National Healthcare question for the candidates

Don Boudreaux at Cafe Hayek (a frequent stop for me), ran into some long lines at the airport, and missed a flight because of it.  Here's his description of the experience.

After reading that, I envisioned a sharp journalist with a probing question, one intended for candidates advocating federally-managed healthcare (as distinct from federally-supported healthcare):

"Government employees run the post office, and they also run airport security.  Long waiting lines are commonplace for both.  Will your system of government-run healthcare result in longer waiting lines for that, too?"

Yes, it's a longshot to hope for a journalist who would ask a question like that.  No, it wouldn't change any candidate's policy position.  But at least it would get them onto the record, for whatever that's worth. 

Potential bonus: If government-run healthcare, as distinct from government-supported healthcare, turns out to be unstoppable, maybe we could at least get a sunset provision into it ...one that mandates automatic repeal if predetermined performance measures are not achieved by a specified date.  (We should do that with a lot of programs and laws, not just healthcare.) 

Dream on, Steve. 

Anyway, regarding federally-managed healthcare, it's appropriate to keep in mind Henry David Thoreau's comment:

"If I knew for a certainty that a man was coming to my house with the conscious design of doing me good, I should run for my life."

Comments

[Aaron]

I completely agree with the automatic sunset clauses...but shouldn't we worry about the federal employees who would lack job security if such laws were enacted?

(sarcasm)

[Loneryder]

Answer : Yes

And you have to pay a private health insurance, too.

It´s our european system.

From Spain

[Chris J. Breisch]

Steve,
I go even farther. Whenever any new government program comes up, I point out that historically, government has ALWAYS been a) less efficient, b) more expensive, and usually c) lower quality than the private sector at doing the same thing.

So, I always ask, "What makes you think that this is the ONE thing that government will be able to do better?"

The problem with a certain sector of our population is that, to them, the next thing, be it education, shipping, welfare, or healthcare, is always the ONE thing. And after they get a satisfactory level of control of the government in that area, then they'll move on to the next thing, which will undoubtedly be the ONE thing.

Maybe they'll eventually be right. They'll find that ONE thing. However, in the process, we'll find 1000 more examples that aren't the ONE thing.

[Jimmy the Dhimmi]

Consider that America is one of the last remaining industrial nations to have a for-profit health care market. Other nations require the government to set prices on pharmaceuticals and other medical technology.

If the same system were to be adopted here, investment in the global pharmaceutical industry would plummit, as prices would inevitably be tied to manufacturing, rather than research costs. The government not only would have to fund the astronomical costs of health care distribution, but also use taxes to fund all the research.

Read my lips: No New Cures.

[PseudoNoise]

Raise your hand if you never have to wait for an appointment, operation, procedure, etc., under our current private health system.

Here's a good story about how Mark A. Kleiman was nearly waited-to-death:
http://maxspeak.org/mt/archives/003183.html

Private insurance has a profit motive to delay care to very sick people.

[workindev]

My 2 year old son had to get tubes put into his ears a couple of weeks ago. He had so much fluid built up in his ears that the doctor said that everything would sound like he is underwater. He kept getting ear infections and his speech progress was slowed. We went to the specialist, he confirmed there was a problem, and we scheduled the surgery that same week. He is fine now, talking up a storm, and the doctor confirmed that his hearing is much better.

In Britain, the same procedure requires a 2 year wait to make sure that the condition doesn't go away by itself, after which you have to schedule the surgery several months in advance. Parents in a similar situation over there would have to choose between 2+ more years of ear infections and slowed speech development, or to pay to fly overseas to have the surgery done in a different country.

And people are trying to tell me that we should be more like them?

[Bob]

For every argument for some sort of national health program there are arguments against and vice versa. My realistic side tells me some national program is on the way.

What I don't hear anybody discussing are answers to questions like this:

What are the strengths and weaknesses of our current health care system?

What are the strengths and weaknesses of alternative proposals?

What exactly is causing health care insurance costs to inflate? (I want to see numbers...all of them, no anecdotal B.S.).

What are the projected costs of alternative programs and how will those costs be managed?

