Health care is a basic human right. No human right should be placed on any marketplace, however perfect. The pro-mercantile bias in discussions about healthcare is breathtaking.

This leads to a number of interesting questions. Are any US markets perfectly competitive? How close to perfect competition do we have to get before we feel comfortable using economic theory? What are the benefits of perfectly competitive markets? Why would a model which fails in step one be used as a foundation for further analysis?

A “perfectly competitive market” seems to be one of those academic assumptions that has no parallel in reality, which sooner or later leads to the type of idiocy and craziness the US and global economies have been having to deal with these last thirty years

Hmm, haven’t read these articles, but clearly, structural adjustment and austerity measures as debt payoff for IMF loans isn’t useful social policy. DUH.
For a cogent critique of modern capitalist economic theory in practice, read “The Shock Doctrine”, by Naomi Klein, for an indictment of Milton Friedman’s theories and policy advice to various public officials, esp Augusto Pinochet and Ronald Reagan. Nice company to keep.

Lets make it truly competitive I wonder if I can take my tax money and buy into Canada’s healthcare plan, Cuba’s etc. If France were to set up clinics here:)
I want drugs to be priced the same as other countries why should we pay more we are a captive market with no bargaining power.
If the free market was truly more efficient wouldn’t we pay less for drugs than other countries?

the health care industry sort of occupies a place and performs a role in society that was once (for millenia) the domain of a proffesional preisthood.

Great read, masaccio.

This is one to bookmark for reference.

Thanks for your work.

The Farm market is given tax dollars to compete since farm workers don’t get overtime they have an unfair advantage compared to other industries as far as labor costs.
Despite these advantages free trade lowers food prices so much farming is more and more done on an industrial scale to squeeze costs. This lowers prices more and drives out more farmers.
However we do get foreign fruit in winter at low cost. Any policy that lowers needs government help is uncompetitive. Any government policy who’s end result results in less competition is a failure.
Any policy that reduces the pay of its workers..uh just why are we paying farmers again?

American Farming practices also cause soil erosion in a sense we are killing the very industry we are trying to save by paying farmers to produce as much as they can.

We can make similar arguments for the american auto industry. Government protection regulation is needed but we need long term plans for industry imagine if Al Gore had gotten GM, Ford and Chrysler to cooperate and they made the first hybrid car instead of the Japanese?
Imagine that Bush gave the Hummer tax credit to American hybrid cars instead. We need policies based on national interest we import oil.
Stopping that as best we can means more of our money is spent in our economy. The good of the rich who invest in oil companies is not the same short term as the good of the whole.
The rich have shown during the Bush/Obama years that they can’t think long term they can’t control their hunger. They snack on fast food/ponzai schemes before eating healthy meals/invest in making products people need.

All 4 of those assumptions are wrong, not just with healthcare, but any of the markets we now have. I have to say this is small potatoes. We are three years from the housing blowup, two years from the meltdown, and a few economists are beginning, beginning, to reassess some of their ideas. This reeks. Economists are right up there with alchemists and phrenologists for most discredited pseudo-science. The best thing that business, government, and academia could do is fire all of their economists. There aren’t probably more than about 20-30 reputable economists in the whole country. I definitely would fire every economist at the Fed. A bigger claque of hubritic disconnected idiots is impossible to imagine.

Economists suck because the whole human project is a total greed idiot fail, and headed toward well-deserved oblivion.

Hug your cat, lay in the grass, enjoy the sky and trees and breezes.

We need Keynes the rest are well paid hacks.

When can I buy into the Canadian health care system? LOL

Let’s not overlook the ‘price’ we pay owing to the deregulation of government services, in this instance, the near-dismantling of the medical and scientific research ‘faculty’ at the FDA. Since Reagan’s administration, the efficacy of medicine – the trials and analyses of various therapies – has been given over to the pharmaceutical industry and its employed scientists and physicians. Their exhaustive research and publications (leave bias aside for this instance) is always too voluminous for adequate review by the limited resources at the FDA level. Even more troublesome is that the physicians and care givers, while they have full access to all the research data, have no time to analyze any of it. The peer-reviewed literature published in medical and professional journals is also too voluminous now for anyone to digest or even keep up with. Our point-of-service medical providers must rely on collegial conferences and the best judgments of their colleagues, whom they meet with regularly at hospitals and health centers they are associated with. It’s overwhelming and wasteful – all in the name of cutting government spending.

