Whoa, what?!

I'm 100% pro-immigration. I'm just saying that Americans are not Britons, just as Canadians are not Americans. We have completely different societies. If we learn anything from Iraq, to quote an example, shouldn't it be that social systems require proper context to be effective?

ADismalScience

Dickdogfood

Moff

In other words, we have lots of immigrants, right? Well, Canada has one of the highest immigration rates in the world. And a much smaller per capita GDP than the U.S., yet is somehow able to maintain a health system that's far, far, far more popular among voters than anything in the U.S.

...That's all for me today. It's been fun, you fascist bastard!

Botswana Meat Commission FC

"And everyone HAS TO HAVE IT, thus expanding the risk pool to all Americans."

Well, everyone who drives has to have it. And there's a presumption that if you can afford a car, you can afford the costs that go with it. Also, everybody doesn't have to have it so much as not get caught not having it. And if they catch you, the worst thing that happens is that they take away your license or fine you or possibly throw you in jail (but probably not). So anyway, I know no analogy is perfect, but how much water does the car one hold?

On the other hand, does mandatory health insurance mean companies can't deny coverage to high-risk applicants? What happens if you have to have health insurance but no one will sell it to you at a reasonable price?

(Note: These might be stupid questions; I didn't get that much sleep last night.)

Moff

A few problems with the discussion so far:

The "other countries" polemic doesn't work for me for a number of reasons. America has a very different demand profile and infrastructure design that places different pressures on its health care system. Furthermore, Britain and Canada are riddled with examples where there is de facto denial of service; the British dental system is an excellent case study of the phenomenon. It is 100% the fault of a rationing-based cost-control process that limits choice and constrains supply creation.

Car insurance is actually a GREAT example of why the insurance model for health care is a good idea! It has good incentives: personal poor behavior or unsafe habits make you more expensive. The structure is risk-based. And everyone HAS TO HAVE IT, thus expanding the risk pool to all Americans. Consequently, safe drivers defray some of the cost from unsafe drivers right up until the point that they're considered unsafe enough to expel from the pool. The same process would be used to expel chronically ill patients from the health care system. I mean yeah, cruel, but less cruel than denying care based on age. Life is a limited-resources problem.

The biggest problem with health care today is that not enough young men and women pay for it. If you expand the risk pool to them, it will help float the health costs of baby boomers. Combine that with a freedom of choice and you'd even maybe make it efficient!

@Corydon:

Define life-saving care! Or better yet, bury the concept in horrible American faith-based shit bureaucracy for 20 years. Even scarier than the economics is the fact that you'd be handing the debate over defining coverage structure to one of the most divided Governments in the world vis a vis patients rights and acceptable medical practices.

ADismalScience

Not only does the man command a spaceship, he can also READ YOUR MIND. If that's not elitist, I don't know what is.

ByOsmosis

Mediahohoho

Mediahohoho

LoveHandles

That would indeed be repugnant. However, I'm not aware of any healthcare system in the developed world that denies life-saving care. On the contrary: people who need life-saving care are bumped to the top of the list ahead of those needing only elective procedures.

It's a simple matter of triage.

Corydon

Mediahohoho

Man, you had me right up to this point. The funny thing is, in most of the developed world where they have got some form of socialized health care or some variant of socialized insurance, they spend less than the US does, people are more-or-less happy (or at least happier than we are), and everyone gets covered.

I'm a big fan of policies that actually work, not forming an ideological picture of the Way the World Ought to Be. Thus, I buy the idea that the free market is not ideal but is the best solution in most situations.

Health care seems to be one of those situations where it is not the best solution. I've reached that conclusion by drawing on my own experiences and that of family and friends living here in the US, in Canada and the UK (not to mention any reading on the subject that anyone with an internet connection can easily do).

Personally, I think that the insurance model is a terrible one to apply to health care. Insurance protects you against unlikely but catastrophic events. I'm unlikely to have a car wreck. I'm unlikely to have my house burn down. But if it does happen, insurance protects me.

