No you can’t opt out. You can’t even choose to keep paying the government mandated levy and opt out as there are no provisions for that in the private market and isn’t allowed. You got one choice, pay the incomelevy or pay the income tax levy.

    The drugs they offer on subsidy are mostly generic crap. The anit-biotics I wouldn’t even offer to an animal. If the drug is off the regular subsidy plan the doctor has to go begging the the regulators to allow it. They also don’t like to offer tests and try to disuade you at every turn. So your sitting in front of a dude or dudette who’s basically playing a guessing game with what is wrong with you.

    You have to go through a GP to see a specialist (seriously) and then there could at times be a 3 week wait because they is a closed shop.

    That’s why I bought an international cover through Chubb.

    It’s a make believe medical system, here which only people who don’t know quality health care would support. In other words it sucks big time.

    —————————–

    Can the people who are making all these assertions about US tax receipts during the 80 just post the site you are referencing. It is just silly to argue about a provable fact.

    Yea sure: Bob Bartely’s book. Former editor of the Wall Street Journal called 7 Fat Years.

  3. #3 nanny_govt_sucks
    July 20, 2007

    Screw regulation. Long live thalidomide.

    LOL! So the ineptness of the FDA is what makes it so great?

    Let’s put that red herring to rest:

    http://w3.aces.uiuc.edu:8001/Liberty/Tales/Thalidomide.Html
    “However much we all like heroic tales and medals, there is actually very little in the record to bear out the official heroic version of the thalidomide story. Upon careful examination it appears that no reproductive tests were done at all on thalidomide before 1961, nor indeed did the FDA ask for any. In fact, it appears that even had any pre-marketing reproductive tests of thalidomide in rats been done, they would have *still* have shown negative results, for thalidomide (as it turned out later) does not cause birth defects in rats. We now know that it would have taken a much more exhaustive set of animal tests to catch thalidomide than was routinely used anywhere in 1961. An honest reading of the facts thus forces the conclusion that (questions of luck aside) Dr. Kelsey’s medal was awarded basically for being a delay-causing bureaucrat and thereby allowing Europeans to serve as first-class “guinea pigs” for Americans, in a case where (quite literally) guinea pigs themselves would not have done an adequate job.”

  4. #4 Jackson Lewis
    July 20, 2007

    The ‘reason’ health care in the US is “expensive” is a few reasons. The number of drugs developed and recouping the R&D costs etc. The speed with which you can be seen. The large numbers of people with no money using emergency rooms for non-emergencies. Per capita incomes. The amount of government control and intervention. The societal makeup of the country.

    The reason the gun culture doesn’t reduce the number of murders is just because of what it says; it’s cultural. (The idea it does or doesn’t reduce murder (or increase it) is meaningless anyway, because it can’t be proven or disproven.)

    Observation on the lowering of taxes is that it increased GNP and reduced unemployment. Impossible to prove due to the chaotic nature of an economy as a whole, and the lag. e.g. Stock market crash, a boom going bust, when it happens (or why) the results come “later” and is one of many factors.

    If those with the biggest guns would take everything over, why doesn’t the US military and law enforcement own everything? No matter, you can’t compare Miami to London or Buenos Aires to Somalia or Sierra Leone anyway.

  5. #5 Eli Rabett
    July 20, 2007

    The best source for US data are the Statistical Abstracts AFAIK every government issues something similar.

  6. #6 Jc
    July 21, 2007

    Ian Gould

    Do you think market forces don’t apply to healthcare? It’s not a racist question by the way.

  7. #7 dhogaza
    July 21, 2007

    nanny_govt_sucks knocks down a strawman argument as to why Ms. Kelsey refused to approve thalidomide for use in the US.

    Not surprising. Here’s the real story…

    Kelsey had other worries about thalidomide as well. She wanted to know about the drug’s mechanism of action – its effects on human metabolism, its chemistry and pharmacology and its stability.[2] However, none of this data had been provided by Richardson-Merrell. There had been no chronic toxicity studies, excretion and absorption data was inadequate and there were few manufacturing controls in place to assure quality.

    Kelsey rejected the application and requested the aforementioned data from the company in a letter. Richardson-Merrell resubmitted the application but with no new information and Kelsey turned it down again. She continued to request more data from the company and with each request the 60 day clock was rewound to its beginning. As the end of 1960 approached and with it the holiday season (the best time for selling sedatives),[3] Richardson-Merrell began ratcheting up the pressure on the FDA and Kelsey. Executives and scientists telephoned and personally visited Kelsey, and executives complained to her superiors that she was nit-picking and unreasonable.[1][5]

    That’s from wikipedia, which, while not a perfect source of information, in general might be expected to be a more neutral one than a random website at a university which has been put up by a libertarian.

    nanny_govt_sucks is correct in claiming that no reproductive tests were performed on thalidomide in this period, but that has nothing to do with the “heroic” story in regard to Kelsey.

    She refused to approve the drug because the company had not done the PROACTIVE WORK to demonstrate safety required by law and the regulatory framework.

    My initial comment stands:

    Libertarians would free drug companies of the requirement to demonstrate to a reasonable degree that new drugs are safe in a government-mandated regulatory framework.

    If consumers are harmed as a result, their solution is that those harmed can sue in civil court. Potential damages are enough, in their eyes, to cause companies to make sure their products are safe without the need for regulation, despite a couple of centuries of data refuting that simplistic point of view.

  8. #8 dhogaza
    July 21, 2007

    That nice website linked by nanny_govt_sucks lists the refusal to approve the sale of thalidomide in the United States under its “Tales of Woe” The Many Abuses of Big Government section.

    So, tell us, nanny_govt_sucks, do you agree that the refusal to allow sales of thalidomide in the United States an example of an abuse of big government?

    Should thalidomide have been sold to pregnant women here in the US?

    Is this how you intend to win the hearts and minds of the populace, by arguing that regulation by the FDA unfairly limited the rights of pregnant women to give birth to flipper babies?

    Good luck with that.

  9. #9 dhogaza
    July 21, 2007

    Oh, yes, another example of a hero of the libertarian movement from the website linked by nanny_govt_sucks.

    Marinus Van Leuzen was a pretty lucky man. Van Leuzen owned a waterfront lot. Because the lot contained wetlands, local officials informed him that it could not be developed without a permit from the Corps of Engineers. Notwithstanding this advice, Van Leuzen raised the elevation of the site by about three feet and built a pole house. Unfazed by repeated warnings that his construction activity was illegal, Van Leuzen added a shell driveway, a concrete deck and sidewalks. He installed a septic system, sodded the lawn and added more fill.[2] Van Leuzen’s development of the site in clear violation of the Clean Water Act[3] triggered a lengthy criminal investigation that culminated in high level discussions at the Justice Department about whether he should be prosecuted for filling wetlands without a permit. To Van Leuzen’s good fortune, the criminal case was closed without further action and the matter was referred for civil enforcement.[4]

    Well, this isn’t quite the story told by the libertarian site linked to by nanny_govt_sucks.

    Their tale of martyrdom leaves out the fact that Van Leuzen was warned beforehand that he’d need a permit from the Corps to place fill on his land. And that he continued to fill and do construction on that fill despite numerous warnings that he was in violation of the Clean Water Act.

    This is the libertarian world view – people who knowingly break the law are heros as long as libertarians disagree with that law.

  10. #10 jc
    July 21, 2007

    dhogaza

    Do you think FDA requirements are overly restrictive, still weak or about right?

    It costs about $2 billion dollars to bring a drug to market these days.

    Cancer patients on their last legs are denied experimental drugs in case they’re too dangerous.

    You’re also have one huge hole in your argument about thalidomide. Even if the US regulator succeeded the Europeans regulators failed.

    It seems from your link that the US fluked it because of failed filings rather than the observations of the brave hero.

    Would you call this a success or an evens bet, so to speak. A broken clock is right twice a day after all.

    The threat of legal action can be used as a risk management tool, you know.

  11. #11 dhogaza
    July 21, 2007

    You’re also have one huge hole in your argument about thalidomide. Even if the US regulator succeeded the Europeans regulators failed.

    That is the strangest argument for weakening regulation I think I’ve ever seen.

    It seems from your link that the US fluked it because of failed filings rather than the observations of the brave hero.

    And proper filings would’ve raised other red flags, that rather being the point behind their refusal to do the necessary work.

    The threat of legal action can be used as a risk management tool, you know.

    Thank you for confirming my statement regarding the libertarian’s approach to product safety. Let companies market products that kill people, then let the surviving relatives sue. They’ll be able to afford a nice funeral, after all!

  12. #12 liberal
    July 21, 2007

    Jc wrote, Do you think market forces don’t apply to healthcare?

    It’s not that market forces don’t apply to healthcare. Rather, it’s that whatever market forces do apply, it’s an empirical fact that gross market failure in healthcare is inevitable because of information problems and perverse incentives: mainly, that suppliers of healthcare have no incentive to provide good long-term outcomes at a reasonable price.

    This point is discussed in the excellent article, “The Best Care Anywhere”.

  13. #13 liberal
    July 21, 2007

    nanny_govt_sucks wrote, Financing? US Government? We’re talking about regulation at all levels, Ian.

    Let me make a wager: you don’t consider government-granted monopolies in the health care market (aka “drug patents”) to be a form of “regulation.”

  14. #14 oconnellc
    July 21, 2007

    liberal, I know you didn’t ask me for the wager, but I would say that it doesn’t really matter if we call drug patents “regulation” or not. If we ever want another drug developed by a pharmaceutical company, we better not get rid of them.

    Also, are you still interested in talking about land rents? I had a couple questions I posted above that I was hoping you might want to address. Thanks.

  15. #15 SG
    July 21, 2007

    jc is now bringing a whole bunch of silly extraneous arguments into his healthcare polemic. Let’s see:

    Cancer patients on their last legs are denied experimental drugs in case they’re too dangerous

    This is not due to the type of health care market in which people operate: it’s doctors’ self-regulation, to do with the ethics of administering treatment.

    The drugs they offer on subsidy are mostly generic crap. The anit-biotics I wouldn’t even offer to an animal.

    Do you mean, for example, zithromax, the current recommended antibiotic for the treatment of pneumonia? Produced by pfizer and on the PBS? real generic crap, that is.

    You have to go through a GP to see a specialist (seriously) and then there could at times be a 3 week wait because they is a closed shop

    Yes, because the concepts of primary, secondary and tertiary health care are purely the products of a nationalised health service. There is no benefit to this at all… and “they is a closed shop” because of the system of socialised health care – not because they have their own, private industry body which controls certification and registration of specialists.

    The ‘reason’ health care in the US is “expensive” is a few reasons. The number of drugs developed and recouping the R&D costs etc

    Hint jc: go to the OECD website and get their stats on relative costs of different elements of national health systems. Drugs are not the main cause of differences between Australian and US prices – the main cause is the extremely large amount of expensive machinery in the US, and the extremely high staff-to-patient ratios.

    But in the end your argument here rests on a simple case doesn’t it JC? You think that spending 16% of GDP on health instead of 8% is good, and being a good libertarian you want to institute a system in Australia which forces me to pay the same inflated costs as you.

    Why should I pay extra so you can have dancing girls in your hospitals?

  16. #16 oconnellc
    July 22, 2007

    < >

    That doesn’t make me feel good about any changes to the US healthcare system. I haven’t heard anyone suggest any changes the include destroying existing equipment or forcing hospitals (clinics, whatever) to cancel any purchasing requests that they would make. I certainly haven’t heard anything about firing staff. I know this is off topic, so I apologize.

