Debate:Should a just government provide healthcare to its citizens?
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::::You're espousing a view which has been succinctly boiled down by someone I admire as "I want the freedom to be rich, and you can have the freedom to go starve". It's hard to see where empathy comes into your view. In NZ, taxation is I believe somewhere between 30 and 40 percent. From that the government maintains a wide range of social programs including interest-free student loans (a nice compromise between paying for all tuition and making people pay for the benefits of education themselves). There's a social security program which, admittedly, is often abused by people who don't wish to work, but cutting it off probably wouldn't make them work, and a lot of people who genuinely need it rely on it too. I'm not going to say our system is perfect, but everyone's housed, no one starves, there's general access to healthcare and education and you have the freedom to do what you want with your life, within the limits of the law. We sometimes get accused of a nanny state, but it's better that people get looked after than that they try to find a way to look after themselves. The crime rate here is fairly low. [[User:Wazza|Wazza]][[User_Talk:Wazza|<sup>Hello? Is there anybody in there? Just nod if you can hear me...</sup>]] 19:39, 2 December 2008 (EST) | ::::You're espousing a view which has been succinctly boiled down by someone I admire as "I want the freedom to be rich, and you can have the freedom to go starve". It's hard to see where empathy comes into your view. In NZ, taxation is I believe somewhere between 30 and 40 percent. From that the government maintains a wide range of social programs including interest-free student loans (a nice compromise between paying for all tuition and making people pay for the benefits of education themselves). There's a social security program which, admittedly, is often abused by people who don't wish to work, but cutting it off probably wouldn't make them work, and a lot of people who genuinely need it rely on it too. I'm not going to say our system is perfect, but everyone's housed, no one starves, there's general access to healthcare and education and you have the freedom to do what you want with your life, within the limits of the law. We sometimes get accused of a nanny state, but it's better that people get looked after than that they try to find a way to look after themselves. The crime rate here is fairly low. [[User:Wazza|Wazza]][[User_Talk:Wazza|<sup>Hello? Is there anybody in there? Just nod if you can hear me...</sup>]] 19:39, 2 December 2008 (EST) | ||
:::::Again, I know little about NZ, clearly it will benefit me to look into it. In the meantime, I will address the personal insult. I clearly do have feelings, or I wouldn't ask you to respect them. If you're rational, then this should be obvious to you. Instead, you hope to imply that my having feelings should bring me around to your point of view. This is clearly silly. To illustrate, while my view can be boiled down to what you said, it can also be boiled down to: "I want the freedom to get rich for both of us, knowing that freedom implies responsibility, and the risk of failure, because I do not wish to have things stolen from me by individual or by state." Surely we can agree that we'll get a more interesting debate if we leave the bile of personal insult out of it, no? Unless, of course, you're not interested in debate, but rather in an opportunity to subject those you hate to clever quips. [[User:BlueSprite|BlueSprite]] 19:50, 2 December 2008 (EST) | :::::Again, I know little about NZ, clearly it will benefit me to look into it. In the meantime, I will address the personal insult. I clearly do have feelings, or I wouldn't ask you to respect them. If you're rational, then this should be obvious to you. Instead, you hope to imply that my having feelings should bring me around to your point of view. This is clearly silly. To illustrate, while my view can be boiled down to what you said, it can also be boiled down to: "I want the freedom to get rich for both of us, knowing that freedom implies responsibility, and the risk of failure, because I do not wish to have things stolen from me by individual or by state." Surely we can agree that we'll get a more interesting debate if we leave the bile of personal insult out of it, no? Unless, of course, you're not interested in debate, but rather in an opportunity to subject those you hate to clever quips. [[User:BlueSprite|BlueSprite]] 19:50, 2 December 2008 (EST) | ||
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| + | Presumably one would have no qualms about providing health and welfare support for one's husband/wife & children? How about parents, grandparents, brothers sisters? How about nephews & nieces? Nephews'/nieces' wives/husbands? The friend or guy next door who falls and injures himself leaving his family unsupported? You see where I'm going? When do you stop, assuming you've started? <br />Also don't forget "''rich''" is a comparative term - it needs "''poor''" to remain valid. In a decent society everyone would be "rich", as far as health care is considered. So the problem shouldn't arise. <br />In the kind of libertarian society seen many times in science fiction, the "rich" live long, healthy lives in walled enclaves served by the ravening hordes of "poor". If that's what you want then good luck, but it's not my ideal world. {{User:Toast/sig/sig}} 20:21, 2 December 2008 (EST) | ||
Revision as of 01:21, 3 December 2008
I'd like to note that this is largely a question of ethics. The question isn't flawed just because a "just government" doesn't necessarily exist. Answers should prove why a just government (your subjective definition thereof) should or should not provide healthcare (non-private) to its citizens (individuals legally residing in said country). Good luck! --e|m|c [TALK] 14:21, 20 February 2008 (EST)
- Back up one step. Should hospitals be required to make a best effort to save the life of anyone who walks in immediate need of medical treatment? For example, you are walking down the street in your home town and start vomiting and fall unconscious. I would assume you would like them to take you to a hospital and make a best effort to make you better - even if you don't have an idea or aren't from the area (check your pockets, oops, this guy is from Canada, ship him north guys). The extension of this is what do you do for a homeless person who starts vomiting and falls unconscious on the street. Well, the hospital is going to try to help that person too, and the tax payers are going to pay for it. It has been found time and time again that preventative healthcare is much more cost (effective?) than emergency health care, both in terms of time and quality of life. One could (I don't, but one could) care less about the quality of life of other people, but most people prefer to pay less taxes.