Health related catastrophes aren't just likely, they're inevitable. We're all going to die after all, and many of us will suffer crises before that point that will require expensive treatment over a long period of time with costs that can be very difficult to quantify (unlike a car wreck which happens once: the insurance company deals with it and it's over).

I'd also point out that the US system already engages in some pretty severe rationing of health care. It justs rations on the basis of how much money you have to spend.

Corydon

Rationing makes no sense from an economic perspective. Demand-side pressures should be restrained organically by pricing. Otherwise, you remove the supply-side desire to tailor innovation and capacity increases to the client base, effectively limiting available care.

You also mentioned the scary prospect of essentially constraining costs by limiting service. You would deny life-saving care on an artificial basis? What's next, a sliding age-based scale of what care you're allowed to receive? This is infinitely more repugnant than demanding someone simply pay the price. Also, economically, the fact that you're even considering rationing should be a pretty big hint that you're looking to install a terrible system.

ADismalScience

Moff

PattyCake

A lot of anti-single-payer people trot out horror stories about waitlists in Canada, but rationing makes sense from an economic and public health perspective.

Also, the idea that people will suddenly gorge themselves on healthcare seems far-fetched. Will people over-consume past the point of useful preventive care just because it's free? I have a hard time buying that. Most of us hate going to the doctor enough to avoid unless we truly have to.

Botswana Meat Commission FC

You're spot on! You really are!

That's exactly where I'm at, honestly. I understand that purist capitalism often fails to deliver unless it's overseen by non-economic adjudicators of fairness and responsibility. That's the whole point of regulation, which I'm strongly for.

However, you have to START at a concept of choice, and continue to include choice and competition as the primary drivers of a robust social process. Too many people start at the end result or the entitlement: "All Americans will have health care!" That's the wrong approach; you wind up with something expensive and broken that biases the outcome to the usage.

Be usage biased! Start with: "All Americans CAN have health care!" and then start reinforcing the behaviors that cause people to choose health care and choose it wisely. Use regulation to modify unfairness, but sparingly and only when the cost of unfairness exceeds the cost of the cure. That way, you empower people while allowing market forces to create efficient socioeconomic structures.

ADismalScience

At some point this becomes less about reason and more about how we've each chosen to view the world. I think we're there. I respect your choices and values, but I do not share them. You have every right to disagree with me on the bases you've chosen - for example, denying medical care for the pursuit of the Greatest good or most appropriate incentive structure is abhorrent to some. It's hard to see the later for the now, especially when the now is sick and crying for help; morals often don't even consider the later in such circumstances. Which is fine; I get that. I just won't agree to policy based upon it.

ADismalScience

the market economy as taught in econ 101 is a lovely abstraction

unfortunately, the world doesn't work like that

if_i_only_had_a_heart

i do believe there is room in a market economy to make people's lives better, not worse

the race to the bottom is not a pretty sight

and i do believe that nafta has turned out to be an ugly lie that has benefitted owners and ruined swaths of communities of (former) workers

if_i_only_had_a_heart

Dickdogfood

As well they should.

Moff

"Sometimes I wonder if you aren't the biggest idealist around here. It's beautiful, man."

Yes! And it is beautiful.

Moff

TheHonJudgeSmails

I hold it as axiomatic, but a great deal of Monetarist research exists that validates my theory. Neo-Keynesian economists, of course, have conflicting information. The truth, as always, is somewhere in the middle.

ADismalScience

Of course, when you promise me free choice, I have to wonder about how free that could ever be at the supplier end of things. Getting back to the premise of this post, do I have any reason to believe that the boards of the biggest insurance companies would not get together to decide rates, reimbursement, procedures allowed and effectively slap down any smaller providers impertinent enough to offer lower rates or better service? After all, it's the history of commodity capitalism in America--from oil to labor and most of the reason for the reform movement and regulation in the first place. Call me a skeptic, but I just don't have that much faith in my fellow humans

Sometimes I wonder if you aren't the biggest idealist around here. It's beautiful, man.