  17. #17 SG
    July 22, 2007

    Any such claims would be scaremongering, oconnellc. It’s unlikely that if the US moved to a fully socialised health care system tomorrow their proportion of GDP spent on health would change very much (although there is a lot of profit-taking at various levels which would be eliminated). But over time, the cost controls and efficiency improvements of a government-controlled health care purchasing system would contain costs, so that as the US economy grew the costs came more into line with other countries.

    You asked earlier about information about the cost of oz vs. US health care systems. I think you can find it easily at the OECD website on health statistics, or by searching the journal Health services review. For example,

    http://content.healthaffairs.org/cgi/content/abstract/16/6/163

    although probably you need a university subscription to view it. An approximate figure is Australia, 9% of GDP, US, 16%, UK, 8%. It’s noticeable as well that over the last 30 years US health outcomes have slid down the OECD list, while their costs have grown. If you visit the OECD website you can find an excel spreadsheet with these figures and a whole bunch of information about health risk factors, for which Australia and the US are almost exactly the same. The big difference is that the US population is younger than the UK or Oz, and so should have better health outcomes, not worse. (you can read about this in the journal Health Affairs too).

    For a simple summary though, you could look at this website from General Motors:

    http://www.gm.com/company/gmability/workplace/100_news/120_news/healthcare101.html

    Big Auto has a big interest in changing the health care system, because it is holding back their profitability. Countries like Japan have much lower health care costs and much smaller burdens of health care payment on their large companies (although I think big auto are kidding themselves if they think this is why they are being out-competed by Japanese car companies).

  18. #18 Ian Gould
    July 22, 2007

    “Tax recepits are rarely ever spoken of in real terms and Pved to a past date for the simple reason that expenditure is treated in constant dollars too.

    nice slight of hand, Mr. Mirthless.”

    So by this reasoning economic management in Germany post world War I was a brilliant success since nominal tax revenue rose by several thousand percent.

    Sure prices rose by several thousand percent too but that’s meaningless.

    JC, you CAN’T be as stupid as you pretend. If you were, I doubt you’d be able to type.

  19. #19 Ian Gould
    July 22, 2007

    “Observation on the lowering of taxes is that it increased GNP and reduced unemployment.”

    And observation from the period 1992-2000 is that raising taxes also increased GNP and reduced unemployment.

    Gee maybe there are factors other than tax rates affectign the economy?

    Next thing you know people will be trying to tell me that my brushing my teeth at night doesn’t make the sun rise. After all, one precedes so the other so it MUST cause it, right?

  20. #20 Ian Gould
    July 22, 2007

    “I’m curious about how someone can opt out of the Australian national health care system. If I were to choose to ‘opt out’, do my taxes decrease?”

    Here’s how the Australian health system works:

    - Australians pay 1.75% of income as a Medicare levy on top of income tax.

    - Private health insurance is subsidised and tax deductible.

    - High income earners who don’t have private insurance pay a higher levy. (Or they used too. I haven’t paid much attention to this issue over the past few years.)

    - Members of the public are free to see whatever doctor they like and doctors are free to charge whatever they like. However, the government pays around 85% of the scheduled cost for medical procedures. If your doctor charges more than that, you shoulder the difference. Doctors are required to treat pensioners fro the scheduled fee.

    - The government subsidises the cost of most drugs. But, for example, won’t subsidise a brand-name drug if there’d an equivalent generic. Again, if you want a drug that isn’t subsidise, you can buy it. You just have to pay the full cost.

    - A safety-net arrangement applies where the out-of-pocket expenses for a family exceed a certain level. Above that level the government pays 100% not 85% of the cost.

    - Hospital treatment is provided by for-profit private companies AND not-for-profit hospitals (most of them Church-affiliated) AND public hospitals. All three sectors compete for patients – public hospitals take private patients for an additional fee, private hospitals tender to provide treatment for public patients.

    Australia screws up in any number of ways but we have one of the best medical systems in the world – that’s why 13 years into the reign of the self-described “most right-wing Prime Minister Australia has ever known” the system remains intact.

  21. #21 Ian Gould
    July 22, 2007

    “In other words I’ll take care of my own insurance through the market.”

    You DO know that you can get private health insurance, right?

    And in fact the government will subsidise your premiums?

  22. #22 Jc
    July 22, 2007

    Ian
    Private insurance in Oz covers crap. It doesn’t cover the gap between the Medicare co-payment and the fee(in most cases). It doesn’t cover meds. It more or less covers hospital stays and a couple of other things like vists to the voodoo/witch doctor. In other words compared to the American system it’s a pretty poor insurance coverage.

    Now to give you and example. Let’s compare top of the line cover in Oz/US.

    Bascially US top of the line insurance get you a private room, 100% doctors visits, and you can go straight to a specialist and by pass the GP gate keepers that we have in OZ. It also gets you free meds. There are no co -payments in the top of the line insurance. Now compare that with OZ?

  23. #23 dhogaza
    July 22, 2007

    I haven’t heard anyone suggest any changes the include destroying existing equipment or forcing hospitals (clinics, whatever) to cancel any purchasing requests that they would make.

    Actually this is discussed frequently. Rationalizing the purchase of MRIs and other expensive equipment would be one step towards making the US health care system more efficient. No one’s quite figured out how to make it work, though. Hospitals look at their equipment inventory as being a marketing plus, and as long as those in the system will bear the increased cost (transfered to consumers in the form of higher premiums), they aren’t going to change.

    BTW the description of the oz health care system above sounds much like the french system, as I understand it from my french girlfriend’s discussion of it. I think France came out #1 in the rating system mentioned by Moore in “Sicko” (with the US being #37 and poverty-stricken Cuba #39). My GF is living in Spain, which has a fully socialized system of medicine with private care available at your own expense if you choose. Spain ranks in the top 10 in the world, which given her economic ranking in the EU (GDP per capita 13th in the EU, though she’s closed the gap and is close to France, Germany etc these days) is quite impressive.

  24. #24 SG
    July 22, 2007

    Yeah Jc, and what great insurance coverage you get. A young professional has to pay more than $400 a month to get the stuff you’re talking about just for themselves. For a family you’re looking at upwards of $1000 a month. The cheapest plans for a family can still be $800 a month, and they have massive deductibles. $800 a month is 25% of the take-home pay of the average Australian. Currently that Australian pays $100 a month in the medicare levy, with zero out of pocket expenses outside the drugs they buy – and that $100 a month is NOT in their take-home pay.

    You want Australians to triple the cost of their health care system, and have it come out of their after-tax pay, so you can have a room of your own and not have to pay $15 for drugs? You are stupid.

  25. #25 jc
    July 22, 2007

    SG

    The levy is but a fraction of the 8% we spend on healthcare.

    Do you numbers again and add in the additional money that comes out of general revenues.

    “Yeah Jc, and what great insurance coverage you get.”

    Oh Really:

    http://www.reason.com/news/show/120998.html

    http://www.kff.org/kaiserpolls/upload/7572.pdf

    But his radical prescriptions, which include a call for a British-style, single-payer system, will likely have little resonance with viewers. Indeed, according to a recent ABC News/Kaiser Family Health study, insured Americans are overwhelmingly (89 percent) satisfied with their own care, while broadly concerned about rising costs of prescription drugs and critical of the care others receive

    Despite what the girthed one has told you 89% of Americans are happy with their healthcare.

    I agree. As I said before it is superior to anything you’re used to here. Don’t be scared, SG. the big bad market isn’t going to make you cry.

  26. #26 SG
    July 22, 2007

    Jc, whether the levy is or isn’t a fraction of the 8% we pay, we still pay half what the US does. And remember for all the money that private individuals pay in the US, that much again has to come from general revenues because the government still pays for 45% of US health care. So in addition to their huge private bills, Americans are spending as much as we are through general revenues.

    And while Americans may be happy with their care, this doesn’t change the fact that even though they are a younger population than us with similar risk factors, they have much worse health outcomes.

    i asked you before, that if it is axiomatic that increased competition drives down prices and improves quality, does that mean that the almost entirely government run Australian system is more competitive than the largely private US system? If not, how can you explain the discrepancy? If so, why do you argue the US is better?

    (And no, I won’t answer your question about why health care does not respond to competitive pressures; Ian did. And in any case, if it were true that health care did respond to competitive pressures, can you explain why in the US it does not?)

  27. #27 Jc
    July 22, 2007

    SG

    I’m the good guy here, remember. I have answered numerous questions you have posed and you don’t even show gratitude in return.

    So I’ll ask the question one more time…

    Please explain to the kids why you think healthcare does not respond to market forces? This is not a trick question by the way, so don’t think I’m trying to place your had in a vice and squeeze hard.

    Please try and answer that question in your own words.

    thanks.

  28. #28 Eli Rabett
    July 22, 2007

    “The speed with which you can be seen” in the US is another one of those myths. Mark Kleiman recently wrote about how the delays imposed by the US system came very close to killing him

    Now that Michael Moore’s SICKO has raised again the question why the Canadian health care system functions so much better than ours, supporters of the current mess have gone back to chanting

    “Hip replacement! Rationing! Hip replacement! Rationing!
    Markets! Markets! Markets! Markets! Sis, boom bah! ”

    or words to that effect.The response, of course, is that rationing, including rationing by queuing, is just as much a feature of the U.S. system as it is of competing systems. And while waiting for a hip replacement sounds pretty bad, there are worse things to have to wait for. Take it from me.

    In the spring of the year 2000, after several months of what in retrospect was intolerable negligence both by me and by my internist, I was diagnosed with cancer. I had fancy-dancy health insurance through my employer, which as it happens also owns one of the world’s dozen best medical centers.

    Read the whole sad story (with happy ending)

  29. #29 z
    July 22, 2007

    “The ‘reason’ health care in the US is “expensive” is a few reasons. The number of drugs developed and recouping the R&D costs etc. The speed with which you can be seen. The large numbers of people with no money using emergency rooms for non-emergencies. Per capita incomes. The amount of government control and intervention. The societal makeup of the country.”

    Of course, the fact that you need to shave 7-20% off the gross to feed the shareholders does not raise the costs at all.

  30. #30 z
    July 22, 2007

    “The ‘reason’ health care in the US is “expensive” is a few reasons. The number of drugs developed and recouping the R&D costs etc. The speed with which you can be seen. The large numbers of people with no money using emergency rooms for non-emergencies. Per capita incomes. The amount of government control and intervention. The societal makeup of the country.”

    Likewise, the need for floors and floors full of clerk types who typically have nursing degrees and command nursing type salaries to tell people on the phone “yes, you are authorized to have your broken leg treated in the emergency room yesterday” has no impact on costs, nor does the floor full of highly paid executives who deliver the overall decisions on that, and the floors full of middle management who pass the decisions on. All multiplied by the number of companies, of course.

    Nor does the need for each doctor to spend up to half their highly paid time on the phone negotiating their way through the confusing maze of which company covers what on which date, and which drugs are on each company’s fomulary at any given time, and filling out all the variations on billing forms provided by each company.

    As I’ve posted elsewhere, I just recently gave in to my (highly regarded) insurer’s nagging to get my annual physical. Which was followed, inevitably, by a bill from the doctor for $250 as my insurer doesn’t cover annual physicals, only every 24 months. Which of course was covered by my asking the doctor to resubmit the bill as followups to all the issues previously raised, which it was; which the doctor graciously did, since they have to do it for a huge fraction of their patients anyway. Lucky that none of this impacts costs.

