Mistakes to Avoid When Discussing Health Care

Noah Smith has an interesting piece on health care at Bloomberg.  The piece is worth a read, although there are some head-scratchers in there.  Smith’s big conclusion is this:

In other words, don’t believe the argument that the cost difference between the U.S. and other countries is the inevitable price of a more innovative health-care system. Americans really are being greatly overcharged for their care. For whatever reason, health seems to be one industry where government does things more cheaply than the private sector.

There’s a problem with this conclusion, namely that it uses biased data to support the claim.  Health care is cheaper in other countries because the price system is rigged: universal health care keeps prices down by refusing to let them rise.  So, one cannot compare prices in a system where prices are allowed to fluctuate vs one where prices are determined by government diktat.

Prices are a signal.  They provide us valuable information about the relative scarcity of commodities.  When prices are allowed to adjust, they provide accurate information.  When they are not, they provide poor information, and lead to worse outcomes.

It is also important to note that monetary costs are not the only costs involved.  They are one cost, sure, but there are many other kinds of costs: wait times, quality, quantity supplied in general, that sort of thing.  Monetary prices can/will adjust for these different factors (for example, a luxury higher quality car may sell for more than a lower quality car), but if prices cannot adjust, these other costs will rise; there ain’t no such thing as a free lunch, after all.

Let’s take, for example, Canada.  In the US, monetary costs for doctor visits may be higher, but in Canada, wait times are much longer (in the US, it’s approximately 24 days to see a doctor.  In Canada, it’s 20 weeks).  This is a real cost.  Quality of care is another cost.  In Britain, for example, you’re about 45% more likely to die in a hospital than the US.  This is a real cost.

It’s admirable to want to compare costs and benefits among two systems like Smith does, but he makes two major mistakes when doing so: 1) he compares price signals from a relatively free market to price signals that are artificially low, thus biasing his estimate (this is a point Bob Higgs has made repeatedly when discussing GDP), and 2) does not do a full accounting of the costs.  Smith may be right that health care is an area where government can provide cheaper than the private sector, but the evidence he puts forth for his claim is weak.

31 thoughts on “Mistakes to Avoid When Discussing Health Care

  1. Government cannot provide ANYTHING less expensively than the private sector because the factors that force them to operate efficiently are not there.
    Another area often cited is prescription drugs. We could easily by government edict make existing drugs less expensive. But this would inhibit the development of future drugs. This is a real cost also, and one government can hide because nobody will ever know what was not developed because there was not enough profit in it.

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    • Exactly. The huge costs imposed by government on the development and testing of new drugs pretty much guarantees that only high profit drugs for which there is a large market will be developed.

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  2. Wow! Noah Smith has found a free lunch.

    As with immigration, by observing where people move for greater opportunities, you can pretty much tell where people get better medical care by the direction in which the most traffic flows across borders.

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  3. Jon

    Smith may be right that health care is an area where government can provide cheaper than the private sector, but the evidence he puts forth for his claim is weak.

    Not according to Hayek. 🙂

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      • Sorry, I wasn’t clear. Hayek spoke to me in a dream last night, pointing out that Noah Smith’s claim is not weak.

        No, wait. It’s the other one.

        While anything is possible, it seems highly unlikely that government could ever provide anything more cheaply or efficiently than the private sector, due to the Knowledge Problem described by Hayek. And our experience with government healthcare tells us that while government can and does control the prices of healthcare by simply not paying them, it doesn’t actually provide it “cheaper”.

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  4. Jon,

    I think Noah’s post and yours are mostly compatible. He is not denying that governments use price controls to achieve lower costs. And he is not denying that that results in other costs like increased wait times.

    His main point is that the innovation argument for the U.S. system has been greatly oversold as a reason we pay so much more for healthcare than the rest of the industrialized world. And that many nations get overall health outcomes that are as good or better than the U.S. results while spending much less. I would add also that they do it with much greater levels of public satisfaction with their systems than we have here in the U.S. despite the fact that many people there have increased wait times for medical services.