Look, there is a lot of emotion (Steve's favorite human condition) on both sides. I have yet to find any concise study of where we are now, why we are here and what can be done to make improvements.

Maybe there are problems with the way things are done today that can be fixed. If so, let's fix them and see what happens. If we can't or won't fix them then lets give the public a chance to view alternate proposals.

What I see as the real problem? An enormous convergence of special interests stirring up the pot. And I mean big time stir.

I'm more frustrated about this subject than any other. The reason is that, IMO, there just isn't data and information available to the public to make informed decisions. I hate that.

[Kevin]

Well, not sure there's much value in these anecdotal experiences like I'm about to relate, but... I travel to the UK once or twice a year on business. When there I always find the BBC obsessing over how much the NHS sucks, the public dental systems sucks, the public long term care system sucks (though Lord knows they're not going to advocate private alternatives).

My last trip, dental care problems were the dominant story, and reporters showed something I'd certainly never seen before -- a very long line of people snaking into the street, as if waiting to buy their iPhone -- but in line to see one of the few available dentists in the region that still participated in the public system.

Me, I'm accustomed to sitting down in the dentists parlor and trying to skim thru one article in an automotive magazine before I'm called in -- usually I'm kind of disappointed I don't have time to finish the article.

[rufus]

1. Participation MUST BE MANDATORY. Period. Otherwise, you're guaranteed to get Adverse Selection, and incredibly high premiums.

2. There MUST BE CO-PAYS. The "Consumer" must have some skin in the game.

Think about some sort of combination of SR-22 Auto Insurance, and Medicare Part D.

[JJ]

Wait a minute, I'm confused. We're talking about what a disaster the airline security (government staffed, yes) lines are and how they result in poor service, missed flights, etc., and completely ignoring what a disaster the state of service of the actual airlines is. *Private* airlines I might add, which have the lowest satisfaction, on-time flights, and highest cancellation rates in about 30 years. They laid off huge numbers of employees after a taxpayer paid bailout of unprecedented size after 9/11-- did I mention they still laid most employees they were planning to lay off, off? So private industry is always more efficient?

Further, a huge number of airport security workers are in fact, non-government contractors (private companies) and not actually TSA, and lastly, you're acting like the pre-911 era of private airline security was some sort of golden-age of efficiency. You *have* to take into account the huge bloat in security measures (taking of shoes, excess wanding, more scrutiny of x-rayed bags, random nitrate swabbing etc.) which the privatized 7.50/hour security staff would surely be just as inefficient at carrying out.

You good folks aren't naive to think there's an actual market with real market forces in these large industries like airlines or big pharma, are you? They spend hundreds of millions (billions?) lobbying for bailouts, special considerations, anti-competitive legislation against foreign pharma competitors, etc. Having worked at 2 Fortune 500 companies and a Fortune 100 company, I can tell you they are *not* paragons of efficiency. There's just as many paycheck-waiting, year counting burnouts waiting for retirement in those *private* companies and a lack of organizational agility as there is in government agencies.

How about when you take into account the audacious fees insurance and other financial services companies charge less-savvy customers, I'm hard pressed to see how they're 'more efficient' than the social security system which admittedly gets lower returns, but the overhead per dollar is inarguably lower.

How about the military? That's not privatized and it does its job better than the Blackwater (private military contractors) monkeys I've been forced to endure in the past. And for heaven's sake, I'm talking about the *military* here, hopefully well-known amongst readers here as often frustratingly bureaucratic.

[Steve]

Raise your hand if you're saying the waiting lines will get shorter after the government takes over -- and that the law should be repealed if the lines end up getting longer.

[Bob]

JJ:

Amen, brother. I'm a bona fide, card carrying anti-bureaucrat zealot. And the thought of the government in this business makes me ill. However, I am a realist and I see something coming.

Since we're on the topic of efficiency whose to say our current system is efficient? Are hospitals run well? What are the metrics to measure all of this?

I feel the beginning of a rant coming so I'll back off. I also suffer from some cognitive dissonance on this topic so excuse
me if I flip-flop from time to time.