  31. #31 z
    July 22, 2007

    Three months ago a homeless seventh grader in Prince George’s County, Maryland, died because his mother could not find a dentist who would do an $80 tooth extraction. Deamonte Driver, 12, eventually was given medicine at a hospital emergency room for headaches, sinusitis and a dental abscess.

    The child was sent home, but his distress only grew. It turned out that bacteria from the abscessed tooth had spread to his brain. A pair of operations and eight subsequent weeks of treatment, which cost more than a quarter of a million dollars, could not save him. He died on Feb. 25.

    There’s a presidential election under way and one of the key issues should be how to provide comprehensive health coverage for all of the nation’s children, which would be the logical next step on the road to coverage for everyone.

    That an American child could die because his mother couldn’t afford to have a diseased tooth extracted sounds like a horror story from some rural outpost in the Great Depression. It’s the kind of gruesomely tragic absurdity you’d expect from Faulkner. But these things are happening now.

    ”People don’t understand the amount of time and stress parents are going through as they try to get their children the coverage they need, in many cases just to stay alive,” said Marian Wright Edelman, president of the Children’s Defense Fund and a tireless advocate of expanding health coverage to the millions of American children who are uninsured or underinsured.

    Medicaid and the State Children’s Health Insurance Program provide crucially important coverage, but the eligibility requirements can be daunting, budget constraints in many jurisdictions have led to tragic reductions in coverage, and millions of youngsters simply fall through the cracks in the system, receiving no coverage at all.

    http://select.nytimes.com/search/restricted/article?res=F40715F93A550C7A8DDDAC0894DF404482

  32. #32 z
    July 22, 2007

    Fans of the TV series Lost may recall a plot point wherein the young female protagonist’s mother is massively injured in a car crash and she has no idea where she can get the money to care for her; then out of nowhere comes her long lost dad, to cover all the bills. The punchline is, this was supposed to be happening in Australia to Australian citizens. I suspect that in fact, it does not happen in Australia, and the writers are projecting what does occur in the US.

  33. #33 z
    July 22, 2007

    “I haven’t heard anyone suggest any changes the include destroying existing equipment or forcing hospitals (clinics, whatever) to cancel any purchasing requests that they would make. I certainly haven’t heard anything about firing staff. ”

    Actually, in the US healthcare organizations including hospitals are pretty heavily regulated. We don’t have any for-profit hospitals in my state, but the non-profits are regulated as most nonprofit organizations are in most places in exchange for being considered nonprofits and paying no taxes; in particular, starting a new hospital, expanding a hospital, buying hugely expensive equipment like MRI machines, starting a cardiac surgery center where there had been none, etc. all require submitting a certificate of need to the state, which is then reviewed to see whether there is, in fact, a need for said expansion, or whether it’s just a little empire building ploy. They will not approve said application if it turns out that there is not a need for it, and it will only succeed by stealing patients from an already existing facility. And the bottom line is, it seems to work pretty well, there certainly isn’t any clamor to get rid of it because the population is underserved. In fact, outcomes in Canada where cardiac surgery centers, etc., are even more tightly regulated, are better, because as one might expect, the success rate of medical providers is closely tied to the amount of experience they have with that type of service, which is closely tied to being one of a few large centers with a large throughput, rather than giving individual care and attention to the only patient in your local hospital’s cardiac unit, no matter how lavish and personalized.

  34. #34 z
    July 22, 2007

    “And lest you think that this is a small matter, ask yourself what fraction of income people pay for housing these days. (Economists’ claim that land rent comprises about 2% of GDP in the US is a sick joke; the actual number is probably more like 10–20%.)”

    Ah, that’s the kicker alright. “Nickel and Dimed” by Bárbara Ehrenreich explains it well, but just the summaries page from a Google search tells the tale:

    “What percentage of income should go to housing? … All together it should not be more than 28% of your gross monthly income. …

    Federal housing guidelines recommend spending no more than 30 percent of pre-tax household income on housing. To stay within these guidelines

    The federal government states that to be considered affordable, housing should not consume more than 30 percent of a household’s income. …

    HUD Families who pay more than 30 percent of their income for housing are considered cost burdened and may have difficulty affording necessities such as food, …

    In New York City, more than half of all renters now spend at least 30 percent of their gross income on housing, a percentage figure commonly used to …

    In Clifton, N.J., the percentage of mortgage holders spending at least 50 percent of their income on housing rose to 27 percent in 2005 from 12 percent in …

    For example, Southern California suburb Temecula had 74 percent of renters paying at least 30 percent of income on housing, while another suburb in the …

    More than 13 million households pay more than 50 percent of their income …

    The MHC report found that one in eight low income families spent more than 50 percent of its income on housing.

    Specifically it found that Chicago families with moderate incomes (betweeen $20000 and $50000) spend an average of 55 percent of their income on housing (28 …

    About 28 percent of Latino renters paid over 50 percent of income for housing, and had a median income of just $7700 (see table 1). …

    Some 59 percent of poor renters paid at least half of their income for housing in 1995, compared with 20 percent of renters with incomes between 100 percent …

    In 1990, nearly one-fifth (17.8 percent) of all American renter households devoted more than half their income to housing costs.[31] At least one-third of …

    84 percent of all severely cost-burdened households – those spending at least 50 percent of income on housing – are in this income group. …

    In San Diego County, 1 in every 5 renter households spends at least 50 percent of its income on housing, posing economic burdens that show up in …

    Severe housing affordability problems–needing to spend at least 50 percent of income on housing–are limited almost exclusively to low-income residents. …”

    etc. etc. etc.

  35. #35 z
    July 22, 2007

    “Please explain to the kids why you think healthcare does not respond to market forces?”

    Well, that’s kind of a tautology; I think what is being discussed is “why market forces in healthcare do not operate so as to reduce costs to a minimum”

    As has been discussed, the current setup, wherein you are the ultimate consumer; your employer is the indirect purchaser; and an insurance company is the direct payer has somewhat more complex market forces than shopping around for the cheapest price on toothpaste. Those who decry the concept of single payer insurance in the US need to realize that they are not defending the simple free market ideal they idolize, they are defending the system of employer-paid insurance, which is really hard to defend.

    Secondly, there is the problem that economies of scale operate on healthcare in a funny way. On the one hand, as I described above, successful outcomes for risky/difficult procedures are substantially correlated with large centers where the patient is just one small statistic. On the other hand, savings from the kind of blanket pooling of patients done by insurance companies as in “ICD-9 diagnosis 72.33 requires no more than 2 days hospital stay” (numbers made up by myself) cut badly into positive outcomes, as the application of the rule is done by somebody other the actual provider with full information on the case.

    Timing of return on investment is another issue; proper treatment of even things with seriously expensive consequences, like diabetes, high blood pressure, circulatory problems, etc. doesn’t begin to pay off until years down the line, even decades. Currently, the median US insurance “member” changes companies every 2 years, whether because his employer gets a better deal, or because he got a better employer. Thus, company A is putting money into managing the patient’s diabetes in order that company B reap the financial rewards. In fact, it is to the credit of all the major insurance companies that I know of that they do, in fact, sink a lot of money into preventive care, disease management, etc. in the full knowledge that they will not be receiving the payoff from the individual expenditures; however, every company keeps funding analyses to “prove” savings from these procedures, which never pan out because of the lack of longterm followup for enough patients with the same insurer, so even if nobody breaks the unwritten pact and stops providing other insurers with savings while cashing in on the savings from other insurers’ good practices, it does stick a pin in the simplified “market forces” balloon; best healthcare requires ignoring what market forces strongly push.

    And of course, all the usual and obvious factors regarding the lack of interest in or ability of the consumer to rate the provider vis a vis their charges, the lack of even the vaguest information gathered by most consumers regarding said charges, despite the efforts by the insurers to teach the consumers that if they keep an eye on their medical bills it will pay off (see “tragedy of the commons”); the aforementioned tangled conflict of interest between patient, employer, insurance company, and medical provider; the rather special status of keeping alive in the spectrum of things prioritized by what one is willing to pay for them, and what extra one is willing to pay for higher quality, etc. etc.

    Reminiscent of the argument that CEO salaries are not too high, they are set by “market forces”. I have yet to see reasonably reliable any ranking of CEOs in terms of competence and quality, let alone any table estimating what it is worth to a company to get the 14th best CEO in the country instead of the 15th best, and therefore what the optimal premium in salary to hire said individual would be.

  36. #36 SG
    July 22, 2007

    There you go Jc, the second (and more detailed) answer to your question. Now let`s suppose you`re the genius you claim to be, and z is entirely wrong, i.e. that health care responds to market forces. Why is the cost of US healthcare higher and the outcomes worse than a whole host of government systems which aren`t subject to competition?

  37. #37 jc
    July 22, 2007

    Z

    Well, that’s kind of a tautology;

    Hahahah Lol of laughs. Z is now explaining health economics and business finance to the masses when he is isn’t busy with AGW.

    Asking SG a simple question as to why he doesn’t think health economics is responive to market forces is not a tautological, Z. It’s a reasonable question to ask someone who thinks the Soviet model of command and control is er, a little out of date.

    The last bit is the best:

    “Reminiscent of the argument that CEO salaries are not too high, they are set by “market forces”. I have yet to see reasonably reliable any ranking of CEOs in terms of competence and quality, let alone any table estimating what it is worth to a company to get the 14th best CEO in the country instead of the 15th best, and therefore what the optimal premium in salary to hire said individual would be.”

    Shorter Z. Barney Frank and Karl Levin should choose all CEOs’.

    Want to look at decent market based system?…. South Africa of all places is doing it well. It’s a sysetm that is relatively open, competitive and is repsonive to the price signal somewhat.

    http://www.reason.com/news/show/34764.html

  38. #38 krusty
    July 22, 2007

    “Come back here, I’ll bite yer legs off!” – JC

    Stay down JC this is a brutal spectacle, about as fair as a chihuahua in a dogfight. I bet you that if you keep going a fellow libertarian will eventually have to weigh in to shut you up.

  39. #39 jc
    July 22, 2007

    Why the need for that, Krusty.

    “I bet you that if you keep going a fellow libertarian will eventually have to weigh in to shut you up.”

    Any libertarian would just get a kick out reading gibberish that passes for economic thought and people defending command and control theories such as having a singularly bad experience on a hospital stay is the hard evidence required that demand/supply/price signals stop at the doctors door.

    Its funny.

  40. #40 SG
    July 22, 2007

    Still no answer Jc? Why?

  41. #41 SG
    July 22, 2007

    Jc, your amusing little article in Reason (is that where you get all your info?) links to a company which doesn`t have a website; the recruitment page of a private hospital; so we can`t confirm Reason`s facts. The discovery website, however, has extensive information, which confirms that the cheapest insurance – which excludes a whole bunch of stuff, including the famous hip and knee replacements much beloved of libertarian scaremongers, and visits to all but ONE doctor – costs a mere half of the wage of the average maid.

    And of course, Reason neglects to dwell on the fact that private health insurers in South Africa provide a service piggy backing on the state system. I wonder who covers most of the cost of HIV/AIDS management?

    And here`s a great quote from the cheapest health cover, in respect of treatments outside the prescribed minimum benefits:

    We also do not cover the cost of treatment for any complications, or the direct or indirect expenses related to these conditions and treatments

    So if you go get a hip replacement off your own back and there are complications, your health insurance company will see you bankrupt or dead before they cover you.

    You`re selling snake oil, Jc, snake oil.