- On a related note, free housing can also drastically reduce the cost to tax payers in some cases too.[1]
- --Shagie 13:16, 20 February 2008 (EST)
- Sorry to invade your space, but this is a kind of side note: first of all, isn't every doctor obliged to give care to people in immediate need of help? I thought it was in their oath. Second, I have read at least a couple of times, in the Mediterranean country where I am now living, of people who collapsed and died in front of a hospital. In this country, doctors/nurses are required to stay in the hospital, they can't go out - even if just 5 meters/yards! The correct procedure is to call an ambulance, which will come from who knows where and take you to the hospital when it's too late. Editor at RWSchumi on Ducati? 13:44, 20 February 2008 (EST)
- You sure about starting this debate, EMC? We're all gonna' get whumped by PalMD. :-) --
Radioactive Misanthrope 15:00, 20 February 2008 (EST)
Contents |
Radioactive afikomen
Arguably, it is the responsibility of a state to concern itself for all its citizens/residents. An important part of such a responsibility is to protect the innocent and the helpless. The "helpless" includes those who do not possess the means to take care of themselves, which clearly includes those who are too poor or whose treatment is too expensive for them to afford on their own.
Guaranteed universal healthcare would greatly raise quality of living. Additionally, while some (read: libertarians and other anti-statists) may argue that government healthcare would make the people more complacent and dependent on the state, it would actually "help the people help themselves". Particularly when it comes to long-term, often lethal diseases, such as cancer or AIDS, paying for treatment is always very costly. Households often bankrupt themselves, or sacrifice any existing financial security, in order to pay for such long-term, often highly specialized treatment. By letting the government pay for it, people will no longer be driven into desperation or poverty by healthcare costs.
As for the free market, it is arguably ill-suited for providing healthcare. Despite libertarian opining to the contrary, the free market is actually business oriented—when consumers benefit it is only a pleasant side effect. On its own, the free market focuses on selling as much as possible in order for businesses to maintain as high a profit as possible. However, the entire principle behind healthcare is to sell as little as possible, and emphasize prevention over treatment. The ethical goal of healthcare is reach the point where it is only barely needed, and maybe even not needed at all.
There do, of course, need to be a few things purposely not covered by national healthcare. Frivolous procedures like cosmetic surgery shouldn't be covered, except for the injured (burn victims who need skin grafts, for example). Medical woo treatments should also not be covered. --
Radioactive Misanthrope 13:36, 20 February 2008 (EST)
- I need to
pentype a longer response at some point, but a few things. First, while preventative medicine is undoubtedly a public good, and good for public health, it is not clear how cost-effective it is. Whether or not it is cost effective should drop a bit in relevance anyway, as prevention is important to public health. - A few things are involved in centralized health care. First are the ethics, second is how it is put into practice, as the implementation effects the ethics. For instance, centralized health care with Draconian rationing would be perhaps utilitarian, but less ethical than other systems (current US system is rationed, not in a Draconian fashion, but in a somewhat haphazard, economic fashion).