    Many factors confound simple comparisons between our system and theirs. To cite just one example, the fact that the U.S. tends to get better results on cancer care is often touted as an illustration of the superiority of a relatively more free market approach. But cancer is mostly a disease of old people. And in the U.S. payment for medical care of old people is almost full socialized. So you could just as easily use this point to argue that the most socialized part of our medical system gets the best medical results.

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    • “And that many nations get overall health outcomes that are as good or better than the U.S. results while spending much less.”

      That’s the comment that I’m taking issue with. You cannot say that the spending is much less in other countries than the US because the spending is being held artificially low. That is an invalid conclusion to draw.

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    • Greg G.

      I would also object to the statement Jon takes issue with. This subject is so complex and has so many variables that it seems possible to find support for almost any conclusion one wished to reach, so I don’t think it’s useful to compare average outcomes in one country against those in another and conclude one system of payment for medical treatment is obviously better than another.

      And as always, my objections to single payer are the coercion and lack of consent required to make it work at all, and the necessity of one-size-fits-all solutions to problems that can best be solved by a patient and their doctor.

      What I think we can agree on, is that people will spend their own money more carefully than they will spend someone else’s money, and that competition creates competence. And I can think of no other good or service that people actually believe would be provided more efficiently and more cheaply by single payer. What is unique about medical treatment?

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      • Ron,

        I’m pretty sure I didn’t make the argument that medical treatment was unique. I would be inclined to argue for some higher universal level of taxpayer funded basic medical care but I wouldn’t do it by emphasizing what is unique about medical care. I would do it by emphasizing what it has in common with national defense, a judicial system and a police force.

        That is to say I would emphasize how rare it is to see in nature any kind of a society where markets do a good job of meeting the need and, at the same time, everyone needs the service and there is a huge free riding problem if everyone isn’t required to pay.

        Now there is no danger of my preferred system being imposed on anyone but I wouldn’t describe my preferred system as single payer. I would prefer to see a system where government guarantees some minimum level of insurance that meets the basic health insurance needs of most people. But I do think that taxpayers who effectively pay all of their own health costs and part of someone else’s should have the option to purchase additional care in free markets that operate alongside basic care.

        No doubt as you say, people on Medicaid find a lot to complain about. I bet they still much prefer it to not having any coverage or having to pay for their own coverage.

        Since you seem to really want me to find something unique about medical care I will do so but I’m not sure it leads in either direction on who pays. In no other field than medicine is it harder to clearly understand cause and effect. As a result, a huge number of quack treatments and expensive treatments with very small benefits persist in the marketplace. In many cases people DO eagerly pay for these out of pocket because they attribute recoveries due to the body’s natural healing powers to the quack treatments.

        I happen to have a son who does a lot of work at the state level opposing legal efforts to require new professional licensing. Often practitioners of quack treatments advocate for professional licensing in their field both for the usual reason of limiting their competition and also for the apparent seal of approval by the state that suggests the legitimacy of the treatment. He once asked a health insurance lobbyist why they weren’t more help in opposing such licensing. The guy told him that once the hypochondriac customers of alternative practitioners start seeing real doctors that’s when it really gets expensive for insurance companies.

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        • Greg G.

          I would do it by emphasizing what it has in common with national defense, a judicial system and a police force.

          Do you mean the common claim that the market won’t supply enough of those services? Medical care is no more a public good than food – something the market supplies in abundance at low prices.

          That is to say I would emphasize how rare it is to see in nature any kind of a society where markets do a good job of meeting the need and, at the same time, everyone needs the service and there is a huge free riding problem if everyone isn’t required to pay.

          That’s why I asked what was unique about medical care. What isn’t also true of food, clothing and shelter, which are in most cases even more immediate needs than medical care. Everyone needs food, everyone needs shelter, but there is no yuge free rider problem if everyone isn’t forced to pay for them. The market provides all of our other essential needs, and until fairly recently has provided medical care. Why would that no longer be the case?