  42. #42 jc
    July 22, 2007

    SG

    Don’t even show your face to me if you are too cowardly to answer the question I have posed to you time and time again

    Why don’t you think Healthcare doesn’t respond to market forces?

    If you can’t answer that you have no busines talking about anything else..

    Now tell us in you own words….

    Now tell us why the soviet model is superior, SG.

  43. #43 SG
    July 23, 2007

    z has answered you. You don`t have an answer for him do you? And as a consequence you can`t answer my question either. You`re a one track record Jc: “competition good! state bad! You`re a stalinist! nyah!”

  44. #44 Jc
    July 23, 2007

    SG says:
    “z has answered you.”

    He just offered a long winded rant that is difficult to make head of tail of. It’s a lot of wind about the US healthcare system and then offers up as desert some patter about CEO salaries being too high, obviously inferring that Barney Frank and Carl Levin should also set CEO pay instead of the market.

    Oh and I forgot he also argues that economcies of scale are funny in healtcare implying that similar characteristics don’t apply in other ares of commerce.

    This isn’t an economics argument he’s portraying, SG. It’s a tale.

    So I’ll ask you that question again:

    In your own words please tell us why you think market forces don’t work or don’t apply to healthcare?

    If you don’t know just say so. Don’t be scared as I won’t laugh at you for not knowing. So stop hiding behind the towel rack put your clothes on and give it your best shot.

    I give my word I won’t make fun of your answer.

  45. #45 SG
    July 23, 2007

    And in the washup from this little cave troll`s excursion into the sunlight:

    1. no substanstive rebuttal (except insults) is offered by the troll for arguments as to why health care does not respond optimally to competition

    2. no substantive argument (except insults) is given as to why, if health care is responsive to competition, more highly privatised markets deliver lower quality outcomes at a higher cost

    3. claims are made that Australian healthcare provides substandard drugs due to cost-cutting, without evidence; when contradictory evidence is proffered it is ignored (or greeted with insults);

    4. pricing comparisons between the Australian and US systems are ignored (or greeted with insults) and not rebutted;

    5. dubious information about a privatising market is proferred, but mostly cannot be followed up, and when followed up is shown to be misleading (without rebuttal)

    6. much yelling and insulting occurs.

    Another splendid moment in libertarian “intellectualism”. A real truth-seeker aren`t you Jc? And a really professional proselytiser to boot.

  46. #46 Jc
    July 23, 2007

    SG

    Is delusion one of you better qualities?

    The abuse sludging off your key board is getting out of hand yet you accuse me of being abusive? It goes past gall and into the realm of medical science when you see this attitude.

    LOL

    Please answer the question that i have been asking you for a while now. Here I’ll remind you

    Please explain to us why market forces do not and can’t apply to Healthcare….?

    Ivé been asking you to put it in your own words but I’ll let you plagiarze if that gets it out of you.

    You’re a smart guy, give it your best shot. :-)

    Don’t be scared now.

  47. #47 SG
    July 23, 2007

    Now you’re just being silly Jc, sorry, I’m not biting. z responded to your question and you abused him. If you can’t answer z’s points with anything except a torrent of insults, why should I bother?

  48. #48 Ian Gould
    July 23, 2007

    “Bascially US top of the line insurance get you a private room, 100% doctors visits, and you can go straight to a specialist and by pass the GP gate keepers that we have in OZ. It also gets you free meds. There are no co -payments in the top of the line insurance. Now compare that with OZ?”

    you left out one rather critical point – what odes it cost?

    Oh and gap insurance has been available for several years now.

  49. #49 Ian Gould
    July 23, 2007

    Let’s look at an actual example:

    https://secure.medibank.com.au/join/join_result.asp?GID=%7BCC06B408%2D7A46%2D41C2%2DB2EC%2D7A30000A1F39%7D

    Premium cover via Medibank Private for a single adult, which includes pharmaceuticals; dental; optical; guaranteed same day hospital admission; specialist referral and various “alternate therapies (for what they’re worth) will cost you around A$1900 after the government rebate. (That’s currently a bit under US$1700 per year.)

    For someone on $50,000 a year, the medicare levy will be around A$750 (say US$650).

    So the combined total cost for coverage is around US $2400 for full medical, optical and dental. (And yes there’s a co-pay for pharmaceuticals which will max out at around A$20 per script. That’s subject to the government safety net so your maximum meds cost will be around A$500).

    Any Americans want to tell us what a similar level of coverage in the US will cost?

  50. #50 Ian Gould
    July 23, 2007

    “Yeah Jc, and what great insurance coverage you get. A young professional has to pay more than $400 a month to get the stuff you’re talking about just for themselves.”

    Assuming that figure is representative that’s US$4800 per year.

    Or double the Australian cost for a similar level of care.

  51. #51 Ian Gould
    July 23, 2007

    “Indeed, according to a recent ABC News/Kaiser Family Health study, insured Americans are overwhelmingly (89 percent) satisfied with their own care, while broadly concerned about rising costs of prescription drugs and critical of the care others receive

    Despite what the girthed one has told you 89% of Americans are happy with their healthcare.”

    How do we get from 89% of INSURED Americans to 89% of AMERICANS?

  52. #52 Ian Gould
    July 23, 2007

    “Fans of the TV series Lost may recall a plot point wherein the young female protagonist’s mother is massively injured in a car crash and she has no idea where she can get the money to care for her; then out of nowhere comes her long lost dad, to cover all the bills. The punchline is, this was supposed to be happening in Australia to Australian citizens. I suspect that in fact, it does not happen in Australia,..”

    You are correct.

  53. #53 Ian Gould
    July 23, 2007

    Let’s take a look at how market forces operate in the US pharmaceutical industry.

    The drug companies are rational profit-maximising firms. In determining where to invest their R&D budget they look for the following characteristics:

    1. patentable;
    2. treats a condition common in the developed world;
    3. treats a chronic condition (ensures repeat business)’
    4. treats a non-life-threatening/minimally life-threatening condition (reduces the irks of class-action law-suits if something goes wrong.

    So, for example, relatively minor adjustments to insulin formulations are attractive. There are millions of rich diabetics who’ll be taking the insulin for the next twenty years (or until the next improved version comes along.

    Now let’s imagine a one-shot anti-diabetes vaccine. One shot at,say US$300 versus 20-30 years of insulin at $8 per week.

    As a rational conscientious drug company executive where would you put your shareholders’ money?

  54. #54 Ian Gould
    July 23, 2007

    “In fact, outcomes in Canada where cardiac surgery centers, etc., are even more tightly regulated, are better, because as one might expect, the success rate of medical providers is closely tied to the amount of experience they have with that type of service, which is closely tied to being one of a few large centers with a large throughput, rather than giving individual care and attention to the only patient in your local hospital’s cardiac unit, no matter how lavish and personalized.”

    Next you’ll be suggesting for-profit hospital operators have an incentive to perform heart transplants and other high-profile procedures (like separating conjoined twins)almost regardless of their competence in order to get the resulting publicity.

  55. #55 Ian Gould
    July 23, 2007

    “He just offered a long winded rant that is difficult to make head of tail of.”

    For you, perhaps.

  56. #56 Ian Gould
    July 23, 2007

    Let’s take a look at a specific new health product – the Humad Papilomavirus Vaccine.

    In Australia (where JC assures us that pharmaceutical cover is limited to ineffective generics, the vaccine is being provided free. That’s because over the next 20-30 years, the cost will be repaid many times over by the reduced spending on cancer treatment.

    http://www.tonyabbott.com.au/news/Article.aspx?ID=2386

    In the US, unless you’re lucky enough ti live in one of he states which subsidises HPV, the treatment will cost you $140.

  57. #57 Jc
    July 23, 2007

    Ian

    Don’t be silly.

    The medicare levy doesn’t even come close to covering the entire cost the government forks out. The missing funds are paid out of general revenue. You know that.

    Private insurance covers sweet FA here. I used to have the top cover and gave it up because all we seemed to get back was $33 dollars on everything no matter the charge with the rest being co-payments. The other thing is that a private room is bullshit. You don’t get a private room until one becomes available and they never are.

    In any event why do you go straight to the straw man and bring the US into the equation when you have been told time and time again that the US IS NOT A FREE MARKET in healthcare.

    Come on have an honest debate without this obfuscation. It simply detracts for getting to the truth.

    Now you asked the other day why is US healthcare more expensive than other places seeing they spend around 13% of GNP on healthcare.

    Let’s leave aside the fact that from a libertarian argument it could very well be because they want to.

    Let’s leave that aside and go for a few reasons, bearing in mind that it’s an extremely complex subject that people like SG would have difficult grasping J

    Some reasons:

    1. The US spends a great deal more on R&D than other countries that gets factored into the US health costs but doesn’t in other places because they simply don’t spend as much

    2. A lot of what goes into healthcare packages gets prescribed by the states who insist on lots of bells and whistles to cover their political backside.

    3. Violence- more deadly violence than other nations

    4. Free riders- 11 million illegals riding on the system, turning up at public hospitals and not paying the bill.

    5.Injured vets from various wars compared to other places.

    6 Malpractice litigation- more so than in many other places.

    7. More drug abuse than other places

    8. Admin costs- for some reason the level of sophistication in terms of updating this area is behind as there is still a lot of paper flying around.

    9 Compensation. Docs and medical staff are more highly compensated than in other places.

    10 Doctors in the US have greater freedom in setting rates than they do elsewhere.

    11 Drugs. There are laws preventing medicare and medicaid from directly negotiating with the drug companies. The law was set up by the Dems because they think there is too much conflict of interest if they did.

    12 technology per patient. The US is streets ahead of anyone else in terms of the concentration of technology per patient. Use of MRI’s is 30% the rate for Europe for instance compared to the US

    13. Indirect costs. Government mandates in terms of record keeping is much higher in the US. Records have to be kept and layered. See also 8

    14 Health- Americans are big junk food eaters and that has an effect on health outcomes for individuals.

    14 (a) A lot less physical activity causing lots of related health problems.

    15 Employer pays plans instead of single payer system. This has the effect of no one really caring that much about relative costs. Whereas single payer system through a private market would help being a driver in terms of holding down costs.

    Anecdotal. Our last kid was born there. I counted 9 people in the delivery room, which I later found out were covering each in case of a problem that would invariably lead to litigation.

    I keep telling you that the US medical system is not a free market system and you seem to have this mental block in believing this.

  58. #58 jc
    July 23, 2007

    umm dunno what happened to the numbers

    Now the last bit about comparisons:

    “So the combined total cost for coverage is around US $2400 for full medical, optical and dental. (And yes there’s a co-pay for pharmaceuticals which will max out at around A$20 per script. That’s subject to the government safety net so your maximum meds cost will be around A$500).

    Any Americans want to tell us what a similar level of coverage in the US will cost?”

    You’re comaparing apples with oranges.

    Dentist… that’s fully covered in most plans in the US with little co-payment. You end up paying about 45% out of your own pocket here.

    That’s just one example. In most plans in the US you don’t “enjoy” the co-payments we end up getting hit with.

    So you have to compare like with like. It’s like buying car insurance and comparing the cost when there are different deductibles.

    Sg you wanna answer that question I left for you? Don’t be a chicken, SG.

  59. #59 jc
    July 23, 2007

    Ian says:
    In Australia (where JC assures us that pharmaceutical cover is limited to ineffective generics, the vaccine is being provided free

    Ian , will you please stop this nonsense. You got to get it out of your head that this is free. it isn’t “free”. It is paid for by the government. It isn’t bloody free.

    this is the real problem in Oz (to all our American cousins). The place is littered with people who think like ian: that if the government offeres us something it is free of cost….as though no one is paying for it. You wouldn’t believe how deep socialist thinking is here.

