03 September 2009
eh
This has been making the rounds on social networking, etc.
There are several problems.
1) There isn't a bill in front of Congress to do anything like what it suggests should be done. More over there isn't even enough popular (much less corporate and medical lobbying) support to get a bill like that introduced into Congress. Consider how much resistance taxing employer benefits or, to a lesser extent, the half-breed of a public option have encountered. Then imagine how well actually putting into the public an actual radical overhaul, in either direction, would go over. To put it mildly, I have only faint hopes that anything sensible will emerge anyway. But I have no hopes that anything useful will (and for the purposes of this argument, useful might even include a universal single-payer system).
2) Out of all the arguments for a nationalized health care system, the demagoguery of profits is probably the worst one possible to make. Non-profit administration of something does not necessarily make it efficient or provide optimal social results. In fact, quite often it is one of the worst ways possible to provide an optimal result. See: road congestion pricing versus present or education cost inflation.
3) More over, the entire problem of non-profit does not actually address the issue of cost. To my mind the highly inflating future projected cost is probably the foremost reason to address this issue with any reform to begin with, with some safe assumptions being that reducing inflating costs to a modest inflationary rate can bring it in line with people who cannot presently afford health care or health care insurance. "Free" in slogans does not equal free in economics. This has a cost to someone somewhere. Some of these costs are hidden or are opportunity costs (costs of sacrificing innovation or research). Some of those can be recaptured. Other costs are not so obvious but become apparent when you examine the health care issue as a portion of the general economy. A large portion. Every dollar which is spent on health care becomes a dollar that is not spent on something else. Such as education, police, infrastructure, military, whatever your preference. If our dollars on health care are not spent wisely and efficiently to begin with, something our present government programs do not do, then we have all sorts of major distortions in other price markets.
4) Now it might be sensible to argue that consumers really want to spend one-sixth of their incomes on their health care needs as they do presently. But if that's the case, they should be receiving a greater, more transparent, and more obvious value for the money they spent in terms of health care outcomes (which we do not). And they should also consider that lots of places, even places with universal single payer plans, spend a lot less than we do. Maybe people in Singapore just don't care as much about health care as an industry, but spending about 3-4% of the entire economy on health care sounds more reasonable to me than 15-18% and counting. It's probable that a healthy balance can or would be struck somewhere in between 3 and 18% and that this balance would result in a greater value and great health overall anyway. People just aren't spending their money on health care outcomes right now at all. And I have not seen a strong case that they would do so any better with the government footing the bill instead of private markets (preventive care does not even rely on a government system, it's just difficult to do in our current heavily regulated and largely insurance funded system).
5) Health care, to me anyway, has yet to be demonstrated to be either essential or a right. I think a strong case can be made that health as a component of general well-being and happiness could be construed as an essential right. And that protecting the general health of the citizenry would be construed as a legitimate function of the government, such as by using environmental or safety regulations. It does not automatically follow that health care, defined as a large and expanding bubble of goods and services, is a human right. In opposition to something like food, which we cannot survive at all without, health care is not a basic necessity for someone. It is, in effect, a consumer good which people choose how much or what kind to consume.
6) There are distributional problems with the way access to health care occurs which can be viewed as suboptimal for the provision of public health. And I accept that this means we should probably have some form of government health care (or a subsidy for private health care) for people who cannot afford it. But this is not the same as claiming some sort of provisional right to distribute health care as we see fit to ourselves. I agree completely that people really seem to want health care and therefore should be able to find access in the event of emergencies that require treatment (cancer, broken bones, etc). That's why insurance exists in the first place: emergencies. It isn't that difficult to expand access to people who cannot afford the cost of insurance. But this is not the same as a suggesting a requirement for single-payer health insurance.
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3 comments:
I got issues with #5, but not enough to time as of yet. If I remember, I'll get to that one later.
Outside of emergency care for injury or sudden onset of disease I don't see what the problems would be. And really all I did when I popped a ligament in my foot was wrap it and stay off extensive exercise for a few weeks. Which is basically all a doctor could have done for it.
I think there is a weak case that access to health care is important and that that should be distributed in relative fairness. But the question of what "access" means is so bound up in individual and subjective determinations that any attempt to distribute socially health benefits is practically useless, much less the attempts to define this away as an inherent moral right. It exists more as a developed legal right out of the possibilities of a modern human society.
It becomes really difficult to claim that it is a "right" in the sense that human beings should not be denied it in whatever manner they please for any price imaginable, as with the sort of basic rights that we might normally speak of, free speech for example (it amuses me that we have a government that's capable of restricting our negative rights, but it's perfectly interested in expanding positive rights, this isn't a Democratic problem per se, they both do it). The basic difference is that most of our negative moral rights do not consume anything at all. My thoughts and opinions do not consume other people's thoughts and opinions out of existence. Health care by contrast does. As a result it has a condition of scarcity. Decisions to apply health care to the aid of one person can affect, even eliminate, the ability to aid and comfort another person. Where it doesn't do that, it eliminates the ability to educate, or police, or save for retirement. It consumes resources generally that negative human rights which are constitutionally guaranteed do not and can not. So I again think there's a case to be made that "health" is in and of itself a useful right of some sort, but there isn't a way to define "health care" so easily as anything other than a valuable consumer good which can contribute, sometimes critically, to "health". I do think it's perfectly fine or reasonable to apportion resources for health care so as to insure some level of distributional fairness in terms of accessibility to quality of care and basic health, but it's generally better economically if consumers have most of the controls rather than as a claimed right. Right now they have almost none at all, so I am no less a supporter of doing something. Just not what that video purports to sell. And certainly not in the way it sells it.
A wealthy society certainly can afford to provide health care, much cheaper than we do here, but I think talking about it as a right is just an shortcut excuse to have government provide it rather than to look at the most serious problems and solve them. There are compelling economic or philosophical cases to make for that case (and some not so compelling as that video showed), given some externality benefits and costs for public health and safety. But talking about health care as a right is not a compelling case. In fact, if you wanted to make the strongest possible case for universal single-payer health care, it's almost certainly one of the first things you would throw out of the argument. You would immediately have to move to a paternalistic grounding, that people would, in a market system, misappropriate their social and moral rights to health care on other "frivolous" things, things which other people might subjectively value more than a few extra weeks of life, or provide themselves with the wrong care (more commonly).
I think if one looks strongly at Singapore, that's more or less what they settled on as far as the arguments. They (the government) provide health care for catastrophic events, but the business of basic health maintenance is largely privately concerned, and mostly paid for with mandatory savings (in the same way OASI sort of works).
Now if all somebody means is that a person does have the right to use their own resources, or a fair share of societal resources, to provide themselves with health care or the access to such care, that's actually a bit different than an unqualified right to health care within a society. That's more or less operating like a contract enforcement at that point and not a moral guarantee.
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