          No doubt as you say, people on Medicaid find a lot to complain about. I bet they still much prefer it to not having any coverage or having to pay for their own coverage.

          Do you mean coverage or medical care? My point was that the single payer in this case, doesn’t provide very good service, and so comparing with market provided medical care is like comparing dining at MacDonald’s to dining at a a sit down restaurant with waiters and cloth napkins. Yes, you can get a meal at either place, but they aren’t exactly the same products, Having low prices may not be the most important factor.

          I happen to have a son who does a lot of work at the state level opposing legal efforts to require new professional licensing.

          Good for him! I approve wholeheartedly. Professional licensing is, as you say, a scheme to limit competition and keep prices artificially high.

          In no other field than medicine is it harder to clearly understand cause and effect. As a result, a huge number of quack treatments and expensive treatments with very small benefits persist in the marketplace.

          I agree. Similar quackery exists in the food market, and in many cases government helps promote it.

          “Got Milk?” “Beef: It’s what’s for dinner.” And of course there’s the FDA food pyramid.

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        • Greg G.

          Since you seem to really want me to find something unique about medical care ..”

          It’s not my wanting anything, it’s you indicating there is something special about medical care. Something not associated with other critical human needs such as food, clothing, shelter, transportation… Something about the market being unable to adequately provide medical care even though it works well for every other critical need.

          It sounds like you would prefer the Singapore system of healthcare provision.

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          • Ron,

            I did indicate the things I thought were special about medical care and they weren’t things shared by food, clothing, shelter and transportation. They were things shared by national defense, a judicial system and a police force. You normally read more carefully than this.

            I am well aware that you think private markets could easily do a better job with “every other critical need” including nuclear defense, a judicial system, a police force, interstate highways and urban water and sewer. I am sure you are well aware how vanishingly few people agree with you on that.

            From what little I know about it, I understand that the Singapore system works well for that younger, healthier, and wealthier population. I believe it is a relatively more free market system than ours but still very far from no government interference.

            As for your point about real free market medical care before the 20th century, that medical care was more likely to kill you than to heal you.

            Modern medicine is constantly coming up with amazing new advances that are both very effective and very expensive. I had a total hip replacement five years ago. A generation or two ago I would be a cripple today. Instead, I skied 49 days last winter and topped three trees today. Your comparison of modern medicine to markets in useless 19th century medicine is really not relevant.

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          • Greg G.

            I did indicate the things I thought were special about medical care and they weren’t things shared by food, clothing, shelter and transportation. They were things shared by national defense, a judicial system and a police force. You normally read more carefully than this.”

            I did read it carefully, and I couldn’t imagine why you think medical treatment is a public good, as it is neither non-excludable nor non-rivalrous, and you didn’t explain yourself.

            You can make a pretty good ‘public good’ argument for national defense, a less convincing one for a justice system, and none at all for public, taxpayer supported police forces.

            Medical treatment is a service like any other. User pays in a competitive free market would work just fine, as it does with most other goods and services. High deductible insurance against catastrophic expenses and medical savings accounts would round out the needed protection for individuals, and private charities, mutual aid societies, and other compassionate efforts providing for those who can’t afford to pay for needed medical treatment – just as such organizations currently provide food,shelter, clothing, etc. for those who can’t afford those things.

            I am well aware that you think private markets could easily do a better job with “every other critical need” including nuclear defense, a judicial system, a police force, interstate highways and urban water and sewer.

            Indeed I do.

            I am sure you are well aware how vanishingly few people agree with you on that.

            If true, I’m not sure why you think that’s relevant. I don’t think truth is discovered by consensus or majority vote.

            [Singapore system] “I believe it is a relatively more free market system than ours but still very far from no government interference.