    You can get a hammer to their heads and they still think the same way.

    That’s it for me.

  60. #60 SmellyTerror
    July 23, 2007

    Please explain to us why market forces do not and can’t apply to Healthcare….?

    But… aside from the answers you got but said you didn’t understand (“…difficult to make head of tail of”), think about the point given to you over and over:

    Australia’s system is less exposed to market forces. Yet it is much better. So if healthcare does respond to market forces, then it’s in a negative way.

    See? If the answer to your question is yes, you lose. If it’s no, you lose. Why do you keep asking a question that leads inevitably to your own bollocking?

    The stats are in. It doesn’t matter how many anecdotes you have about the undiluted awesome of the US system, the stats show it to be worse for outcomes than the Australian model, at a greater cost. If you have stats to show otherwise, planet earth would love to see them.

    And just to add yet another answer to your famous question, in case you’re planning on bringing it out again: if I have appendicitis, I need my appendix out. That’s it. I don’t have any other options. So I can choose to have it out successfully, or… what? Can I get a cheap option, where they take out, say, my tonsils instead? Or go to a cheapo place that’ll take the right organ, but give me life-threatening complications? No?

    There is rarely any choice involved in medical care, and even when there is it is simply a choice between courses of care. You don’t “shop around” – you just get the best you can get. Every single time a consumer will simply choose the best possible quality they can afford. It’s not a choice, it’s an asset test. You can’t just die a little bit. Medical care is either best practice, or it’s killing people. Those are the options.

    Do you see how this is different for food shopping? I might like brand X, or brand Y, I might be happy with the cheaper brand, I might like to buy something completely different tonight. I might buy stupid stuff on a whim that I hate, or forget to buy something I really need. I can wander into the supermarket and just let brand recognition, habit, and packaging guide my purchases. I’ll frequently buy something I’ve never heard of simply to try something new. But I won’t die. There’s plenty of scope for competition because there is a lot of room for variation.

    Importantly, there’s no scientific test to say one option is better than the other. In medicine, there is.

    If, at the supermarket, brand X was safe, and brand Y killed 3% of the people who ate it, no-one would buy brand Y. Unless, of course, they HAD to pick one or the other, and they couldn’t afford brand X.

    Once again, this is not a choice, it’s an asset test.

  61. #61 Eli Rabett
    July 23, 2007

    Someone want to post outcomes where the US scores better than other industrialized countries on health related issues?

  62. #62 Ian Gould
    July 23, 2007

    Don’t be silly.

    “The medicare levy doesn’t even come close to covering the entire cost the government forks out. The missing funds are paid out of general revenue. You know that.”

    Yes ansd neither does the US insurance cost come close to covering the full cost. We’re comparing what you as an individual pay. In fact, my figures are overly generous to the US since the US government also pays money out of general revenue for health care costs. So really, US costs are more than double.

    “Private insurance covers sweet FA here. I used to have the top cover and gave it up because all we seemed to get back was $33 dollars on everything no matter the charge with the rest being co-payments. The other thing is that a private room is bullshit. You don’t get a private room until one becomes available and they never are.”

    So basically you’re claiming that Medibank Private is engaging in fraudulent advertising?

    I guess that’s one way to deal with unpleasant facts.

  63. #63 Ian Gould
    July 23, 2007

    “Now you asked the other day why is US healthcare more expensive than other places seeing they spend around 13% of GNP on healthcare.

    Let’s leave aside the fact that from a libertarian argument it could very well be because they want to.”

    Riiight – and maybe there are more homeless people in the US because they just happen to enjoy hypothermia more.

    The point isn;t that the US spends more on healthcare – its that they spend vastly more with equivalent or inferior results.

    If you paid $100,000 for a car would you be satisfied if it did 15 miles per gallon and had a top speed of 100 KPH?

    “The US spends a great deal more on R&D than other countries that gets factored into the US health costs but doesn’t in other places because they simply don’t spend as much”

    Right, because US medical corporations don’t sell their drugs and equipment internationally and recover psrt of their R&D costs by doing-so.

    Also IS R&D expenditure, as a percentage of GDP actually higher in the US? I’d like to see some support for that claim beyond “I read it in a book”.

  64. #64 Ian Gould
    July 23, 2007

    “10 Doctors in the US have greater freedom in setting rates than they do elsewhere.”

    You mean their cartel has greater freedom in abusing their market power? Agreed.

    “11 Drugs. There are laws preventing medicare and medicaid from directly negotiating with the drug companies. The law was set up by the Dems because they think there is too much conflict of interest if they did.”

    Actually those laws were introduced by Republicans (Do the names Bill Frist and HealthSouth ring a bell?). The Democrats have now repealed them.

    Coming soon from JC-land “Between 200 and 2008. Democrat President George W. Bush massively increased government spending.”

    Hopefully now the US government agencies will be able to do what governments around the world have been doing for decades – use their market power to force down prices. Of course, in a so-called free market system this would be impossible since there would be no government purchaser of health-care services.

    “12 technology per patient. The US is streets ahead of anyone else in terms of the concentration of technology per patient. Use of MRI’s is 30% the rate for Europe for instance compared to the US”

    Yes, meaning that Europeans aren’t being conned into paying for unnecessary full-body scans as a preventative measure. These scans carry with them a (very small) risk of cancer but have next to no medical value.

    But hey the doctor gets his kick-back from the pathology company.

    “I keep telling you that the US medical system is not a free market system and you seem to have this mental block in believing this.”

    No, I simply think it’s largely irrelevant to the discussion.

    The current US system represents possibly the worst imaginable mix of government and market forces. (Worst from the perspective of the people paying the bill, best from the perspective of the people collecting the money. This is where the names Frist and Healthsouth pop up again.)

    The question is what should replace it?

    1. A system already in place (in various permutations) in dozens of other countries which has been proving to save money and make people healthier or
    2. the system which applied through out the world up until the 1930′s which delivered far worse outcomes.

  65. #65 Ian Gould
    July 23, 2007

    “Ian says: In Australia (where JC assures us that pharmaceutical cover is limited to ineffective generics, the vaccine is being provided free

    Ian , will you please stop this nonsense. You got to get it out of your head that this is free. it isn’t “free”. It is paid for by the government. It isn’t bloody free.”

    It is free to the consumer at the point of application.

    Now will you stop with the nonsense about how the US doesn’t spend massive amounts of government money subsidising health care (in a hugely inefficient fashion.)

    After massive hand-outs, Merck STILL gets away with charging $140 a dose in the US. (Oh and the R&D for this one was all done right here in Australia by CSL. Merck is just the licensee.

    As I’ve already pointed out, HPV vaccination should save the health care systems billions. Getting as many women vaccinated as possible should therefore be a priority. In the US system, if the state governments don’t step in and subsidize it, who will?

    Let’s take another example, in Australia insulin and blood sugar testing supplies for diabetics are subsidised. In the US, they aren’t.

    Guess which country has a much higher rate of blindness and amputation resulting from complications to diabetes?

    What do you think makes more economic sense? Subsidising insulin by a couple of hundred dollars a year or losing thousands of people a year from the workforce due to complications from untreated diabetes?

  66. #66 Ian Gould
    July 23, 2007

    http://en.wikipedia.org/wiki/Universal_health_care#Universal_health_care_economics

    From wikipedia (and therefore subject to the usual caveats)

    Doctors per 1000 persons:Australia 2.47; US 2.56; France 3.37%.

    So Americans aren’t paying for more doctors, they’re just paying more for doctors.

    Nurses per 1000: Australia 9.71 US 9.37.

    Dollar health care cost per person: Australia: US$2519; US $5711.

    Percentage of government revenue spent on health care: Oz 17.7% US 18.5%.

    Percentage of health care costs met by government: Australia 67.5% US 44.6%.

    Got that, people? The US government already spends $5711 x 0.446= $2547 per person on health care. That’s more than the combined total cost (public and private combined) in the UK or Australia.

    If the US system were as efficient as the British or Australian system it could more than half the total cost of health care while providing universal coverage. Hell if just the government spending component were as efficient as in Australia, you’d save around US$900 per person per year.

    That’s $270 billion a year – hell that’s more than the current US budget deficit isn’t it?

    But think of the Healthsouth share price!

  67. #67 Ian Gould
    July 23, 2007

    Oh and those Australian co-payments that JC complains about?

    Those are an example of those market forces he claims to love.

    This is in opposition to the US system of government-subsidised insurance with minimal co-payments which ensures that the person making the buying decision (the insuree) is largely indifferent to the additional cost of the additional and often unnecessary services the US for-profit service providers pad out their bills with.

    At the same time, the person footing a big chunk of the bill (the US taxpayer) has no say.

  68. #68 oconnellc
    July 23, 2007

    This is the sort of thing that gives many of us pause when we consider putting the federal government in charge of anything else. What I think many of us would like to hear is something that realistically makes us think that the new health department won’t become an equivalent to the IRS or drivers license bureau or passport office…

    http://news.yahoo.com/s/ap/20070723/ap_on_go_co/subsidies_dead_farmers;_ylt=Aq8C.VpblmKH9GNxjIM47xsb.3QA

  69. #69 Ian Gould
    July 23, 2007

    You wouldn’t need a huge new bureaucracy.

    Here’s an outline of what I’d do:

    1. Convert a stack of existing funding into a credit for every American worth about $1500-2000.

    2. People with existing private insurance could use that money to go towards paying for their coverage. People in corporate schemes could either opt out and get private cover or surrender the credit to their employer.

    3. Private insurers would tender for the right to provide basic health cover to people currently uninsured. There’d be competitive bidding, minimum service standards and the total premium couldn’t exceed the credit.

    A thousand dollar credit for every American would cost around $300 billion. You’d get most of that back by shifting people out of Medicare and Medicaid into private insurance. You’d significantly reduce the cost of private insurance and the health costs of private businesses would reduce significantly.

    There’d also be major savings from including preventative health care in the basic insurance. What’s cheaper – spending $10 on folic acid tablets for a pregnant woman or spending thousands on her premature baby’s health care?

  70. #70 jc
    July 23, 2007

    Excuse me Ian, but why do you think that would be a far different proposal from the one I would support.

    Pity you had to go find the straw man and impugn racism otherwise we could have got there after three comments.

    So you do recognize there is a reason to have market forces working in healtcare?

    What from I understand of your system:

    Offer vouchers and then let the people choose their providers by going to a single payer type system. Is that correct? Is that how I am understanding it?

    Pity you don’t support that for Oz.

    The LDP proposal is a voucher based system too.

    If SG is on his medication today may be he could answer the question i posed him.

  71. #71 Ian Gould
    July 23, 2007

    Market forces can apply in some segments of the health care system and no-one here has ever denied it.

    The argument has been over your view that complete unconstrained market forces will solve all problems.

    And the system I proposed of government subsidies for private health insurance accompanied by a safety net is quite similar to the Australian system.

    But given the different histories of the two countries and the different structures of the health sectors in each (e.g. the much larger role of private hospitals in the US system) you’d expect there to be some differences.

  72. #72 Ian Gould
    July 24, 2007

    The LDP’s policy is hilarious:

    “By cutting back the proportion of health care funded directly by government and re-aligning incentives, enormous savings can be made by reducing the waste and excessive costs of a public system.”

    Yeah just because we have about the lowest-cost health-care service on the planet there’s no reason to assume we can’t achieve “enormous” savings.

