• “But a policy of coercively preventing exchanges that help someone (the doctor, at least!) but harm no one is flatly unjust. Which leads to the conclusion that the attempt to prevent some inequalities in the provision health care is ruled out by the requirements of justice.”

    WTF does that even mean? You need to get out in the real world, young man, and stop thinking and start doing something… anything… useful to society.

  • CraigMcGillivary

    I think you are basically right at least given your assumptions about how the health care market works. Most people on the left tend to think that European stile health care systems work better than America’s and this is really at the heart of the matter. There are different forms this argument takes, but I think Yglesias makes a good point about blood letting and health care markets has a lot of merit. Also its really difficult to have a properly regulated health insurance market and if you can’t make the market work there is going to be a tendency to want to have the government replace it.

  • JB_Shotworth

    I’d prefer the PC model of medicine. In 1977 the cheap Apple IIe cost $4000.00 in today’s dollars; laptops which are better in all regards cost as little as $300.00 today. The government was and is much less intrusive in that market than in health care. The rich/savvy are the early adopters/Guinea pigs who make the market work. Everyone else follows. Nobody has to use guns to divide the pie when new pies are being baked that quickly.

    Even laymen could list several government policies that jack up the price of health care today, but social-dems insist that what we have is free-market health care. When government restrictions and meddling in health care approach what we have in the PC market, we can start calling it that.

    If you don’t know anything about Minute Clinics, Zenni Optical, or PHRs, then you have no idea how many health problems could be taken care of immediately if social-dems were interested in improving medicine instead of enforcing impossible equality.

    • fredrik

      1) A primary driver of both the rising quality and falling prices of computers is Moore’s Law. There is nothing remotely close to Moore’s Law in medicine.

      2) Early adoption in medicine leads to rising prices, not falling prices. The rich like spending tons of money on their health care… the savvy may be changing their tune, but verrrry slowly.

      3) It is not difficult for a consumer to gauge the functional quality of a computer. It is more or less impossible for a consumer to gauge the efficacy of various medical treatments; even consulting studies gives you out-of-date and incomplete information. Medicine is more of a black box than computing.

      4) It was decades before most Americans could afford computers. Is your contention that the poor, sick & disabled should simply hang out until the health care market finds them to be attractive buyers, years down the line?

      Are Minute Clinics a good thing? Sure. Would things be better if the employer tax exemption was rescinded, and consumers had a clearer sense of what their health care cost them? Absolutely. But your analogy is nonsensical. To pretend that health care lends itself neatly to market solutions is to ignore, well, just about every salient detail of health care. This is not a simple problem.

  • Chris Shearer

    “A primary driver of both the rising quality and falling prices of computers is Moore’s Law. There is nothing remotely close to Moore’s Law in medicine.”

    I’m not so sure about that. Mid-70’s Heart disease care consisted of blood pressure meds, somewhat effective meds for cholesterol and open heart surgery
    Mid-80’s newer, more effective meds for cholesterol (HMG- CoA redu. inhib), catheter-based procedures (angioplasty), ACE inhibitors for heart failure
    Mid 90’s thrombolytics for acute MI, cardiac stenting
    Mid ’00’s – new anti-platelet drugs, rapid MI diagnostics leading to rapid cath and stent

    We’ve seen dramatic decreases in heart disease death rates but I don’t believe we seen coincident decrease in cost.

    so technology has made “it” better and faster but not cheaper?

    • fredrik

      “so technology has made “it” better and faster but not cheaper?”

      Some health measures, like cardiac care, have gotten better over time… many haven’t, and not many have gotten cheaper. Moreover, improved health care has the additional complication of longer lives leading to more health measures per person; that’s a good thing, obviously, but it makes things more expensive. The longer we live, the more likely we are to run into cancer at some point, and there aren’t many cheap ways to deal with cancer. It’s more like going from a $4000 Apple IIe to a $4000 laptop that’s more likely to need replacing in the near future. Better computer, but the cost problem is worse than before.

      Of course, Will’s original post is about health care, not medicine, so this is all sort of beside the point. But health care does not lend itself to easy analogies. Better computers do not force you to buy more computers — you can not negotiate better prices on food simply by joining collectives with your follow consumers. Both Will and JB are pretending that health care is a discrete economic product so they can bluster about markets. I’d like to think that at least Will knows better.

      • JB_Shotworth

        “The longer we live, the more likely we are to run into cancer at some point, and there aren’t many cheap ways to deal with cancer.”

        You don’t know whether this is about to change. T. Colin Campbell has done fascinating work on this and cancer wouldn’t be the first intractable seeming malady that someone just up and cured. You’re assuming a lot.