- Health care is not as amenable to a pure "marketplace of ideas" as other services. It requires highly specialized professionals who have a fiduciary relationship with their patients. The current (US) financial incentives can disrupt this relationship.
- Under our current system, all hospitals (at least, all that participate in any government programs--US) are required to treat emergencies to the best of their abilities. People in private practice like myself have no such obligation (i'd go broke anyway).
- More later, but it's just some things to chew on.--
PalMD --You don't know harsh! 14:04, 20 February 2008 (EST)
- Do you have any quibbles with the financial argument (second paragraph)? --
Radioactive Misanthrope 14:10, 20 February 2008 (EST)
- Any system that provides real health care (as opposed to voodoo, etc) will spend a lot of money on a few people. Given it's a gamble to figure out who will be the few expensive people, the only way to finance such a system is by pooling risk and money.--
PalMD --You don't know harsh! 14:40, 20 February 2008 (EST)
- Any system that provides real health care (as opposed to voodoo, etc) will spend a lot of money on a few people. Given it's a gamble to figure out who will be the few expensive people, the only way to finance such a system is by pooling risk and money.--
- Do you have any quibbles with the financial argument (second paragraph)? --
- This subject is a veritable mine-field as the provision of universal healthcare can be a tremendous drain on the public purse if not controlled. I don't know if this debate was inspired by my posting about my wife's cancer therapy but we received a lot of value back from our health taxes. There's a lot wrong with the British NHS but there's a lot of good there too. In the UK the Government is the primary employer of health-care workers so has the controlling say in how most of them are paid, people don't want to pay a lot of tax so they try and keep wages low, this tends to lower the quality of native healthcare workers but our wages are still higher than say the Philippines or Poland so we get an influx of foreign workers who are often higher qualified than those they replace. However, they have no long term comittment to stay in the country and might return home if conditions improve there which means that a lot of qualified staff could disappear at short notice. Pharmaceutical companies spend a lot of money developing drugs and have to recoup their costs and make a profit. Now in some countries (like the USA) they can charge a high price as a lot of people either are prepared to pay for the treatment or can afford health insurance. However, at some point that price puts a cap on sales as there are a lot of poor people in the developing world who can't afford the drugs. Socialists (for example) then make a point of bashing big pharma for not giving the drugs to these poor countries or maybe charging a much lower price. Well as the actual costs of manufacturing the drugs are often not a significant part of the price the companies could charge a lot less and still make a profit on these extra sales, profit that they wouldn't have had if they charged the same premium price as in the USA. Now if you are an African entrepeneur of some kind you can see that there are a bunch of cheap drugs being brought into your country, so spotting a business opportunity decide to sell them back in the USA either to people who can't afford them in the first place, or to someone who can afford them but would rather spend their money on something else if they could. This then removes the drugs from those who need them in Africa and undermines the pricing structure in the USA. There is also the dilemma of how much treatment you give one person, there have been cases where a health authority has refused to supply a particular drug because of the cost. Patients in other areas where the needs are different may have been given the drug, the patient then goes to court to get the drug prescribed. This may cost as much £5000 per month for the rest of their life (although the cost would probably come down over time). The health authority now has to fund that drug which may mean reducing treatment for 10 people who need something that costs £500 per month. How we balance the value of the one person who needs the drug against treatment for all the others is really a no-win situation. Do we place a higher value on someone who has great potential or treat someone who is old but has paid their share of taxes and is entitled to something back? Cosmetic surgery may actually be a valid procedure. In my twenties I had a mole on my face removed (it was done privately) because I was very self-concious about it. Some people can be greatly affected by parts of their body which they find disfiguring, like birthmarks, harelips or even moles and may be driven to self harm or suicide. I am currently afflicted by a rapidly expanding bald patch and it's driving me to despair. In France, quite bizarre treatments which are more in the realm of health-farm treatments are available. Unfortunately the demand for these has led to an enormous national debt that must be settled at some point. It may sound callous but as everything has to be paid for, ultimately we may have to put a price on everything including people's lives and make those who can afford treatment pay as much as they can to subsidise the less well off. After all, a lot of rich people's wealth is obtained as the result of other people's low wages. People who cannot afford to pay for their own medical care. Some of us vote with our heart while others vote with their wallet, I'm just glad that I don't have to make a judgement of Solomon over this.