    “At the same time, relaxation of regulatory controls will allow new organisations providing health services to emerge that will help to limit costs while improving quality.”

    Laetrile here were come.

    “The LDP will deregulate the health insurance market to facilitate a wider range of innovative policy options. This will enable the introduction of policies based on recognition that good insurance should not attempt to cover for low-cost events that are a threat to nobody’s security, but must cover the high-cost events that can cause financial ruin.”

    Yrah deregulation worked so wonderfully well in the general insurance industry here. its jsut what health insurance needs.

    Of course that “…not attempt to cover for low-cost events…” means scrapping cover for most conditions currently covered. So you’ll no longer need to worry about “co-” part of co-payments JC, you’ll be on your own footing the full bill. Of course, the option of going to public hospital clinics won’t be available either seeing as that’s where those massive cuts will be being applied. Still the deregulated market in kidneys and corneas will open up exciting new avenues to pay for Little Johnnie’s braces and grandma’s rheumatism medicine.

    I”nsurers will be at liberty to offer incentives for preventive healthcare such as weight control, solar protection, diagnostic screening and ceasing smoking. Consumers will be able choose for themselves whether to take advantage of these.”

    Private insurers already do this. But if in future they’re only insuring for catastrophic life-threatening conditions they’ll have less incentive to do so.

    “Instead of limiting the availability of screening tests, diagnostic and treatment facilities to what can be made available to everyone – whether people want them or not – an increased range of options would then become available to those who want them. ”

    Yeah increasing unnecessary testing levels to US levels is obviously the way to limit costs.

    “The LDP would reform access to pharmaceuticals so that pharmaceutical prices were deregulated but consumers were able to maintain access to high priced products through insurance.”

    So the optional private health insurance industry will pay whatever the pharmaceutical industry cartel wants to gouge them for. Of course, people who aren’t covered by insurance (or whose policies were with NRMA)will be able to explore the new pain management options opened up by the relaxation of the drug laws.

    “Pharmaceutical companies would set their prices according to market forces – ”

    Yeah because huge unregulated companies with patent monopolies are famous for their lack of market power.

    “Injecting competition into health care will assist the disadvantaged.”

    Yeah, better a quick death than a life of humiliation on the dole.

    “while we would all like to assist the poor, we do not wish to encourage over-consumption of scarce health resources by providing blanket subsidies. The poor should be asked to first appeal to the generosity of their local communities. ”

    The LDP: bravely forging a path froward into the 18th century.

    “The LDP believes government should intervene only on a case-by-case basis, where other avenues have been exhausted.”

    Yeah but obviously making that case-by-case analysis will take zero time and generate zero paperwork seeing as waiting lists and bureaucracy will be eliminated. Maybe it’ll be as simple as presenting your Party card at the local LDP Gauleiter’s office and hoping he’s in a generous mood.

    Interestingly, the word “voucher” doesn’t appear anwyhere in the policy which rather tends to contradict JC’s claim that it’s a “voucher-based system”.

    So let’s hope those “massive” cuts are sufficient to offset JC’s loss of his 30% tax deduction for insurance premiums and the added cost of all those non-essential tratments no longer covered by insurance. (Although given that we’re told endlessly that the insurance industry will be deregulated and consumer choice will be expanded you have to wonder how the LDP can determine in advance that the range of conditions covered will decrease.)

    In fact, there’s no suggestion I can see after a quick

  73. #73 Ian Gould
    July 24, 2007

    Continued:

    In fact, there’s no suggestion I can see after a quick perusal that there would be any form of subsidy or assistance to pay for insurance premiums.

  74. #74 jc
    July 24, 2007

    “The argument has been over your view that complete unconstrained market forces will solve all problems.”

    When did I ever suggest it would solve ALL problems. Stop being silly. I inferred we would end up with a better outcome….. and we would.

    I believe the old soviet model of command and control cannot work and ends up with a worse outcome than if the market was allowed to figure it out. So stop being a dinosaur.

    What i find hilarious is that you would allow a sort of voucher type system to work in the US (sort of), but you seem to think we are unable to have one here. Now that’s racism: a form of inbuilt low expetations.

    The LDP policy would offer superior outcomes because it is market based, responsive to conusmer wants and it would allow specialization and segmentation: two elements that create efficiences.

    Ian, you need to get it out of your head that our Healthcare is cheap. It isn’t cheap and it isn’t that fantastic. Just because a great deal of the funding comes from general appropriations doesn’t mean it’s free. You got a figurative clip over the ears for thinking like that in an earlier comment and you continue to do it. Stop it right now.

    Get out of your socialist dinosaur costume and join the modern world. You’re smart and will be able to see it.

  75. #75 oconnellc
    July 24, 2007

    I guess I’m not convinced about how efficient things will get. From the research I did, it looks like the Commodity Credit Corporation makes about $5B annually in direct payments to farmers (http://www.usda.gov/agency/obpa/Budget-Summary/2006/06.FFAS.htm). Over seven years, that is roughly $35B. During 7 years, they gave about $1.1B to dead people. That is somewhere between 2% and 3% of the budget. And we see this level of accountability from the schmoes responsible:

    John Johnson, a deputy administrator for the Farm Service Agency, said there is no indication that the payments were improper

    Seems reasonable…

    So, the proposal on the table is to create a new government branch responsible for doling out $450-$600B annually (the $1500-$2000/person number). Of course, we spend $5000/person annually, so that puts us at a $3000/person annual shortfall. I can imagine that maybe we don’t need all the insurance companies we have, but I can’t imagine how many choices I will have left once the CFO’s start to do the math. Of course, the government agency responsible not only for doling out the cash but verifying that every policy meets the government standards will not become a big beaurocracy.

    There is a lot of hand waving about why costs will go down. I agree that once we get a certain segment of the population to stop going to the emergency room when they have a cold, costs will decrease. But, from reading here, I was under the impression that are costs are due to equipment and number of staff. I keep reading in the paper and hearing from a couple friends who are nurses in hospitals that there is a nursing shortage. And, despite our current luck to be a young country, in the next 20 years, we are going to get real old, real quick. Of course, I agree that folic acid tablets are a good way to spend money. But, that doesn’t change the fact that culturally, here in the USA, we are fat lazy slobs who are way overweight, don’t exercise and have many health problems because of it. Myself included. I’m sure a bunch of new “Wellness” programs will be created at almost no cost, but in the meantime we will keep eating Doritos and buying those little gizmos that strap around the waist and use electric impulses to work your abs and driving to the Taco Bell drive-through (ummm… Nachos Bel Grande!).

    According to this study: http://www.cdc.gov/od/oc/media/pressrel/r040121.htm
    about 5% of all health care costs are due to obesity ($75B). I don’t see how changing who pays will change that. Also, the prevalence of obesity is much higher in that population we are hoping will see the greatest costs decreases once they get insurance. I don’t see that happening. I may get crucified for this, but obesity is due to lifestyle. A small percent may choose to change, but I don’t believe that the people with the worst health in this country will suddenly decide to change the way they live.

    Sorry, but I’m not convinced that anyone here actually has an idea that will make a difference.

  76. #76 Jc
    July 24, 2007

    Continued:

    In fact, there’s no suggestion I can see after a quick perusal that there would be any form of subsidy or assistance to pay for insurance premiums

    That’s because you stopped right there and didn’t read the rest of the platform.

    You would find that the party supports a negative tax up to the tax free threshold of Aprrox. $30,000.

    The effect is it would immediately end the churning where now 40% of each dollar going in to the government’s coffers costs 40 cents more when it comes out to be spent.

    That’s called churning, Ian, something you and your socialist dinosaur mates seem to think is quite ok despite the inefficiences that are created such as the countless tax eaters working for the government who process all this expenditure.

    You got to get it out of your head that money coming from the government is free , ian. You’re not getting a bag of goodies for nothing.

  77. #77 Jc
    July 24, 2007

    oconnellc
    You can’t change the composition of health spending if people don’t get off their butts and exercise. However a recent Harvard study showed that advances in medical assistance has generally reduced weight related illnesses to the extent that fat bubblers are living that average life span.

    That’s a good thing but it adds to medical costs compared to say Euroland where people like the Frog version of Algore and Michael Moore tell us to consume less. Meanwhile they’re gorging on the 6 big macs at one sitting 6 times a day and endangered fish species as desert.

    It was Ian who said US med coost were much higher than elsewhere…. If you look up the thread you will see I gave him he reasons why, which he indigantly ignored.

  78. #78 SG
    July 24, 2007

    Jc and oconnellc, you might need to look elsewhere for your excuses for bad American Health. They have very similar rates of obesity to, and exactly the same rates of smoking and drinking as, Australia. As for higher drug use – australia has one of the highest rates of heroin overdose death in the world.

    However, America has a younger population which means it should have much lower rates of chronic illness and palliative care costs. By your logic America should have better health outcomes even if its health care system were only as bad as Australia’s. It doesn’t.

    If you doubt these facts, look them up at the OECD. Not that jc ever allowed the facts to interfere with a good story.

  79. #79 SG
    July 24, 2007

    And JC, in response to your question that you still seem to think hasn’t been answered (or is this a personal vendetta?) I give you the wisdom of SmellyTerror (which of course you conveniently ignored):

    Australia’s system is less exposed to market forces. Yet it is much better. So if healthcare does respond to market forces, then it’s in a negative way.

    See? If the answer to your question is yes, you lose. If it’s no, you lose. Why do you keep asking a question that leads inevitably to your own bollocking?

  80. #80 SG
    July 24, 2007

    Here Jc, is a response to some of your other points (the ones Ian didn’t cover), which are strangely reminiscent of a Republican talking-points paper (though more poorly written).

    2.A lot of what goes into healthcare packages gets prescribed by the states who insist on lots of bells and whistles to cover their political backside.

    So state intervention pushes up the price of healthcare. Meanwhile, here in our command and control socialist health system (or should that be stalinist?) where there is more state intervention, prices are … lower.

    3.Violence- more deadly violence than other nations

    If you ask Ben you’ll find that the US has a similar rate of assaults to the rest of the developed world, but a higher rate of gun deaths. In any case, these people are much less likely to be insured and are covered in these cases by the state system or by state emergency departments, so there is no particular reason to think they are pushing up the price of private health cover.

    4. Free riders- 11 million illegals riding on the system, turning up at public hospitals and not paying the bill.

    Ah, blame the foreigners… thought you didn’t do race baiting? And if these people are turning up at public hospitals how are they pushing up the price of private health care?

    5.Injured vets from various wars compared to other places.

    Now, is it not the case that the Department of VA is the cheapest health care provider in the US? And isn’t it held up by conservatives everywhere as a model of the evils of cheap and nasty socialised health care…? So how is this pushing up the price?

    6 Malpractice litigation- more so than in many other places.

    I’ll grant you that. But if you fiddle around on the web you’ll find papers discussing this, which argue that ultimately it doesn’t reduce the rate of serious injuries much at all relative to no-fault systems.

    7. More drug abuse than other places

    Drug abuse goes in cycles, so how come health prices just keep rising? Also, see my previous comment – heroin overdose in Australia is extremely high by world standards but strangely hasn’t inflated our prices. I wonder if this is because they their narcan free, so mostly don’t end up at emergency wards? That’d be that old $100 vs. $10,000 dilemma.

    8. Admin costs- for some reason the level of sophistication in terms of updating this area is behind as there is still a lot of paper flying around.

    Once again we see how the market always extracts maximum efficiency from its participants. Perhaps if the government mandated efficiency to these market players they would pick up their game?