It’s obviously impossible to provide and assure good health care to 300 millions of people without also providing sufficient resources.

Call it socialized medicine or government-subsidized health care, but what’s necessary is a well-funded agency with research physicians and scientists living and working everywhere in the country. It’s not that we can’t afford it, you know?

The day we take over the government the day after the economy crashes again the week after the Fed tries to bailout the banks again and Obama and the GOP rush to cut Social Security.

Don’t forget the cost of more food recalls and the cost of people getting sick because food is not regulated, inspected or the regulations are not enforced.
We need numbers on these costs vs the numbers for having enforced regulations and inspections of food in other countries.

I agree – I put Naomi’s book on my 16 year old grand-daughter’s IPOD – and she is listening(she may one of the few to show up for my funeral).

Meanwhile health insurance as a competitive good for sale can only start with a standard policy and standard rules for claim payment. Health care can only start with standard rules for reporting outcomes relative to riskiness of problem the health service is attempting to care for. Neither of the above is coming soon.

So we are left with putting in place a single payer national health and a national budget for basic care that dictates price, or an internet approach along the lines of Yelp. And Yelp has not gone in that direction as yet /s

…imagine if Al Gore had gotten GM, Ford and Chrysler to cooperate and they made the first hybrid car instead of the Japanese?

Guess what? Something like that actually happened. The government created the safest car ever built:

The result: Three swamp-monster sedans of more than 5000 pounds apiece that did double-duty as safe transportation and appetite suppressants. The October 1972 issue of Popular Mechanics laid out the details: Roof-mounted periscopes; bumpers wide enough to haul Dom Deluise; and in the GM model, a rear-seat “credenza,” so back-seat passengers would be protected in crashes by smacking into a vinyl-covered bosom.

Unsatisfied with the vault-on-wheels solution, the National Highway Traffic Safety Administration changed course. It held a bake-off in 1975 for what a safe car in 1985 might look like. Ford and Volkswagen offered ideas, but NHTSA awarded what would become a $30 million contract to two independent engineering firms, Calspan and Minicars.

Minicars successfully created an amazingly safe, yet desirable, car. Unfortunately the private auto market dominated by the big Detroit car makers wasn’t interested in selling them. And when Reagan took office he ended the program and had the safe cars destroyed. Of course. It took another round of government regulations to force car makers to add airbags as a standard safety feature, which didn’t happen until the mid-1990s.

Most economists honor the tenet “he who’s bread I eat his song I sing”. Like our politicians.

Well said – a point I forgot to mention. Reagan caused so much harm – Nixon killing American military and the “enemy” so as to keep a war going so as to win his re-election was very G W Bush like, but Nixon also was into improving the social safety net and the efficiency of the economy wherever government could help. The quality of the GOP has gone down since Nixon – and Beck and company establish a new low.

Adams introduced the word confusopoly in this book. The word is a portmanteau of confusion and monopoly (or rather oligopoly), defining it as “a group of companies with similar products who intentionally confuse customers instead of competing on price”. Examples of industries in which confusopolies exist (according to Adams) include telephone service, insurance, mortgage loans, banking, and financial services.

http://en.wikipedia.org/wiki/The_Dilbert_Future

I think this explains why the free market is not working. Its easier to make profits cheating people by confusing them. Free Market economists assume people and companies are more honest and informed than they actually are.
They assume business and government do not get along when actually they get along quite well at our expense.

In Wealth of Nations, his seminal book on capitalism, Adam Smith argued that the “invisible hand” of the marketplace, better known as greed, optimally regulates the marketplace. Today’s neoliberal free-market enthusiasts thunder against any form of government regulation insisting that regulations create inefficiencies that reverberate throughout the market hampering its effectiveness. The fundamental flaw in Smith’s invisible-hand theory is his assumption that people are reasonable and will make well informed decisions balancing short term and long term factors after considering all of the relevant facts.

Ain’t going to happen. Ever.