            Correct. I understand that taxpayers subsidize medical care based to some extent on means testing, by providing accounts similar to medical savings accounts from which consumers make their own spending choices. This makes a yuge difference in keeping costs low, and availability high, while providing needed care to those unable to afford it.

            As for your point about real free market medical care before the 20th century, that medical care was more likely to kill you than to heal you.

            You’re right, and I stand corrected on that point. I’m reminded that pokey probey fingers probably killed Lincoln as surely as the ball in his head.

            Modern medicine is constantly coming up with amazing new advances that are both very effective and very expensive.

            Yes, I agree. it’s something to celebrate, and has nothing to do with single payer healthcare coverage. Innovations result mostly from a desire for profit. Efforts to control medical costs by fiat have the opposite effect.

            I had a total hip replacement five years ago.

            Let me guess. Government didn’t pay for your hip replacement, I don’t know how old you are, but I believe it’s hard to get such procedures approved by Medicare after you reach a certain age, because the additional time and quality of life you gain from such an expensive surgery isn’t worth the expense, especially considering that people past retirement age no longer “contribute” to the ponzi scheme, so it’s all cost and no benefit for the system.

            A generation or two ago I would be a cripple today. Instead, I skied 49 days last winter and topped three trees today.

            Wow! I’m thinking I should probably get a hip replacement even though I don’t need one, just so I could feel that energetic again.

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  5. Jon,

    I take your point (and I did acknowledge) that more socialized systems do have costs (in wait times and constraints on people’s options) that are not fully reflected in dollars spent. We agree on that.

    I thought it was reasonable to assume that you would understand that by “spending” I was referring only to the more specific cost in dollars spent. Dollars spent are what they are whether or not you want to label that level of spending as “artificial.” It seems odd to me to insist on using the word artificial to describe the real world systems while presumably viewing as more real a system that exists only in theory.

    I don’t think it is controversial to point out that the extraordinary amount of additional money that we spend on healthcare in the U.S. currently produces surprisingly little benefit in measurable health outcomes compared to most other modern economies.

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    • Greg G.

      Yes, dollars spent are what they are, but they are spent at artificial.prices.

      I’ve noticed that most of life’s necessities – food, clothing, shelter, and transportation – which are provided by relatively free markets in which competitors fight for consumer dollars, have become better and cheaper over the years, while those financed largely by monopoly government – education and medical care – have become far more costly. Is there a connection?

      Admittedly medical care has improved dramatically, and newer technology is expensive, but education? Not so much.

      BTW if you know any folks, as I do, who depend on Medicaid for medical treatment, ask them how they like their coverage and the level of quality treatment they receive, My admittedly limited experience with Medicaid patients is that they suffer from an incredible amount of bureaucracy and red tape, and arbitrarily limited options for treatment. In addition my impression is that it is mostly the least experienced and least competent practitioners, as well as a few genuine saints, who will accept Medicaid as payment because the payment amounts are so low.

      I fear this is a preview of what we would all be forced to suffer if we relied on single payer healthcare.

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    • “I thought it was reasonable to assume that you would understand that by “spending” I was referring only to the more specific cost in dollars spent. ”

      Forgive me. I do not think I am being clear in my objection. I understood your meaning as “specific cost of dollars spent.” I still object because it’s comparing apples and oranges.

      Maybe a metaphor will help:

      Two people step on different scales (for the sake of argument, assume the two people are identical in every way). One scale is accurate. The other scale is rigged to never read over 100 lbs. The first person steps on the first scale and it reads: 200 lbs. The second person steps on the second scale and it reads 100lbs. From this measurement, can we conclude the second person weighs less than the first person? No, the scale is rigged. For the same reason, I say we cannot conclude that the cost in dollars spent is lower in universal health care systems because the prices are rigged to be low. It’s kind of like begging the question

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      • Jon,

        I think we mostly agree on the effects but are using different language to describe the same thing. Yes, price controlled health care prices are “rigged to be low.” Yes that creates other costs and trade offs due to the the loss of information that relatively more free market prices would have provided. That’s the part we agree on.