    9. Indirect costs. Government mandates in terms of record keeping is much higher in the US. Records have to be kept and layered. See also 8

    This is padding. It’s the same as 2 and 8.

    14 Health- Americans are big junk food eaters and that has an effect on health outcomes for individuals.

    14 (a) A lot less physical activity causing lots of related health problems.

    Australia and the US have very similar profiles of risk factors for lifestyle diseases, but Australia has lower rates of these diseases. You could work this out for yourself if you knew how to research facts. See Ian Gould’s example of diabetes for more information.

    15 Employer pays plans instead of single payer system. This has the effect of no one really caring that much about relative costs. Whereas single payer system through a private market would help being a driver in terms of holding down costs.

    Yes, because those private enterprises like GM and Ford have absolutely no interest in keeping down their costs, and won’t be using their role as a bulk buyer of health insurance to force down prices as much as they can. And it certainly is the case that GM have no interest in health care costs…

    Really Jc, is this the best you can do? Mindlessly reciting idiotic excuses for mediocrity from republican health industry shills? Or did you read these pearlers in Reason magazine, home of the broken link?

  81. #81 Jc
    July 24, 2007

    SG, you come out of the swamp every day or so fling around figures you think sound good, throw abuse around, and pretend you’re an expert but are still unable to answer the question. Other than kneejerking back to your socialist reference guidebook, you’re unable to answer the question.

    I’ve told you more than a few times that using the US as a comparison does not substantiate why market forces wouldn’t provide a better outcome, yet you continue to go back to that coffin trying to resuscitate a dead corpse.

    Let’s offer a hypothetical for a moment. Let’s say that every single comment you have made is right on the ball (they aren’t of course but let’s pretend). You have still been unable to answer the question as to why you think market forces don’t apply to health care.

    That’s because you can’t.

    Old socialist dinosaurs like Ian at least try to debate and isn’t afraid to answer questions. He inadvertently (AlMOST) got to the market solution by arguing for competitive tender in the US health market (incidentally, Reason argues the same thing… of sorts)

    I’m afraid your socialist knee jerk response has let you down, SG. You can’t answer the question because you’re unable to. Now please dive back to that sorry swamp you live in.

    If you have a change of heart and decide to take a stab at it here’s a clue for you.

    You need to tell us why the price signal wouldn’t work in healthcare and why the command and control system is better.

    Come on now: don’t be scared. Give it the old socialist bash. Everyone’s supporting you. Even me and I gave you my word as a gentleman that I won’t laugh at the final result.

  82. #82 Jc
    July 24, 2007

    SG says

    “because those private enterprises like GM and Ford have absolutely no interest in keeping down their costs, and won’t be using their role as a bulk buyer of health insurance to force down prices as much as they can. And it certainly is the case that GM have no interest in health care costs…”

    SG

    Do you even understand what it is you’re saying here? You are actually trying to suggest that GM and Ford both of whom may end up going broke because of the healthcare issue aren’t interested in keeping their costs down in healthcare.

    Now I’m not going to add this to the other sorry comments you’ve made because I don’t like seeing blood in this quantity splattered all over the floor.

    I’ll just kindly ask to take it back and nothing willl ever be said about this again.

    Ian can you please help him? He seems to listen to you for some unknown reason.

  83. #83 SG
    July 24, 2007

    Jc, I have been trying to argue with you in good faith. Not the good faith that you actually care about exchanging ideas, or even earnestly responding to a point. But the good faith that you can read. Yet here you are interpreting my response to your last point as serious.

    You can’t read irony? That means you have misunderstood probably upwards of half the comments directed at you on this thread. I can only assume you’ve misunderstood all of them, because that last comment was so obvious only a drooling idiot could miss it. See those little ellipses at the end? I even included them to make the hint and you still missed it.

    My god.

  84. #84 SG
    July 24, 2007

    Oh and Jc, now SmellyTerror has also answered your question. That’s 3 times your question has been answered and ignored. Yet you still want me to have a bash?

  85. #85 jc
    July 24, 2007

    SG

    That was supposed to be funny? Yep your right the thre “dots” gave it away.

    Errrr, ok. If you say so SG. It’s hilarious.

    “Yet you still want me to have a bash?”

    Why not? Let’s judge you from the your serious side of irony then.

    —————

    I missed the Rmelly Rat’s response. It’s a truly pathetic attempt at explaining the economcis side. It’s another rant this time adding the violin teasing comment about needing to get your appendix out and other drivel about how best practice etc. is somehow analogous to the question asked.

    You give it a try, SG. Even someone semi-literate in economics could do better.

  86. #86 stewart
    July 24, 2007

    Now, given there actually IS a field of health care economics (like, with journals and EVERYTHING), JC and Oconnelc might be able to look up the information they want on this topic, to inform their opinions from folks in the field.
    Really, there is no such thing as a free market in health care, for the reasons Ian Gould mentioned above, as well as the reasons that the most effective health care interventions are typically the ones delivered at community level, and the people most in need of health care interventions are the ones with least money. If you can get used to stepping over sick people in the street, you can substantially reduce costs.

    I think this goes to the point of this and the next post. Libertarians are committed to an ideology, to the point of beleiving it applies everywhere, good and hard. All who disagree are fools and frauds (what was that about climate science, or health care..) Or, if it conflicts with another belief (say, Al Gore is the antichrist), then they’ll dump their libertarian positions (that markets can provide informations about better and worse options) and argue that ‘food labelling is all nonsense, you’d have to check the whole supply chain yourself’.
    I can see libertarianism working quite well in a 4 to 5 person, all-adult household. I just can’t see it working well beyond that, based on the reactions I see on this blog.
    So, about that Jason Soon… perhaps response number 1 (disagreement must be with malice and stupidity aforethought?)
    Time for another open thread,Tim? We can even mention the Canadian health care system again.

  87. #87 SG
    July 24, 2007

    perhaps the hilarious Jc doesn’t understand that irony isn’t always meant to be funny? I wasn’t trying to make a joke, dear.

    Oh and look, having asked me to answer a question you insult someone who has without responding to the points contained therein. Yet strangely you think I’ll bother…

    No Jc, I think you’ve done your dash here. You can crawl back to your slimy little libertarian burrow and pretend you won the mighty health care argument, having proven to all and sundry once again that libertarianism is nothing but piss and vinegar, and its adherents ignorant pigs. Well done!

  88. #88 mndean
    July 24, 2007

    Hmmm. The mighty morphin’ Jc (or is it jc?) cannot understand irony. Maybe it’s a bot? Would explain its rather mulish behavior as well.

  89. #89 jc
    July 24, 2007

    Stewart

    I don’t think you can say that all libertarians think AGW isn’t a potential problem. After giving it some thought i think there is a cause to be concerned.

    However where a lot of us part comppany with the socialists is the ways in confronting it.

    Forgive me for saying this but spending $us trillions of dollars over this century through a socialist plan such as Kyoto to achieve a tiny fall in temps isn’t going to cut it.

    It will impoverish us and not get the job done.

    There is tons of better ways to do it.

    The issue with healthcare economics isn’t a free market doesn’t exist in the modern world but that people seem to think that it wouldn’t work with a superior outcomes. It’s not factual that we have never had a free market in healthcare. Healthcare only recently became socialized whereas historically it has always been a free market.

    It is however quite difficult to make comparisons to earlier times for the obvious reasons to do with relative per cap population wealth etc. But the point is that there has been a free market in healtcare from a histoical perspective longer than the current soviet style command and control system people like SG slavishly adhere to.

    It’s just that socialist dinosaurs use myths and lack of knowledge of economics to disguise the fact they know sfa about the subject and try to scare the kids.

    However healthcare is a great place for the free market to to its thing. Its very large so economies of scale would set in along with the interplay of the price signal and people would take advantage of the various points of the demand and supply curves. You would see a lot more specialization and consumers would have a great deal of choice.
    ——————–

    SG, you asked if I wanted you to answer the question. I repsonded in the affirmative and now you again play these silly childish games. You’re a joke.

  90. #90 SmellyTerror
    July 24, 2007

    JC, you’ve refused to listen to plain english descriptions of why you’re wrong, phrased in multiple ways by multiple posters. You fail over and over again to address the issues, and simply resort to incomprehensible insults (“Rmelly Rat”? What does that even mean?). Do you honestly expect to convince anyone of your position by repeatedly unzipping your ignorance and waggling it around?

    The Australian system is better than the US one, and it costs less. http://www.who.int/whr/2000/en/whr00_en.pdf All your theory-crafting can’t get you over this plain, simple fact. It doesn’t matter how you think economies “should” work. You’re wrong. Look at the facts.

    It’s like a guy saying the sky can’t be blue, because air doesn’t have a colour. All his theories and extrapolations can be vigorously argued, and he may even convince himself that he’s right – but only if he ignores the shouts of everyone else to just LOOK OUT THE DAMN WINDOW!

  91. #91 Jc
    July 24, 2007

    ST
    Surely you are kidding aren’t you? I have been called all sorts of names here. Being referred to as an ignorant pig by SG is the latest example.

    Look, let me explain this one more time and hope the kids here learn something. I have explained to you that the US is not an example of a free market in healthcare ad nauseum and yet the tipsters bring up that straw man as some sort of affirmation it is. It’s not. Period.

    I blame the Gould for that shallow bit of obscuration as he tried to conceal realities. I explained to him why I thought the US system is superior to ours from a personal perspective and he turned that into some quasi racist routine. (Superior but not a free market one). It is ok to compare to rigid socialist models and argue which one is better.

    We have then gone back and forth enduring this silly comparison between fairly complex systems of command and control.

    In all that I asked SG (happy feet) a very simple question seeing he’s like a member of the ancien regime (trying to protect the Bastille from being overrun by “ignorant pigs”) as to why he thinks market forces and the price signal (later added) didn’t work when it came to health care.

    He’s literally frothing at the mouth that I had the nerve to ask him that question. Did you see him? Foam is pouring between his fangs s he darts in and out of the dark swamp.

    It’s an honest question that doesn’t deserve all that tactical abuse he’s thrown my way. You either answer the question or you say you can’t. It is not as though I haven’t tried to answer his. He even asked me if I wanted him to offer answer but he just slinked away into the cloudy water again.

    Now quite honestly I took a look at your comment and it would grade it an F because it didn’t answer the question. It isn’t asking about comparison shopping between various systems or just how terrific the OZ system works. I’m asking you to explain how the price signal would fail to work, why a demand curve wouldn’t slope downward (Giffen goods, Ian….I know about them) and why we wouldn’t experience all the factors that impact markets. It’s about service delivery and the cost of such delivery.

    Forgive my naivety but I was always lead to believe that market based outcomes were always superior to the soviet model of command and control. The most obvious place you would see competition is through insurance providers. Arguing there would not be any competition is like suggesting the sun won’t rise tomorrow. Even Ian recognized that but suggested we don’t need it because ours works just fine while the US needs a change to a competitive model. How slick!

    Sorry about scoring your comment so low but SG forced me to as he thought it relieved him from having to present his thesis as to why a socialist system is superior. Funny isn’t it: that’s what he believes in but can’t articulate why.

    Why is that SG?

  92. #92 SmellyTerror
    July 24, 2007

    Healthcare does not follow the usual form of competition because the options are often “live” or “die”. No-one picks “die” if they can afford “live”, no matter the inducements. There is the scientifically determined best-practice, or there is sub-standard care. That’s it. There’s no room for competition in there. What product could you possibly offer that could substitute for best practice?