Referees and umpires are required to promote fairness and prevent cheating in the marketplace just as they are needed to assure that both teams play by the rules in the World Series and the Super Bowl.

Blankenship in the mining industry and BP in the oil industry are the latest examples that have proven that the invisible hand doesn’t work.

It’s long past the time that everyone should accept that free markets don’t work. The discussion should be about determining the most effective set of regulations and the most effective method of enforcing them.

Mindset rules and overrules. “Your insurance won’t pay for it.”

I had excellent insurance and also an ‘ugly’ skin tag on the middle of my back, like a big nipple. The dermatologist (in the ‘network’) said he couldn’t remove it because my insurance wouldn’t allow it. Huh? I said, Hey, I’ll pay with my own money, okay? How much? He made an offer – after a weird kind of lightbulb turned on inside his obfuscated skull.

To create better regulations they should be goal orientated toward the public good we need a discussion on the public good. For cars and oil we need to create jobs for americans, and pay less for foreign oil by making more fuel efficient cars.
For farms we need farm workers to get overtime farm practices that enrich the soil without chemicals and if that means we produce less fine we already import food.
But the world’s farmer’s incomes will go up if we don’t drown the markets in low cost corn and grain paid in part with our tax dollars immigrant labor and legal labor that doesn’t get over time:(
A much larger discussion of the common good needs its own front page thread.

A much larger discussion of the common good needs its own front page thread.

Like the Federalist papers of Madison, Hamilton, et al., but this time around an exchange between, say, Elizabeth Warren, Naomi Klein, and Frances Moore Lappé?

That would be so great I might not comment just read:)

It’s long past the time that everyone should accept that free markets don’t work. The discussion should be about determining the most effective set of regulations and the most effective method of enforcing them.

Yes, but it’s our rotten luck to be living during the worst of times when all the policy makers, all the elected officials, and all their support staffs are law school graduates. They are all trained in getting over and around anything that can be put into words. And they’re practiced in pitching their point of view on behalf of their ‘client’. It would be ‘unethical’ in the extreme for any of them to advocate for any ‘contrary’ (or alternate) point of view.

That would include both a recommended treatment and a list of reasons why other treatments might be better…

…or worse. That’s a big piece in American care delivery – expensive ‘treatments’, touted by their makers, that are not ‘remedies’.

Great idea for a salon where we’d just “listen” to their 60-90′ discussion perhaps introduced by Jane Hampsher.

karen

Even if we grant Reinhardt and Arrow’s assumption that classical economic theory is reasonable and adequate (a position skillfully criticized by George Soros in “The Soros Lectures” 2009) it is obvious that medical care cannot be “optimally” – for maximizing individual health – distributed by a cash market mechanism. This is true for the following reasons:

1.) Even among the well educated with internet access there is a tremendous asymmetry between the doctor and the patient in esoteric technical knowledge and judgment needed for the application of competent and effective medical care.
2.) A person who has an accident or an illness has very limited opportunity or capacity to shop around and compare price or quality. Usually the sicker and more acutely ill the patient the less this capacity will be and well people don’t know what specific areas they need to explore in advance of illness.
3.) During any illness it may be impossible or even catastrophically dangerous for a patient to try out (consume) one set of treatments and the choose to switch to another.
4.) Enduring and managing an illness or an accident inherently involves a huge emotional factor, thus impairing “rational” consumer choice.
5.) Under our country’s insurance system the consumer/patient is mostly both ignorant and isolated from the anticipated or actual purchase prices and costs anticipated or actually incurred.
6.) It is not unusual for a bout of illness to require the sudden purchase of medical care which can be literally catastrophically expensive, yet to forgo it would be to invite personal tragedy and face ongoing pain, disability, or even death.
7.) The purchaser of most medical services and supplies and thus the generator of most medical spending is the doctor, not the patient.

Yes, the purchase of medical services is not like buying a house – or even a beach house. Furthermore keeping people healthy has what economists call externalities (even without moral or social justice concerns) that is, value that benefits the community as a whole beyond any benefit to the individual – thus maintaining a population that can be productive or even be fit for military service.