        As for your metaphorical scale (of a total genuinely free market healthcare system) I think we should remember that it doesn’t exist anywhere in the world, and there is no prospect that it ever will, so therefore anyone can make any claim they want about it without the slightest worry of being troubled by a reality check. So then yes, comparing the imaginary free market in healthcare to much messier real world is always going to be “apples and oranges.”

        That doesn’t mean we can’t make many relevant comparisons between our system and systems in other western industrialized countries. We can compare dollars spent. We can compare spending as a percentage of GDP. We can compare life expectancies. We can compare material survival of childbirth. We can compare coverage for the poor. We can compare public satisfaction with the system as revealed in public opinion polls. We can compare the features you chose to compare in your post here. All these comparisons are relevant regardless of how far they fall short of some imaginary system.

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        • Greg G.

          I think we should remember that it doesn’t exist anywhere in the world,” [a totally free market healthcare system]

          But it did exist, for all practical purposes, until the 20th century, and the market provided a level of service as good as the market provided for every other critical need.

          Since then government involvement in medical care has increased at a much greater rate than it has for any other critical need, and we can see that the costs of medical care have skyrocketed, while most other needs have become ever cheaper as a percentage of individual and family income. Something similar has happened in education.

          Perhaps as a rule of thumb we could say that the relative cost of any good or service is positively correlated with the level of government involvement in the provision of that good or service.

          BTW, you might find these interviews with the other Dr. Murphy interesting.

          http://tomwoods.com/ep-938-law-without-the-state/

          http://tomwoods.com/ep-939-do-we-need-the-state-for-defense/

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        • Greg G.

          We can compare spending as a percentage of GDP. We can compare life expectancies. We can compare material survival of childbirth. We can compare coverage for the poor. We can compare public satisfaction with the system as revealed in public opinion polls.

          Yes, we can compare anything we wish, but it’s easy to leave out relevant data that has nothing to do with medical care, such as genetic differences, and in the US the effects on life expectancy of a high murder rate. Live births are not defined uniformly in all countries making it hard to compare the effects of different levels of medical care.

          I suppose we must make the best use we can of the data available to us, but it seems like a stretch to make hard and fast comparisons based only on who pays the bills.

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          • Ron,

            I don’t see any reluctance on your part or Jon’s part to make comparisons to other systems when those comparisons support your policy points of view. One reason people are more likely to die in hospital in the U.K. is that more people are discharged to die at home under Hospice care in the U.S. That’s a good thing for the U.S. in my opinion but it doesn’t mean that U.K. hospitals are necessarily more dangerous. As you point out it is the norm in medicine for there to be many confounding variables.

            You should look at how maternal deaths in childbirth in the U.S. compare to other modern countries. I’m pretty sure they are defined and counted the same way everywhere and that the U.S. does quite poorly in this comparison.

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          • greg G.

            I don’t see any reluctance on your part or Jon’s part to make comparisons to other systems when those comparisons support your policy points of view.

            Well, of course! 🙂 what would you expect, fairness and even handed treatment? 🙂

            One reason people are more likely to die in hospital in the U.K. is that more people are discharged to die at home under Hospice care in the U.S. That’s a good thing for the U.S.

            I understand that and agree that hospice is a good thing. I personally don’t want to die in a hospital.

            Ah. Maternal deaths. I was looking at infant deaths Yes, maternal deaths in the US are on the rise. To what do you attribute this disturbing trend? Surely it’s not related to single payer.

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          • Greg G.

            BTW I don’t usually compare medical outcomes between countries because there are so many confounding variables, except to point out that when prices are held low by fiat, as they must be in a single payer system, we see the inevitable reduction in supply. That could mean longer waits, fewer choices, or some other reduction in available medical treatment. I’m not convinced any comparison of outcomes necessarily correlates to method of payment.

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          • Ron,

            >— “Yes, maternal deaths in the US are on the rise. To what do you attribute this disturbing trend? Surely it’s not related to single payer.”