    “Oh, this treatment is less likely to cure you, but it comes in a great range of flavours!”

    The same set of trade-offs and cost-benefit analyses you can have for other products can’t apply here. There is one best option. Any room to move in product differentiation has to be outside the basic healthcare outcome. And that’s where we get the bounds of Australian private health insurance. You can pay more for a nicer room, or faster non-essential surgery. You can’t pay more to live when someone without money would die.

    No-one, not one person on earth, would choose to tick the box that says “this product may result in you watching your child needlessly die in pain”. Every single person wants the option that gives their kid the best chance. Every one. So by giving people the “choice”, you get UHC.

    The free market does not provide choice in this case, it limits it. It means that some people can’t afford the thing they would choose if they could. If there are people who can’t afford care, then you have removed their choice.

    Does anyone, anyone at all, who wants “free market” healthcare, who wants to get rid of UHC, actually want to do that so they themselves can have less cover, or no health care at all? Are you chafing at the bit to go un-covered? No? So why the hell do you think anyone else wants to make that choice? You are offering a “choice” that no-one would voluntarily make.

    It seems to me that you are merely trying to take cover away from others in the hopes that it’ll make your own cover better. That’s just repellent.

  93. #93 SmellyTerror
    July 24, 2007

    Actually, I don’t know why I’m bothering to make any kind of coherant reply to JC. It’s not like his posts actually make any sense. Any point he’s trying to make seems to be buried under kind of surly, half-assed ramble.

    Here, I’m going to try to translate the last JC post. Please let me know where I’ve misunderstood…

    From #191:

    ST Surely you are kidding aren’t you? I have been called all sorts of names here. Being referred to as an ignorant pig by SG is the latest example.

    I got called names, so I can call other people names. The fact that the names I call people make no sense is a sign of my superiority.

    Look, let me explain this one more time and hope the kids here learn something. I have explained to you that the US is not an example of a free market in healthcare ad nauseum and yet the tipsters bring up that straw man as some sort of affirmation it is. It’s not. Period.

    The US system can’t be used to compare because it’s not free…

    I blame the Gould for that shallow bit of obscuration as he tried to conceal realities. I explained to him why I thought the US system is superior to ours from a personal perspective and he turned that into some quasi racist routine. (Superior but not a free market one). It is ok to compare to rigid socialist models and argue which one is better.

    …but it can be used to compare when I use it. I also blame Gould for using the issue to obfuscate, even though I use it too, presumably to clarify.

    We have then gone back and forth enduring this silly comparison between fairly complex systems of command and control.

    The system I say is better is too complicated for me to prove it’s better. You just have to trust me.

    In all that I asked SG (happy feet) a very simple question seeing he’s like a member of the ancien regime (trying to protect the Bastille from being overrun by “ignorant pigs”) as to why he thinks market forces and the price signal (later added) didn’t work when it came to health care.

    SG (insert random nonsensical insults – is “happy feet” even an insult?) got asked a question…

    He’s literally frothing at the mouth that I had the nerve to ask him that question. Did you see him? Foam is pouring between his fangs s he darts in and out of the dark swamp.

    …and was strangely annoyed when I ignored the answer over and over again, seeing as I was too busy mindlessly flinging insults that make absolutely no sense.

    It’s an honest question that doesn’t deserve all that tactical abuse he’s thrown my way. You either answer the question or you say you can’t. It is not as though I haven’t tried to answer his. He even asked me if I wanted him to offer answer but he just slinked away into the cloudy water again.

    Now SG doesn’t like me, and actually seems offended at my repeated insults and refusal to address the issues (see this post as an example).

    Now quite honestly I took a look at your comment and it would grade it an F because it didn’t answer the question. It isn’t asking about comparison shopping between various systems or just how terrific the OZ system works. I’m asking you to explain how the price signal would fail to work, why a demand curve wouldn’t slope downward (Giffen goods, Ian….I know about them) and why we wouldn’t experience all the factors that impact markets. It’s about service delivery and the cost of such delivery.

    I think your post was disagreeing with me, so it must be wrong. I transparently didn’t bother to read it beyond the bit quoted by SG, and I sure as hell won’t try to deal with the issue. I also won’t read the rest of the post, just in case it answered the question I need to say wasn’t answered.

    Forgive my naivety but I was always lead to believe that market based outcomes were always superior to the soviet model of command and control.

    Insert staggeringly stupid, unsupported assertion here. Make sure it also contains a laughably feeble straw man.

    The most obvious place you would see competition is through insurance providers. Arguing there would not be any competition is like suggesting the sun won’t rise tomorrow. Even Ian recognized that but suggested we don’t need it because ours works just fine while the US needs a change to a competitive model. How slick!

    Complete misrepresentation of Ian’s argument here, just in case people didn’t already think I was an idiot.

    Sorry about scoring your comment so low but SG forced me to as he thought it relieved him from having to present his thesis as to why a socialist system is superior. Funny isn’t it: that’s what he believes in but can’t articulate why.

    Wait, this is a hard one. I suspect this paragraph was machine translated a couple of times. No literate human could have written it as is…

    …um, I think it says: your points are incorrect because another poster quoted you and he is yet to answer my question enough times for me to notice. I am smugly confident of my own superiority because I’m just too stupid to realise my feeble arguments have repeatedly been smashed in this thread. Willful ignorance is the one unassailable defence, and I’m going to stick to it.

    Why is that SG?

    I forgot who I was replying to. Wait, who am I? What’s going on? Where are my pants?

    …was that too mean?

  94. #94 oconnellc
    July 24, 2007

    I guess I’m still not convinced. JC or SG may or may not be a poo poo head. But someone proposed the US government spending $1500-$2000/person/year to cover $5000/person/year worth of expenses. The fact that the US population is about to get really old, really fast leads me to think that costs/person/year will probably go up. I’m not sure what I am being accused of thinking about that fact, though. But I believe it will probably go up because of that fact. I’m not sure where the shortfall in costs/person/year will be made up.

    I believe that costs will probably come down if we can get the poorest in our society to take a little better care of themselves, and not use emergency rooms so much.

    I do not believe that putting the US government in charge of another ~$600B/year will cause that money to be spent more efficiently. Here in the US, no government body has ever done anything efficiently. Many government bodies have done good things, but never efficiently (please see Department of Defense, any US Public Schools, Department of Agriculture, Dept. of Homeland Security etc. etc). The next incompetent boob fired by our government for being an incompetent boob will be the first.

    And so, it doesn’t really matter how we got to where we are. We are here. Any proposed solution must be based on where we are. The US population is about to get older, and need more expensive medical care then needed in the past. I don’t see how the US government controlling prices by law will help things. We have tried similar things in the past, and they didn’t work. Why will it work this time?

  95. #95 oconnellc
    July 25, 2007

    I found an interesting statistic. This was my source: http://www.abc.net.au/news/stories/2006/04/24/1622228.htm

    I’m not sure if the news is the best source of facts or not, though… Anyway, the statistic is that the number of obese people in Southern Australia has almost doubled in the past 18 years.

    Now, with only casual consideration of the situation, I would guess that to continue to provide these overweight people with proper healthcare, the healthcare spending would have to increase proportionatly. Or, the Australian healthcare system has found a cost free way to care for the ailments that go along with obesity (heart disease, diabetes, high blood pressure). My guess is that the latter did not occur.

    I would view this as an opportunity to vindicate the Australian healthcare system. Someone like JC would assert that Australian healthcare is not in a position to provide adequate healthcare to these people. As such, there would be no increase in spending. Someone like SG would assert that the system is capable of caring for these people, and so expenditures would naturally rise to account for the added cost these people.

    (As an aside, I would think that a statistic like this would go a long way to proving that obesity is related to lifestyle and not genetics. Unless there is some rampant gene splicing going on down under that we haven’t heard about)

    So, my (admitedly casual) research has not revealed these numbers to me. Does anyone care to chime in on my hypothesis? Or help me out by providing some numbers?

  96. #96 Ian Gould
    July 25, 2007

    “I believe the old soviet model of command and control cannot work and ends up with a worse outcome than if the market was allowed to figure it out. So stop being a dinosaur.”

    You also apparently believe in a binary choice between totally unconstrained market forces and soviet-style communism.

    “What i find hilarious is that you would allow a sort of voucher type system to work in the US (sort of), but you seem to think we are unable to have one here. Now that’s racism: a form of inbuilt low expetations.”

    what I find hilarious is that you can;t get it through your head that the current US system is vastly different to the Australian system and I’m proposing a voucher-based system there because it fits better with their current model meaning transitional costs would be lower.

    “The LDP policy would offer superior outcomes because it is market based, responsive to conusmer wants and it would allow specialization and segmentation: two elements that create efficiences.”

    I love how you can read a lengthy detailed analysis of the policy’s faults and respond simply be repatign the party mantra.

    “Ian, you need to get it out of your head that our Healthcare is cheap. It isn’t cheap and it isn’t that fantastic. Just because a great deal of the funding comes from general appropriations doesn’t mean it’s free. ”

    The simple fact which I have pointed out repeatedly is that the total cost of the Australian health system is less than 2/3s that of the US system. Whether the money comes from the medicare levy, general tax receipts of private spending that fact remains.

  97. #97 Ian Gould
    July 25, 2007

    “So, the proposal on the table is to create a new government branch responsible for doling out $450-$600B annually (the $1500-$2000/person number). Of course, we spend $5000/person annually, so that puts us at a $3000/person annual shortfall. I can imagine that maybe we don’t need all the insurance companies we have, but I can’t imagine how many choices I will have left once the CFO’s start to do the math. Of course, the government agency responsible not only for doling out the cash but verifying that every policy meets the government standards will not become a big beaurocracy.

    There is a lot of hand waving about why costs will go down. I agree that once we get a certain segment of the population to stop going to the emergency room when they have a cold, costs will decrease. But, from reading here, I was under the impression that are costs are due to equipment and number of staff.”

    The figure of $15-2000 would not cover the total cost of health care. It would cover basic insurance for the current uninsured and subsidise the cost of insurance for others.

    Forcing insurers to compete on cost would reduce excessive capital investment over time.

    You aren’t going to sort this mess out overnight.

    But you better start sorting it out soon or its going to bankrupt your government and large sectors of the private economy.

  98. #98 Ian Gould
    July 25, 2007

    “You would find that the party supports a negative tax up to the tax free threshold of Aprrox. $30,000.”

    So a “negative income tax” = “healthcare voucher”

    “Some times Winston 2+2=4. Sometimes it equals “3″ or “5″. It depends on what the Party chooses.’

  99. #99 Ian Gould
    July 25, 2007

    JC”Violence- more deadly violence than other nations”

    You know I overlooked this one earlier – there’s only so much stupid I can deal with at a time.

    Let’s see, the excess of US healthcare costs over the OECD average is roughly $3,000/capita or ca. $900 billion per year.

    There are approximately 10,000 homicides per year in the US.

    Let’s assume every single one of them costs the health care system $1,000.000. That’s $10 billion a year or around 1% of the additional cost.

    That’s based on a hugely inflated cost of medical care per case AND an assumption of a zero homicide rate in the rest of the OECD.

  100. #100 Ian Gould
    July 25, 2007

    SG: “Jc, I have been trying to argue with you in good faith. Not the good faith that you actually care about exchanging ideas, or even earnestly responding to a point. But the good faith that you can read. Yet here you are interpreting my response to your last point as serious.”

    SG, JC is,I fear, a lost cause.

    But I am assuming that there are other people more amenable to reason also reading this.

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