Genghis Marauding 15:37, 20 February 2008 (EST)
- tl;dr --
Radioactive Misanthrope 15:55, 20 February 2008 (EST)
- tl;dr --
- This subject is a veritable mine-field as the provision of universal healthcare can be a tremendous drain on the public purse if not controlled. I don't know if this debate was inspired by my posting about my wife's cancer therapy but we received a lot of value back from our health taxes. There's a lot wrong with the British NHS but there's a lot of good there too. In the UK the Government is the primary employer of health-care workers so has the controlling say in how most of them are paid, people don't want to pay a lot of tax so they try and keep wages low, this tends to lower the quality of native healthcare workers but our wages are still higher than say the Philippines or Poland so we get an influx of foreign workers who are often higher qualified than those they replace. However, they have no long term comittment to stay in the country and might return home if conditions improve there which means that a lot of qualified staff could disappear at short notice. Pharmaceutical companies spend a lot of money developing drugs and have to recoup their costs and make a profit. Now in some countries (like the USA) they can charge a high price as a lot of people either are prepared to pay for the treatment or can afford health insurance. However, at some point that price puts a cap on sales as there are a lot of poor people in the developing world who can't afford the drugs. Socialists (for example) then make a point of bashing big pharma for not giving the drugs to these poor countries or maybe charging a much lower price. Well as the actual costs of manufacturing the drugs are often not a significant part of the price the companies could charge a lot less and still make a profit on these extra sales, profit that they wouldn't have had if they charged the same premium price as in the USA. Now if you are an African entrepeneur of some kind you can see that there are a bunch of cheap drugs being brought into your country, so spotting a business opportunity decide to sell them back in the USA either to people who can't afford them in the first place, or to someone who can afford them but would rather spend their money on something else if they could. This then removes the drugs from those who need them in Africa and undermines the pricing structure in the USA. There is also the dilemma of how much treatment you give one person, there have been cases where a health authority has refused to supply a particular drug because of the cost. Patients in other areas where the needs are different may have been given the drug, the patient then goes to court to get the drug prescribed. This may cost as much £5000 per month for the rest of their life (although the cost would probably come down over time). The health authority now has to fund that drug which may mean reducing treatment for 10 people who need something that costs £500 per month. How we balance the value of the one person who needs the drug against treatment for all the others is really a no-win situation. Do we place a higher value on someone who has great potential or treat someone who is old but has paid their share of taxes and is entitled to something back? Cosmetic surgery may actually be a valid procedure. In my twenties I had a mole on my face removed (it was done privately) because I was very self-concious about it. Some people can be greatly affected by parts of their body which they find disfiguring, like birthmarks, harelips or even moles and may be driven to self harm or suicide. I am currently afflicted by a rapidly expanding bald patch and it's driving me to despair. In France, quite bizarre treatments which are more in the realm of health-farm treatments are available. Unfortunately the demand for these has led to an enormous national debt that must be settled at some point. It may sound callous but as everything has to be paid for, ultimately we may have to put a price on everything including people's lives and make those who can afford treatment pay as much as they can to subsidise the less well off. After all, a lot of rich people's wealth is obtained as the result of other people's low wages. People who cannot afford to pay for their own medical care. Some of us vote with our heart while others vote with their wallet, I'm just glad that I don't have to make a judgement of Solomon over this.
Socio-Economic analysis
My general feeling on the topic is "Yes, almost certainly." I probably ought to make some effort to justify that. I'm going to perform some slight of hand magic here, and argue not that a just government should provide healthcare but that a prudent government, just or otherwise, should provide healthcare. I tend to believe these two are equivalent. A prudent government is almost by definition just, providing your serfs with justice tends to be a prudent survival mechanism. Your mileage may vary.
So, where was I? Oh, right. Economics. Health care it seems to me is not an industry that can draw any great benefits from a free market, at least not what we would call a free market. Like any pure service industry, it doesn't really have any great economies of scale. Health care providers and suppliers form natural monopolies and cartels. One can hardly choose where emergency medical care is provided, and since the recipient is in general terms almost never the payer, we aren't in the habit of getting quotes and comparing prices as we would with many other artisans who provide services to us. The supply of drugs and equipment to medical practitioners are largely monopolies too, thanks to the patent system. In really free market, this would not be so, patents wouldn't exist and industrial espionage would be the order of the day. Do we want to go down that road simply to get cheaper medical care? Probably not. On the other hand, I think the WIPO treaty with India a couple of years back is the greatest injustice ever perpetrated by man, no less so for being almost totally unreported in the west. India until recently was the world's largest manufacturer of knock off generic drugs, including AIDS medications at prices the third world could afford. If I ran the world, everyone affiliated with WIPO would be tried for crimes against humanity for forcibly putting an end to that, a crime far worse in scale than Hitler's holocaust. Whatever can be said of Hitler's motives, at least he didn't kill people for corporate gain. But I digress...