Frankly if you want to get serious about how best to distribute health care, I subscribe to the model put forward by the English family doctor Julian Tudor Hart in his book “The Political Economy of Health,” that is, the best way to create and make compassionate medical care universally available is through a society’s cultural commitment to a GIFTING RELATIONSHIP!

Yes! It would be great if they have their liveblog exchange, say, once a month, ‘closed’ to reader/lurker comments as such, but readers could comment in synch, and the participants could reply at some other time.

Actually, Jane Hamsher ought to be included (if anyone ought to be!), but then there would be unintended ‘bias’ and unconscious deference.

But if anyone can organize such a salon, Jane can. And it’s a worthwhile project, which I (and many) would happily contribute $$ to help support.

Pass it on!

Elegant comment and contribution. Many thanks for composing it!

Maybe a human life should not be subject to marketplace but the technology
required to provide the quality of healthcare in this country is.
It takes a tremendous amount of money, investment to create, an MRI, pet Scan, robotic laparoscopic surgical device (cost $2,000,000)
Bone scan machine, not to mention expense that goes into research and development of medication. If this was left to our government to fund this,
our care would be greatly compromised.

Our government already funds much of it, but gives all the profit to private industry, not even taking back a discount on the final product/service.

Yes, but it’s our rotten luck to be living during the worst of times when all the policy makers, all the elected officials, and all their support staffs are law school graduates. They are all trained in getting over and around anything that can be put into words. And they’re practiced in pitching their point of view on behalf of their ‘client’. It would be ‘unethical’ in the extreme for any of them to advocate for any ‘contrary’ (or alternate) point of view.

I respectfully disagree. I was a criminal defense lawyer for 30 years before I became a law professor and I am just as capable of advocating in support of my own values and beliefs as I would be advocating on behalf of a client. Because of my training and experience, I can anticipate opposition arguments and tailor my arguments to defeat their main points much more effectively than I would otherwise have been able to do. Ted Olson and Don Boies, a couple of straight dudes who support same sex marriages, did a pretty good job persuading Judge Vaughn Walker to rule that the voter passed California proposition prohibiting same sex marriages was unconstitutional.

Ethical rules prohibit a lawyer from representing a client when the lawyer has a conflict of interest; they do not prohibit public advocacy in support of the lawyer’s personal views unless the lawyer is a judge and his or her personal views might reasonably be expected to pertain to a legal dispute that the judge might have to decide in the future. Judges have to be careful about what they say and to whom they say it in order to preserve the appearance of impartiality. To serve as a judge, they have to take an oath that they will follow the law, even if the law requires them to reach a conclusion in a disputed legal matter that is contrary to their own beliefs.

Just an example for you to consider: bmaz doesn’t pull any punches when he expresses his opinions here at the Lake.

Thank you for providing a sober and pointed refutation. I surely hope that your more experienced judgment (much more than mine) is the prevalent one and applies to most law school graduates.

Most of the money invested in the production of medical equipment is funded by private investment. Even with some of the money contributed by the government, it is nothing compared to what is provided by private investment. If you are referring to Medicare they are having to reduce what they are paying to the extent that more and more providers are refusing to accept Medicare patients.

That is a lucid description of the problem. It illuminates the issue: what arrangements should societies make to insure that the welfare of the citizenry is maximized.

You will note that Arrow and Rhinehardt are not willing to address the question how should health care be delivered fairly to the citizenry. I have some principles in mind, which I have written about. Short version; read John Rawls and think about how those ideas might be put into practice.

Unfortunately, there is no genuine political discourse in this country. There is only bellowing from hard-headed ideologues. We are a sorry excuse for a democracy.

I’d love to know what the “Recovery Summer” Obama Administration truly thinks – on one hand they seem to be buying their own PR, but on the other hand they seem to be manipulating the numbers. I think there has to be a defenestration of the Rubinites out of the levers of power. As long you’ve got 100% par bailouts for Wall Street (while ignoring everyone else) and the anti-Glass Steigall mindset, it really doesn’t matter what their other economic theories are as you’ve got to get your First Principles right. I also think the whole idea of the G20/G8 is harmful rather than helpful.