            I attribute it to a lot of low income American women not getting the medical care during pregnancy that it would be easy for them to get in almost any other western country. And the epidemic of drug addiction in the U.S. I suspect that being addicted to drugs during pregnancy makes the need for medical supervision and intervention even more significant to the results. The cause is certainly not single payer in the U.S. today because there are many payers of medical bills for women of childbearing age. And even more non-payers.

            It’s “related” to not being able to access and afford the kind of care most women routinely get in many other countries. Which is not good enough for the most prosperous nation in human history.

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          • Ron,

            >—-“when prices are held low by fiat, as they must be in a single payer system, we see the inevitable reduction in supply.”

            Yes that’s true.

            It’s the NEXT leap of logic you always make that is the critical flaw in your philosophy. You always feel free to simply ASSUME as much expansion of supply (under an-cap) as you need to make your ideas work without the slightest constraint by real world limitations. Changes on the margin don’t actually run to the limits of your imagination here in the real world.

            Of course these assertions of fantastic possible supply expansion are never in any danger of being tested because they exist only in a world of imagination. That is the lowest possible bar to clear in any debate. (That’s what I think is relevant about the point Jon.)

            For example, consider the Tom Woods podcasts you recommended yesterday Ron. I made it about halfway through the one on how the free market will provide for national defense before I had to stop because I just couldn’t take it seriously and it was starting to make me want to bang my head against the wall.

            They simply assert without the slightest evidence beyond their own bizarre fantasies that insurance companies (lot of them!) will be eager to insure people against losses from war. Of course they will then be eager to take on the expense of national defense.

            Give me a break. Insurance companies don’t cover losses in war even now when they could profit from this model without all the expense of national defense. But of course in a fantasy world where comparisons to the real world are “irrelevant” then you can assume whatever performance you like from these insurance companies.

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          • Greg, it is easy for any low income woman in the US to get medical care during pregnancy by simply asking for it. Medicaid is available to anyone and everyone with limited means. For anyone not currently enrolled, part of their first “free” visit to an emergency room will include helping them to enroll.

            There is no such thing as “can’t afford medical treatment” in the US. There IS such a thing as not bothering to GET needed medical treatment, which includes drug addicted pregnant women who are reluctant to expose and perhaps jeopardize their drug habit.

            And that brings us to something you’ve written that scares me, and I hope I’m misreading it:

            And the epidemic of drug addiction in the U.S. I suspect that being addicted to drugs during pregnancy makes the need for medical supervision and intervention even more significant to the results.

            Are you actually suggesting that women should be identified as being at risk and treated without their consent if someone decides their fetus is in danger from their mother’s drug habit, or perhaps from other unapproved behavior? I’m triggered by the words “supervision” and “intervention” and I hope you’ll put my worried mind at ease as to your actual meaning in this case.

            I don’t recall that we’ve ever discussed the subject, but I assume you support a woman’s choice as regards the treatment of her unborn child. Please correct me if I’ve misunderstood. Obviously it’s not possible for someone to approved of a woman destroying her fetus by one method, but threatening her with physical intervention if she threatens to harm it in some other way.

            The cause is certainly not single payer in the U.S. today because there are many payers of medical bills for women of childbearing age.

            I didn’t mean to suggest that single payer CAUSED higher maternal death rates, but that single payer would not prevent them. There must be something other than the source of payments that accounts for the higher rate.

            It’s “related” to not being able to access and afford the kind of care most women routinely get in many other countries.

            But that’s just not the case, as I explained.

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          • Ron,

            Sorry I triggered your fears of Orwellian government “supervision and intervention.” Take some deep breaths. I’ll try to be more careful with my language in the future to avoid similar scares. By supervision I was just referring to informed advise by a medical professional who keeps up to date on the specifics of the patient’s condition. And by intervention I was merely referring to the voluntary access to the appropriate medical procedures.