        “Of course, Will’s original post is about health care, not medicine, so this is all sort of beside the point. But health care does not lend itself to easy analogies. Better computers do not force you to buy more computers… ”

        Don’t take this the wrong way, but you sound like the usual pie-slicer; “all we have is this one pie that needs to be sliced up fairly by technocrats.” Clearly, this isn’t how the world works. People are always baking new pies. The proven method for maximum pie production is the freest market possible, not some clowns in a room with guns telling everyone what to do.

        “… you can not negotiate better prices on food simply by joining collectives with your follow consumers.”

        Because the margins are already super-thin. We don’t have a health care market.

        “Both Will and JB are pretending that health care is a discrete economic product so they can bluster about markets.”

        What does this even mean? No one thinks that health care is a “discrete economic product.” The primary thing people can do to improve their health is moderate, regular exercise. Beyond that, their are thousands of OTC products before we even get to an actual health care provider. Am I “blustering about markets” when I say that people should buy their own food? There’s no “discrete economic product” there; are you saying there’s no market for food?

  • JB_Shotworth

    Moore’s Law is just a description of how quickly costs fall for one kind of technology. We have no idea how quickly health care costs could fall if, say, B. Mackey’s ideas were instituted. There’s low-hanging fruit everywhere:

    1)All medical records could be held online. Several systems are available. With easy access to these records, customers could shop doctors without having to do all the same paperwork and all the same pointlessly repeated initial check-ups. This could drive insurance providers to use the same e-forms, etc.

    2)Patients can now keep very accurate records of skin conditions with digital cameras. They can send these to clinicians who can offer algorithms. Some of this is already being done. Perusing these could be easier than perusing X-rays is now.

    3)It could become the norm for people to start with WebMD symptom checker or whatever better product is soon to follow. How often do people show up at a clinic when all they needed was someone/thing to say, “eczema? hydrocortisone.”

    4)Liberals could start pressing the idea of lifestyle changes because there is no medical substitute for regular exercise, but instead liberals spend most of their energy trying to force other people to pay for the health care of strangers.

    5)Etc. times a million. We have no idea what would be produced to make things cheaper, better, faster because no one ever knows what solutions are around the corner in any field. You could probably think of dozens of shortcuts that might work because we have such a non-market for health care that even easy stuff hasn’t been tried.

    Plus, why does some guy have to go to post-secondary school for several years to scrape plaque off my teeth?

    “2) Early adoption in medicine leads to rising prices, not falling prices. The rich like spending tons of money on their health care… the savvy may be changing their tune, but verrrry slowly. ”

    There’s no reason why most health care has to be different from every other service or product. We’re generally talking about people in buildings with skills and capital goods. Now, all we need is some kind of price-discovery process and people with the standard algorithm “get more for less” and we’ll have a system. There’s little point in trying to be savvy now, because prices are often completely opaque because of our retarded government.

    “3) It is not difficult for a consumer to gauge the functional quality of a computer. It is more or less impossible for a consumer to gauge the efficacy of various medical treatments; even consulting studies gives you out-of-date and incomplete information. Medicine is more of a black box than computing.”

    If that’s the case, then Robin Hanson and Tyler Cowen are right: people should avoid new treatments and avoid any screening that doesn’t have a proven track record. Medicine’s black-boxiness is no reason to have government take it over completely.

    “4) It was decades before most Americans could afford computers. Is your contention that the poor, sick & disabled should simply hang out until the health care market finds them to be attractive buyers, years down the line?”

    Why are liberals and social-dems categorically unwilling to be charitable? It seems that they only think a solution is sufficient if it involves coercion. I’m serious about this. There are tens of millions of libs/social-dems and many of them are rich, rich, but none of them seem to have the wherewithal to do anything about this problem but bring in the guns. Plus, the idea of socializing all of health care to take care of a small minority is bad policy.

    “Are Minute Clinics a good thing? Sure. Would things be better if the employer tax exemption was rescinded, and consumers had a clearer sense of what their health care cost them? Absolutely. But your analogy is nonsensical. To pretend that health care lends itself neatly to market solutions is to ignore, well, just about every salient detail of health care.”

    You don’t know this for the reason you just mentioned and more. We don’t have a real market for health care. ERs are forced to take all comers no matter how often they show up (where else is that the case.) People can’t buy insurance from outside their own state (why don’t liberals use the commerce clause to fix that the way they use it on everything else?) Prices are opaque. Roadblocks to trying different providers are everywhere. And to top it off, thanks to generations of social-dems, Americans think they are owed free health care.