Mediahohoho

if_i_only_had_a_heart

Health care becomes complicated because it's not like other businesses. It's one thing to say, "Let's go with the cheaper widget as a component for our gizmo, and the gizmos might not last as long, but what the hell," and another entirely to say, "Let's let them see a doctor, but if they want the MRI, they're gonna have to cough up $10,000."

Moff

the health care needs of the workers are treated in the old supply/demand model as an externality -- something that someone else pays for

a longsighted society would see that better educated healthier people would be more productive, as well as happier, and that would be good for everyone. and they would have shorter workweeks and better schools for their children

or you can just grind the workers down to nothing and build a lot of jails to put them in after you ship their jobs overseas to prison labor

markets are not very good at short term vs long term

if_i_only_had_a_heart

and setting a decent floor is a requirement for a decent society

if_i_only_had_a_heart

if_i_only_had_a_heart

oh yeah and the stealing part. kbr is good at that, too

if_i_only_had_a_heart

i think it comes down to this: as a society we can build schools or we can build prisons

if_i_only_had_a_heart

"And ultimately, capitalism always does a better job providing services to paying customers than governments"

if_i_only_had_a_heart

Isn't that a strong argument for consumer choice, though? It says to me that clients of insurance companies should be given more power to vote with their dollars and stick it to overpriced or stingy insurers by going elsewhere.

The market isn't being ALLOWED to be intelligent. Health insurance is either granted at the employer level or purchased from a limited pool at the individual level when it isn't being overtly supplied by the gubmint. If the market were liquid and involved movement, you'd see quick gravitation to high-quality, low-cost outfits as competition and consumer intelligence took the reins from corporate/government bureaucracy.

This is why I like McCain's recent proposal - it's the closest I've seen to a political argument for complete privatization of health care.

ADismalScience

Moff

Freshrinse

Mediahohoho

Mediahohoho

Moff

Botswana Meat Commission FC

J.D.Regent

TheHonJudgeSmails

Moff

J.D.Regent

I really believe there are ways to make the more long-term incentives clear and to make changes by influencing the monied class that way. And I think we'll start to see it happening more in the near future (barring catastrophe). We've seen more change in the last ten or twenty years than most humans before us did in a lifetime, so obviously, we're in the process of making adjustments. And consequently, it should be no surprise that so many people are keen on clinging to older ways of thinking.

Moff

Mediahohoho

Helman

We don't have to worship efficiency in the short run. Look at what the baby boomers did to you with the Federal deficit, for example. They lived very well by accelerating future resources to be consumed in their life spans.

The problem with social democracy emerges when said social democracy is no longer able to fund its activities with debt. Then, you're simply paying for a Federalized service. And ultimately, capitalism always does a better job providing services to paying customers than governments.

You've confused the unsustainable largesse of the past few decades with economics. It's a common mistake.

ADismalScience

TheHonJudgeSmails

Don't get Morality confused with Necessity. I mean, yeah, I get that certain things seem unpalatable to a moral mind. I get sad when I buy wheat futures because I know that somebody in Africa is going to starve. But ultimately, the market justifies my decisions; Supply and Demand are the only real adjudicators of human existence.

ADismalScience

economics as a profession has moved on from rational man theory to a more behavior based approach that has a lot more to do with the real world where actual people live

finally

if_i_only_had_a_heart

and more efficient to deny schooling to people who need extra help

we don't have to worship efficiency though

if_i_only_had_a_heart

the countries with more commitment to a social contract are winning on almost every measure

if_i_only_had_a_heart

Mediahohoho

Botswana Meat Commission FC

Capitalism being what it is -- an abstract paradigm, rather than a set of explicitly structured goals that may not be relevant at a different place or time -- it's responsive to changes in our cultural mind-set. It can be a pain in the ass to make those changes, but it's heartening to know that (1) they can be made, thanks in part to the fact that capitalism encourages diverse thinking, and (2) that because the most successful strategies in capitalism operate on the principle of self-interestedness, when one works, it comes into play more organically and not in the form of a policy handed down from On High.