To restate, health care does not and can not benefit from the free market. Given this, where does that leave us? It leaves us trying to decide what is more prudent, with no economic distinction to be made. Can we simply leave it to private industry to care for the sick in our society? I do not believe so. With pure private industry involvement, the middle and upper classes can afford reasonable standards of health care without too much impact on their lifestyle. If they choose not to pay, well, that's their lookout isn't it? The poor however, are a different story. Poor people will get an inferior standard of health care, and in some cases no health care at all. What impact does this have on society? There are a number of societally damaging consequences, which include having a whole class of people in society who are simply a breeding ground for drug resistant illnesses and a reservoir for the preservation of illnesses that one might hope to eradicate through vaccination programmes. This is to say nothing of the moral implications of failure to provide health care to any individual. The prudent society must provide adequate health care to all in society regardless of wealth and social status if they wish to have any hope of implementing social health programmes. How this is done seems to me up to the country in question to decide, there are a number of fine schemes for universal health care operated by many different countries. It does not strike me that there is an awful lot to choose between them. As a British person, I naturally prefer our NHS. Since money is never, ever mentioned at any stage of proceedings it appeals to me a great deal.
As a final, personal opinion I'd like to add that access to a decent minimum standard of health care ought to be classed as a human right. Not something that we as a nation seek to supply to our own citizens as an ideal, but that we seek to supply to the whole world as a given. I freely admit this tends to colour my thinking on the matter, so take what I've said in this mini-rant with a pinch of salt. --Jeεv☭sYour signature makes me horny 19:05, 20 February 2008 (EST)
I find it a bit worrisome that in the US right now, your right to exist is directly tied to how much money you have. --Gulik 13:23, 30 March 2008 (EDT)
"Right now, your right to exist is directly tied to how much money you have", Gulik? I think the times in history when this has been otherwise is in the minority. --TheNerd 17:27 1 May 2008 (EDT)
- I believe there's an economic element to health care that hasn't been brought up here: collective bargaining. When I was growing up, both of my parents were electrical engineers at a major tech company, and they got health insurance for the family through their work. The company providing the insurance covered a very large number of people, including all the employees in the health insurance program at my parents' company. As a result, our insurance company had significant leverage in negotiating prices with healthcare providers, and it seemed to do so very effectively. My mom once told me that, on average, the total price our insurance paid for our medical care was about 1/5 (one-fifth) of what the provider initially quoted us for a given doctor's visit/checkup/procedure. We then had to pay 10% of what our insurance paid as a deductible. Her impression was that healthcare costs are ridiculously inflated, and that the doctors and hospitals we did business with could still cover their costs even if they were only paid the 1/5 price our insurance negotiated with them. That means that, when they charge some hourly-wage laborer 5 times as much as they charge us, they make a profit of 80% or more. The only reason healthcare providers don't appear to be absolutely reeling it in is that most of these working-class people can't really pay the inflated prices, so they end up going bankrupt or making some other kind of agreement with the provider. I'm still in college, so I (thankfully) haven't had to deal with insurance or healthcare much on my own yet. That means I can't verify how accurate my mom's description and speculation on all this was. PalMD? OneForLogic 11:37, 17 July 2008 (EDT)
- Since I'm here, I might as well chime in on the rest. I agree that focusing on preventative medicine is definitely better for society than focusing on treatment. This may very well mean that the strict economic analysis favors the action (make and sell expensive treatments) that is less favorable for society; I haven't really thought about this enough to strongly assert that I consider this true, but at a glance it seems plausible. I'm also hesitant to agree with the conspiracy theorists who believe that Big Pharma is deliberately keeping us all sick to suck up our money selling treatments, if only because they're conspiracy theorists.