[JJ redux]

Okay, I'll go on record saying that it's certainly not impossible for lines to get shorter if we go to single payer/nationalized or one of several 'socialized' alternatives to providing healthcare. *Raising hand (if I must)*

What you say in your comment is fair Steve, that if it doesn't work, yes, the law should be repealed. However, I don't think the post itself is fair, it singles out the gov't portion of inefficiency in airline service delivery and completely ignores the privately administrated portion. I also think we have to take more into account than mere waiting times. Privately run healthcare uses triage to determine care as well. What matters as well is, do people get the treatment they *need* (let me explain...)

I've sat in *many* an emergency waiting room under our current (ostensibly private) system for a 12-15 hours at a time, that's hardly efficient. And some of these visits were at private customer-only hospitals like Kaiser (Kaiser is a 'for-profit' and yet horribly inefficient). The reason I sat for so long is because of crowding (yes, there's non-customer load that hospitals must share in an area, but that's equally distributed by all). In the system we have now, many of these uninsured people can't get preventative or routine care except by going to the ER, now that's stupid, expensive, and clogs up a very important resource. If they (i.e. and everyone) were insured, it's completely conceivable that lines would *shorten* in this case (as they would take these cases to primary care physicians). I think the main beef in the US is the 'Canadian myth' of healthcare, that we'll have endless waits for care, which, besides not being true in Canada, we *already* have similar wait times here. My grandma is getting jerked around right now, with *private* insurance (not Medicaid or Medicare) and has waited nearly a year (10 months) for a bypass-- someone going to tell me a bypass is elective now?

What we should be asking is not the cost here, but what we'd get for the money right? So, by paying taxes or by borrowing to pay for single payer care (usually a combination) we could conceivably build a healthcare infrastructure that's more strategically developed to deliver needed care, instead of tactically contingent on a quarter/quarter profit and ensuring a baseline of care. To pilfer a wise man's logic, how can I put a price on my grandma's life (not just my grandchildren's safety when considering defense spending)?

So yes, I'm on record as saying that markets don't solve *all* of our problems. Maybe markets *are* good for healthcare, but we don't know since we don't have a market here. When we actually have a market here for healthcare, we'll talk about that.

[Bob (infrequent poster)]

I can honestly raise my hand and say I've never had to wait for a surgery, doctor's appointment, or lab testings... In America anyway. It's pretty much been, "When's your next day off?"

Canada was a whole other story. I had to wait months for testing and surgery. My cousin who still lives in Canada also has to pay MOST of her MS drug treatment out of pocket. It's sad and it shows the scam that is socialized medicine.

[Stephen Reed]

Isn't this argument a bit of a strawman? I don't think the government runs the hospitals/clinics that Medicare or Medicaid recipients use.

[Steve]

SR and JJ:
If government employees decide who gets paid and how much, government effectively runs the system. On the other hand, if government gives healthcare tax credits to the patients (similar to the EITC), then the patients will make that key decision of who gets paid what. It's the difference between government employees *enforcing* desired behavior, versus government tax laws *incentivizing* desired behavior.

A government-payer system will evolve to (if not start out as) a jobs program for government employees; a patient-payer system will evolve to a better system focused on customers (patients). Customer-focused systems have better track records than jobs-focused systems. In fact, that's a basic difference between the American and typical European economies; consumers are #1 here, jobs are #1 there. The former requires skill at servicing customers to be secure in one's job; the latter requires skill at getting government and union protection to be secure in one's job.

[Aaron]

My suggestion is to keep health reform as simple and transparent as possible.

1. mandatory insurance.
2. subsidize insurance for those under a certain level (To be decided)
3. Insurance cannot be provided by employer, i.e. if you get fired you don't worry about your health insurance and its portable.

Now, everyone is insured, the system is still market oriented, but we do have to pay for some people's care.

I'd allow an opt-out option for libertarians but they'd need to sign several waivers to never allow their case to be portrayed in the media as part of some sob story or part of any statistics and show cash in the bank or HSA. (Just joking on that part.)

[Kevin]

Wow I want to second precisely what Aaron says. I've come to believe one of the worst things about our system is that insurance is usually provided by employers -- completely unlike every single other good or service people consume. The more you ponder it, the weirder and worse it seems -- that is this source of many of the ill effects and distortions.

I would indeed like to see that practice banned by law.