            I have to admit I don’t have a detailed knowledge of how you get medicaid benefits but I think you are overstating how easy it is. It varies by state and not all states are eager to see the program expanded. What people could get and what they do get are not necessarily the same thing. I am skeptical that simply “asking for it” is a good way to describe all the bureaucratic hoops that must be jumped through. And it wasn’t that long ago it was you who was complaining to me how hard it was to find a good doctor who would accept medicaid and how miserably unhappy everyone was with it. Those problems got fixed in a hurry.

            I trust you are aware of there is a big shortage of treatment facilities for those addicted to opioids even among those on Medicaid. And that some of the biggest coverage gaps are for the lower middle class who make too much to be on Medicaid but can’t afford the premiums for good health insurance. People not lucky enough to have group coverage available will find that most individual policies (especially the affordable ones) don’t cover maternity costs. As a result, many pregnant women in the U.S. don’t get the same kind of medical care during pregnancy that women get in many other countries.

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          • It’s the NEXT leap of logic you always make that is the critical flaw in your philosophy. You always feel free to simply ASSUME as much expansion of supply (under an-cap) as you need to make your ideas work without the slightest constraint by real world limitations.

            That’s not true. (about my assumption) It’s been my experience and my observation that supply invariably increases to meet demand when allowed to do so without artificial constraints, as people pursue their own interests by serving others.. ‘Demand’ being an economic term that includes both willingness and ability to make an exchange. The effect on supply of artificial limits on price and the limits imposed by the amount people are willing to pay ls exactly the same. (same effect, not same amounts)

            Changes on the margin don’t actually run to the limits of your imagination here in the real world.

            Ah. The old “imaginary” vs “real” dodge.

            Of course these assertions of fantastic possible supply expansion are never in any danger of being tested because they exist only in a world of imagination.

            Not to be too lofty sounding, but everything in the world today that makes our lives better only existed in imagination at one time. If no one had ever acted on those ideas that had no real world existence we would all still be gathering roots and berries and killing small animals with our bare hands in order to make a living. Primitive people had available to them all the resources we have today, they just didn’t have the knowledge to make use of them (paraphrasing Thomas Sowell)

            For example, consider the Tom Woods podcasts you recommended yesterday Ron. I made it about halfway through the one on how the free market will provide for national defense before I had to stop because I just couldn’t take it seriously and it was starting to make me want to bang my head against the wall.

            Well, thank goodness you avoided self inflicted injury! To tell you the truth, I wasn’t entirely happy with that one myself, but I don’t think the intent was to offer a turnkey alternate solution for national defense in a 30 minute podcast, so much as to offer something for listeners to think about, and perhaps put tiny cracks in the common notion that the only possible national defense must be supplied by a monopoly government through the use of force against its own citizens. “We will protect you from aggression by aggressing against you.”

            They simply assert without the slightest evidence beyond their own bizarre fantasies that insurance companies (lot of them!) will be eager to insure people against losses from war. Of course they will then be eager to take on the expense of national defense.

            They offered an insurance model as one way in which people already protect themselves against catastrophic losses by pooling risk. Insurance already exists in the real world. Whether or not insurance companies would be “eager” to provide such coverage would depend a great deal on how much control they would have over prevention of losses. Currently they have none. The suggestion that insurance companies might offer some forms of national defense or require such protection be acquired by those they insure is not that farfetched, as there are already requirements and limits on coverage today for certain perils..

            In addition insurance companies currently have little or no experience indemnifying losses from war, so premiums would necessarily be higher than for losses that are easier to model. Then, there’s the question of how big the market is for additional protection against damage due to war when people already pay large premiums (or free ride) for protection by monopoly government. It’s understandable that no such coverage is currently offered.

            This is similar to a discussion of public/private schools. Many (most) people aren’t willing or able to pay additionally for the private schooling they would prefer, when they are already required to pay for public schools whether they use them or not.