- I think the macroeconomic analysis might get a little more interesting if you consider the entire aggregated economy, as it also seems plausible at a glance that better pubic health means more productivity and profit for, well, basically any company that makes and sells things, as healthier people will be both better able to work productively and produce things and better able to buy them. I find this effect very interesting, as it implies that it is in the best interests of all for-profit companies to help improve public health, education, and welfare in general (meaning the general kind of "welfare", not the government kind). This kind of analysis, obviously, requires considerations of really big time-scales (think centuries, not years), generally bigger time-scales than individual companies exist in (check on any large currently-operational US corporation; how many mergers has it had in the last ten years? Or, how many companies go out of business within ten years of operation? The answer to both is generally "lots".). Anyway, I digress a little. And I have to get back to work (irony, anyone?). OneForLogic 11:56, 17 July 2008 (EDT)
A Libertarian Perspective
Seems reasonably simple really. If your view is that the role of a just government begins and ends with the responsibility to provide Rule of Law, then I think the answer is a clear "no." I don't think any degree of word-mincing can place health care under the domain of the Rule of Law. Therefore I don't believe Healthcare is the domain of a just government.
Counter-arguments would need to make at least one of two cases: that the role of a just government should exceed the Rule of Law, or that healthcare is, in fact, covered by Rule of Law. I think the former is more likely to be an interesting subject of debate, while the latter is more likely to be an annoying debate about semantics.
But even this is missing the massive elephant in the room, i.e. what exactly is a "Just Government?" I'm pretty sure that question has been the subject of vigorous debate since at least the earliest of the greeks. Even so, I think at least a statement of the premise of what constitutes a just government is a necessary starting point for these arguments. I have not seen any clearly stated so far.
Cheers, BlueSprite 02:04, 1 December 2008 (EST)
- The assumption that government's only role is to provide the rule of law is a rather big step to make. I've always believed that the role of government is to do for people what people can't do for themselves. The Libertarian view is fine for rich people, but from behind the veil of ignorance the rational view is that government should provide more than just a group of strong-arms to break up fights. Wazza (Not Wazzock, Wazza)Approach the Presence 02:15, 1 December 2008 (EST)
- It is a rather large step to make, you're right. Why is it the rational view that "government should provide more than just a group of strong-arms to break up fights?" Further, I assume you're trying to characterize Rule of Law as such. That is not quite the case. It covers a great many things, such as contract law, penal codes, restitution and so forth. It also covers the the establishment of a military to prevent the intervention of foreign law. In any case, sorry to make a meal of this point, but in my opinion this is what this question is really asking: why should the role of government extend beyond the rule of law? BlueSprite 12:55, 1 December 2008 (EST)
- It's a very big step to make. One person providing their own healthcare is all well and good, but can one person afford an MRI instrument? No. Can thousands or millions of people contributing a fairly small amount? Yes, and then it's available for all. I've always viewed government as basically there to protect the people too, because there is so much that can be done when people pool together rather than go gung-ho by themselves. I'm not saying that that's what any one has at the moment working as effectively as it can, but it's damn well better than telling people to deal with it themselves. I'm sure it's a perfectly acceptable view to say that people can pay their own way for health when you're the one who's rich and can personally afford the running costs of some big ass pieces of diagnostic equipment and the expense of medical and surgical training. ArmondikoVnarchist 04:55, 1 December 2008 (EST)
- I'm not sure which point of view you're arguing. What is "telling people to deal with it themselves?" Did someone make that argument? BlueSprite 12:55, 1 December 2008 (EST)
Re: Various criticisms of the Free Market w.r.t. Health Care
When discussing the free market and making the case for it failing in a certain regard, one has to bear in mind two critical things:
1) Free markets are not just about doing things more efficiently. It's about freedom. Everyone who participates in a transaction in the free market does so because they think they will be better off than they would be had they not made said transaction. In cases where the government enforces distribution of wealth/goods, this is not the case, i.e. some individual's right to choose is ignored, and so is their decision about whether or not they will be better off after a transaction has taken place. That is to say, some people will be forced to transact in spite of their desire not to. This is called coercion, and it is immoral. Hence, any case to be made for distribution of wealth/goods through something other than the free market *must* make the case that it is moral to coerce transactions of a certain type. Further, such a case should also demonstrate that it is possible to coerce the desired type of transaction without coercing others, or that these undesired coercions are nevertheless excusable given the stakes.
