CompFedUp said: So, Ralph, since you’re an official libertarian, perhaps you can explain why our health care system is so bad in comparison to other like countries. You can’t claim “it’s gubmit meddling”, because those other countries have greater governmental involvement and yet their health care systems deliver more at far less cost than ours does. Your buddy Chuck has never come up with a good answer; perhaps you can.
For simplicity, let’s say we have three distinct categories of “gubmit meddling”: (1) Free market; (2) Government monopoly; (3) Mixed.
In the free market, resources are allocated by price. Technology tends to drive prices down; often rapidly. As an example, LASIK procedures dropped in price by about 40% in ten years because the market in LASIK procedures is essentially a free market where price and value dominate.
In a government monopoly, where the government is, essentially, the consumer of all healthcare and the payer for the services, the government will hold costs down because the government is paying for it. There will be lots of waste because everything is, in general, free or low cost to the consumer; but, of course, not to the taxpayer.
Finally, we have our current mixed model. This model is worse than either of the other two models.
In this model, the government pays some of the bills; about 50% of all health care spending is done by government in the U.S. today. Then the gubmit makes regulations that the private sector must follow. For instance, mandating that insurance companies provide certain services for “free”. In essence, these are unfunded mandates on the private sector.
So the insurance companies do what they have to do to provide these “free” services: They raise rates. You, as a consumer, have no choice as to whether you want to purchase insurance without these “free” services; so the consumer only sees rates go up.
Of course, the gubmit then rails that the insurance companies are being greedy and that insurance premiums are going up. The insurance companies have no choice, of course, because they know that the “free” services will be consumed. “Hell, of course I’ll get that ‘free’ service,” says Mr. and Mrs. Consumer. “It’s free!”
In addition, the gubmit pays fixed amounts for services without respect to quality. There is, thus, no effort to convince the consumer “We’re better and cheaper!”
It is, of course, worse than that. Gubmit does not pay market rates for care. It often pays way over market for some services (my daughter had direct observation of this at her previous job) and way under market for other services. Both harm aggregate care for everyone.
So this third form of “gubmit controlled not-free-market” — the system we have now — causes us to have the most expensive and least effective health care system. There are few price signals that rationalize resource allocation because the irrational gubmit is such a huge presence in the consumption of health care.
That is why we have such a rotten system of resource allocation here in the U.S.. That is why it is so expensive. That is why every time the gubmit creates more regulation on what is left of a not-free-market that things get worse.
Lotsa words, still wrong, Ralph.
Do a scatterplot of per-capita health care spending vs. what the government's share is for various countries like the US. The US is an extreme outlier – small (in comparison) governmental role, but per-capita cost far higher than anywhere else. If, as you claim, "the irrational gubmit is such a huge presence" that leads to "most expensive and least effective", there ought to be a direct relationship between governmental "presence" and efficacy/cost. There isn't – indeed, the relationship is far more likely to be the opposite of libertarian dogma. Those nations that have more gubmit "presence" have better and cheaper health care systems than we do.
So who's causing our health care to be so expensive and yet deliver so little? Not the gubmit, clearly. Other nations have solved the problems with health care that so far have utterly eluded us. Perhaps they're smarter than we are.
Once you've conceded the facts, then we can move on to another problem with health care in this country – the rigidity in labour markets caused by the iron rod connecting employment and health insurance. How many folks are stuck in jobs that don't help them meet their potential, or, at the worst, they really hate, but because they get health insurance via their employer, they cannot leave?
On the issue of health care, boilerplate libertarian ideology just doesn't square with reality. What's the solution?