ACA Repeal/Replace: Progressives Face Moral Dilemma

[Warren Dew]

(01-25-2017, 05:19 PM)David Horn Wrote:

(01-24-2017, 01:33 PM)Warren Dew Wrote:

(01-24-2017, 01:21 PM)David Horn Wrote:

(01-22-2017, 11:48 AM)Warren Dew Wrote: The reason it's stupid to tie health care to employment is because then the incentives are misaligned between the payer - the employer - and the patient, resulting in inefficient allocation of resources.  That problem applies in spades when you tie health care to the government.

What's needed is for people to pay for their own health care, whether it's directly or through an insurer.  If you really want to subsidize it, give everyone a voucher or a universal basic subsidy.

Healthcare is not a product or even a service in the commercial sense.  It has more in common with fire and police protection.

To the contrary, health care is comprised mostly of services and some products.  There's no fundamental difference between prescription drugs and, say, vitamin D pills other than distortions imposed through regulation.  There's no fundamental difference between the market for doctors and the market for mechanics.

You have an ailment that your fee-for-service doctor indicates is rheumatoid arthritis.  He recommends Humera.  Are you good with that?  If so, start shopping.

You're having a heart attack, and need: a hospital, a cardiologist and emergency transport.  Start shopping.  

I actually had symptoms of arthritis a few years ago.  Based on advice from a diet discussion group I participate in, I made a simple dietary change and it went away.  Occasionally I cheat on the diet change and it comes back temporarily, reminding me why I made the change.

This was of course free so tell me again why I'm paying for a doctor who can't spell "Humira"?  That said, if I loved my nightshades so much I was willing to pay lots of money to keep eating them, and I didn't mind the side effect of taking a medicine that made me more vulnerable to infectious diseases, I could spring for the Humira or ask the doctor if there was a cheaper generic immunosuppressant.  In my experience, doctors are really good about suggesting inexpensive substitutes when they know their patient is paying for his own drugs; from a market perspective, it isn't really any different from asking the help in the grocery store which antioxidant to take.  The drug situation is more expensive due to regulation that supports prices for big pharma and the associated lack of competition, of course, but once price competition was introduced to the drug market, the prices of even brand name drugs would come down tremendously.

None of which means that people who are willing to make the simple, free, and effective dietary change should be forced to subsidize the people who insist on eating quasipoisonous foods, especially if the latter insist on using expensive brand name drugs instead of inexpensive generics.

For the heart attack, I would probably have purchased emergency medical insurance, the same way I have a AAA membership in case my car stops working.  On the other hand, fee for service also works; my father had his heart attack in Beijing; payment was negotiated in time for surgery, and he is still alive 12 years later.  Or, with price competition, my medical insurance company might do studies into Pauling's theory of heart disease, and I might have an inexpensive preventative that's even more effective than aspirin, which by itself can prevent many heart attacks and treat some others.

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Warren Dew Wrote:Police and the associated justice system are different because it involves use of force, and likely devolves to warfare if there are competing "providers" - although I would point out that there are substantial areas that are primarily policed by private police forces, such as many university campuses, so it's really the justice system that's the natural monopoly.

Most university campuses have duly sworn officers (i.e. real, actual police officers), because they have the power of arrest and are self sufficient, unlike the mall cops with the fancy Smoky Bear hats.

Warren Dew Wrote:Fire protection is less clear; the issue there may be that there's too much incentive for private services to engage in criminal activity, though there have also been cases of publicly employed firemen resorting to arson to protect their employment.

The real reason has to do with your local PSAP (Public Safety Answering Point), better know to you as 9-1-1.  They are the ones who coordinate public service response, and also typically sworn officers.  They are not going to dispatch from a menu, and just know how to escalate if your house starts the one next door on fire?

Frankly, you really stretched with this entire response.  I know you have to be loyal to the meme, but really?

There were police and fire departments before 911, as I believe you are old enough to know.  And there's no reason why 911 couldn't dispatch to the appropriate provider; there are things called "databases" these days that could be kept updated by the providers.  However, as I said, I don't have a problem with the present system for police and even fire departments.

As for stretching, you may think I'm too libertarian, but I also regularly argue with anarchocapitalists that have the opposite view and consider me a tool of the state.  In reality, I just happen to be the one that thinks not everything needs to be provided by the state, and not everything needs to be provided by the market, and there's a systematic economic method for distinguishing how things should be provided based on whether and how economic natural monopolies apply.