Unfortunately, there is no genuine political discourse in this country. There is only bellowing from hard-headed ideologues. We are a sorry excuse for a democracy.

What genuine and potentially useful discourse there is resides in collegial monasteries and cloisters. What gets out is ignored, or if it’s circulated at all, it’s marginalized and stunted.

#33,34,37

research funding:
http://www.aaas.org/spp/rd/usba07.pdf

you are right, hijean831; corps derive their products from taxpayer funded research as well as much of the facilities for their products.

karen

what arrangements should societies make to insure that the welfare of the citizenry is maximized.

The welfare of all life forms and the environment that nurtures and sustains them also must be considered. We are all in this together; we are a part of the totality. We harm ourselves, if we harm other life forms, and we would cease to exist should they cease to exist.

Unfortunately, there is no genuine political discourse in this country. There is only bellowing from hard-headed ideologues. We are a sorry excuse for a democracy.

The right wing discarded evidence-based discourse long ago. They have their talking points, which they make up facts to support, and they resort to shouting, ad hominem attacks, and changing the subject whenever they sense that they’re losing an argument. They cannot engage in legitimate debate because they are authoritarian by nature, intellectually lazy, lack critical thinking skills, and they demonize everyone who disagrees with them.

Nothing much can be gained by arguing with adults who are developmentally stuck at age two and hate everyone who disagrees with them or won’t let them win.

We are all aware that there are different schools of thought in the science of economics. I started out in a school that taught the Austrian model, but every time I began work on a paper, I kept running into facts and history that showed that Austrian economics does not work in the real world. I had to change schools to finish my degree. The problem in America is that the people running the country are listening to the wrong economists.

In Canada, Europe, Japan, Australia, Russia, China, South America, in all other modern countries, the costs of healthcare are on the books of society. They don’t insure for that, because this isn’t a risk they are insuring for, it’s a cost. They know what it will be every year from the size and age of the population. America treats it as a risk and prices it accordingly. This, in a nutshell, is the difference between America and the rest of the world. Again, American policymakers are listening to the wrong economists.

i have 5 simple ways to fix healthcare.

1-regulate physicians pay-call it price fixing, capitation whatever you want. This is problem #1 and the true driver of cost that no one speaks of.

2-regulate insurance companies as glorified utilities–this is the closest we’ve come with this so called HCR. no profit and responsible excutive salaries and cut down on the number of lawyers they have.

3-regulate drug companies profits to European levels–this we actually went the other way in this round of reform. Drug companies don’t need 20% profit margins when most drugs are developed by government funding.

4-regulate hospitals profits and their practices.

5-find out a way to do 1-4 without 1,3,4 without losing too many doctors, pharmecutical companies and hospitals.

Simple!

The issue was the money spent on the cost of the production of high tech medical equipment itself. This is mostly paid for by private investment and private pay insurance.
What you are referring to is research in finding cures for disease.

It also illuminates the incredible distortion of reality that comments like Limbaugh’s assume. It is appalling to read Bush II’s “Economic Report of the President” over many years because his appointed ideologues and free marketeers could not envision how having a terminal illness or getting vaccinated was any different than buying a house or a car. Either they were living on a different planet or their market fundamentalism economics was mere window dressing to justify corporate exploitation of the sick.In fact I think that was the same problem Alan Greenspan had with the whole economy.

I agree with health care as a basic human right (along with clean water, clean air, clean soil, education and housing). Another thing is that in most other countries, allopathic medicine is not the predominant approach. So here, not only do we have a monopoly but we have an enormously bloated one. This means the systems sells you a lot of what you don’t need and at inflated prices. Coupled with the fact that the public is being intentionally left unprotected by regulatory agencies to artificially stimulate “demand” from the monopoly, that means our health “care” system is really just another tentacle of the Vampire Squid. One more thing … when I go to buy a cup of coffee, I want the cup of coffee not a voucher for the cup of coffee that a bunch of middlemen might actually decide to honor (costing me time and money to attempt to get the contract enforced by a court of law while I STILL don’t have my cup of coffee). Insurance is a government enforced rip-off which forces the citizens to make uncompensated loans to unaccountable private investors who go play with that money (not their own capital) in The Casino. This corrupt system has got to go.