Moff

Now with industries with revenues that would trump Allison's and Denton's lifetime revenues in a matter of hours in a day, do you think they would not work together on ideas that would reap billions? Are the commenters here, so stuck in their cubicles that they can't understand human nature? Collusion happens everyday, it is a fact rich people will work with others to become richer and guess what? except for the instances of exploitation (entertainers, worker bees, prostitutes, politicians) the only other people who can help rich people make more money are RICH PEOPLE!

Freshrinse

Efficient does not belong in the same sentence as Universal Health Care or Education. In fact, the inefficiency of such pursuits is why they're always unsuccessful. It's much more socially efficient to deny care to certain folks. Of course, I take issue with the selection/incentive mechanism we've established in America, but honestly it's a beautiful day and health care just makes me all blustery.

ADismalScience

ByOsmosis

I'm just like Jack! Only I'm unattractive, unfunny, young, and without pretension to the GE throne.

ADismalScience

SinisterRouge

Fair point. Such complaints are valid; I'm not saying that capitalism is Perfect. Just best.

For the next phase of this classic debate, define a system that does a better job. I'm going to go get a sandwich. If you can name a practical social system that can exceed capitalism's ability to provide equality of opportunity I'll choke to death on it om amazement.

I mean, it's not like we haven't been working on this since Socrates.

ADismalScience

Not so good at providing, say, efficient universal health care and public education.

Botswana Meat Commission FC

bittergreen

Botswana Meat Commission FC

I think a good way to describe capitalism is not so much as the best of our options but as the least worst of them.

@Phyllis Nefler: Exactly. Besides, if I did, my connectedness rating would take a huge plunge.

Moff

SinisterRouge

Phyllis Nefler

Also, for you commies jumping on ADismalScience just realize that neither a socialist nor a communist system would ever have produced Gawker. Chew on THAT!

SpecialK

Priam

SinisterRouge

famousauthor

Our job as responsible capitalists is to continually erode these factors without tipping the balance too far in the other direction.

For the most part, I'd argue that Western Civilization has been doing this job, albeit slowly, for the past 2 centuries or so.

TheHonJudgeSmails

SinisterRouge

Capitalism by itself does a pretty lousy job of providing equlity of opportunity. There's plenty of wasted/unrecognized human talent out there and plenty of lucky chumps who just happened to gain success by being in the right place at the right time.

Botswana Meat Commission FC

SinisterRouge

Moff

SarahHeartburn

TheHonJudgeSmails

famousauthor

surfacenoise76

Dickdogfood

Mediahohoho

flossy

BalknChain

dandles

SinisterRouge

Mediahohoho

SinisterRouge

Mediahohoho

His little "not so much" and "it's a good thing" asides are positively vomitous.

One other thing: is Denton on this list or not?

Dickdogfood

SinisterRouge

Rothkopf: fucking duh. That's kind of the point. Ask anyone who works for a living what their biggest challenges are. It's always stuff like getting buy-in, achieving consensus, sitting through meetings, etc. That's because 1 intelligent, talented human being is almost always more effective than dozens of mediocre ones.

Capitalism creates this structure because it's the most efficient way to run a society. It's a natural outgrowth of the way humans are wired. It isn't intended to provide the structure of equality that makes sense in kindergarten; rather, it's intended to maximize the efficacy of all participants. That, by definition, will require separating wheat from chaff and concentrating power in the hands most fit to wield it.

The great thing is, in our society your efforts will be recognized. You are socially mobile. If you don't see that or believe that, it's because you're less talented, smart, or hardworking than you think you are and you've got sour grapes about the whole thing. Right, David?

ADismalScience

richardmarxhatesmyhair

frobisher

gawksFromaRock

vulturesquadron

SinisterRouge

TheHonJudgeSmails