            Absent mandatory monopoly government provision of so-called national defense, we might have a more accurate idea of how much and what kind of defense people actually want and are willing to pay for.

            Your position seems to be that most people don’t know what’s in their own best interest and therefore you and others who know what’s best for everybody must force them to pay for what you imagine is the correct amount and type of defense.

            It’s obvious that we currently have too much of a “good thing”, with too many “services” being loosely called “defense”, that really aren’t.

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          • Greg G.

            By supervision I was just referring to informed advise by a medical professional who keeps up to date on the specifics of the patient’s condition. And by intervention I was merely referring to the voluntary access to the appropriate medical procedures.

            Oh. OK then.

            What people could get and what they do get are not necessarily the same thing.

            If I understand this correctly you are claiming that the system doesn’t always work as designed. You’ll get no argument from me on that score.

            I am skeptical that simply “asking for it” is a good way to describe all the bureaucratic hoops that must be jumped through.

            Well yes, those hoops certainly exist. I may have oversimplified. Nonetheless, “free” medical care is available at no monetary cost to the patients.

            And it wasn’t that long ago it was you who was complaining to me how hard it was to find a good doctor who would accept medicaid and how miserably unhappy everyone was with it.

            Probably only a few hours ago. 🙂

            When I glibly claimed that medical treatment is available to anyone simply by asking or it, I wasn’t suggesting that it was easy or hassle free, in fact the reality may often be quite the opposite. And the quality of that care isn’t likely to be the best available, but it’s “free” to the patient in terms of money. I assume, maybe erroneously, that people with little or no money have an abundance of time and a concomitant high tolerance for frustration and inexplicable nonsense.

            At least they don’t have to “pay” for medical treatment.

            Those problems got fixed in a hurry.

            Oh no, they still exist, and would almost certainly exist in a single payer system, but the medical treatment is “free” – when you finally get it.

            I trust you are aware of there is a big shortage of treatment facilities for those addicted to opioids even among those on Medicaid.

            No, I wasn’t aware, but I’m sure you’re right. Demand for such facilities must not be high enough, or there would be more of them. Perhaps the amounts paid by Medicaid aren’t high enough to encourage a greater supply.

            And that some of the biggest coverage gaps are for the lower middle class who make too much to be on Medicaid but can’t afford the premiums for good health insurance.

            I know this sounds cynical, but I think “can’t afford” often means “made other choices” I can’t “afford” a Lamborghini, although I really, really want one. Apparently other choices I’ve made along the way don’t allow me to “afford” one at this time.

            I don’t think people are “lucky enough” to have group coverage, I think they choose employment that includes group coverage if medical care is important to them. It would seem that such a choice would be particularly important if a person were considering becoming pregnant, which is, after all, pretty much a choice these days.

            If you want a third party to pay for your medical needs, try to make choices that provide for that arrangement ahead of time instead of just waiting for an emergency and then holding up strangers at gunpoint to pay for your expenses.

            … most individual policies (especially the affordable ones) don’t cover maternity costs. As a result, many pregnant women in the U.S. don’t get the same kind of medical care during pregnancy that women get in many other countries.

            That is undoubtedly true. Medical care, like any other commodity in the world, is scarce. Unlike the air we breathe, there is not as much of it available as everyone would like to have. Therefore It must be rationed and distributed by some mechanism such as price, first-come-first-served, or outright limits on the amount and types of services a patient is allowed. My preference is a price system. (surprise!)

            In a single payer system rationing can be accomplished by capping prices paid, and/or by limiting the number of procedures or the amount of service available to any one patient. To make medical plans “affordable”, some procedures and types of service won’t be covered. As you pointed out that is often maternity care, If maternity is covered, some other type of service may be unavailable. One can’t have total coverage and affordability in the same plan, and few people need total coverage.

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        • “As for your metaphorical scale (of a total genuinely free market healthcare system) I think we should remember that it doesn’t exist anywhere in the world, and there is no prospect that it ever will”

          Fine, but irrelevant.

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