2) Free markets are not perfect. No one with intelligence should assert that free markets are perfectly efficient, or that they will always maximize wealth. What they do well, however, is allow people who observe waste or inefficiency who have spines to profit by eliminating that waste. Hence it is not a sufficient argument against a free market to say that inefficiencies exist. Rather, saying that inefficiencies exist is generally a statement that there is an opportunity for someone to make money. Indeed, to say that the free market cannot do something is to say that no individual with ingenuity can find a way to make money by increasing efficiency. This is a very strong statement, that touches on why many people are justly suspicious of a government's ability to take the free market's place. That is, in a government solution, one person or group of people are given the power of law to implement a particular solution which cannot be uprooted but by revision of the law. In a free market, *anyone* can rewrite the system. In short, to depend on government rather than the free market is to conclude that no amount of ingenuity can *ever* create a more efficient system. This is an extremely strong assertion, and one that should not be made without total certainty.
Hence my conclusion: if in doubt, leave it to the free market.
Please remember that a free market is not just a system of incentives. It is not sufficient to show that no one has found an incentive to the desired outcome to say that a market cannot solve a problem. Rather, a market is statement about the freedom of individuals to pursue their own ends, to come up with ideas, and to try those ideas at their own risk. Entrusting something to the government is not just about providing the "right incentive to get things done," it's about eliminating a fount of ideas and the freedom to implement them, as well as to profit by them.
Treating the Symptoms
I think many don't realize that what is essentially at the root of the health care problem in the United States (and many other countries) is, in fact, a shortage. There is not sufficient medicine to treat all diseases, there are not sufficient doctors to diagnose and prescribe. In short, there is not sufficient medical infrastructure to deal with the health care needs of the world, or of the US in particular.
Now, the question is, what to do about it? I think weather or not it is a right misses the point. You cannot simply declare something that is in short supply to be a right and expect justice to cause the shortage to disappear. Instead, you have two choices that are immediate and obvious: a socialist approach to distribution (by which I mean one that eliminates the capacity of the patient to pay as a factor in determining whether or not they are treated), and a free market approach.
Is one more just than the other? The injustice, as far as I can tell from most arguments, is that people who need treatment go untreated. But neither approach really addresses this. In free market systems, the poor go untreated. In socialist systems, those at the back of the line go untreated. In mixed systems, you often get both.
So why prefer one over the other? There are a few observations to be made here. One is that those by attaching a reasonable cost to something as determined by the free market, you avoid the classic price fixing leading to a shortage scenario, or, put differently, you force people to come to a decision about how badly they really need something and therefore conserve resources. In a socialist system, there is no such pressure. Indeed, if you hand out something for free, generally the incentive becomes to glut on it to the greatest degree permissible before it runs out. Whether this necessarily applies to socialist style health care, I don't know.
In short, the discussion between socialism as a means to justice in the health care generally amounts to a treatment of the symptoms of the problem, rather than the cause.
Treating the Cause
Should a just government provide health care to its citizens? I would argue that it is the role of government to guarantee the freedom of its citizens to work out their own solutions, rather than have solutions imposed on them.
That it is possible that a free market system cannot provide adequate health care is a position I am willing to accept, because the subject is so vastly complex that I cannot form a complete conclusion without vastly more study of the subject than I have thus far done.
Nevertheless, it is my opinion that it is horribly dangerous to focus on socialist measures (i.e. allowing the government to assume command of the industry), because that does not treat the cause. Rather, I am waiting for public discourse to get around to discussing the cause, i.e. how to create more medical infrastructure. It is my belief that reliance on the free market will eventually realize such a situation, and in my opinion it would be just and good to reward someone materially for causing this to happen.
Some observations that lead me to believe there is room for free market to ameliorate the present situation:
- If Insurance companies are making economic profits, then clearly the industry has not matured and there is room for competition.
- If medical equipment is too expensive, then someone must be making profits that are fully economic profits, and there must therefore be room for better production process, that is to say, to increase the availability of medical infrastructure.
- Inventions of life-saving drugs, equipment, and techniques continue to be made in the free market with the intention of generating profits for the inventor.
- Medical tourism is becoming an industry that offsets the expense of insurance companies, reducing costs for patients and rewarding the increase of medical capability worldwide.
- Price fixation leading to shortages and waste continues to be a problem in countries with completely free health care.
- I have personally had medicine sold to me in exploitative fashions that have resulted in higher costs than was appropriate for me to pay. I have since eliminated a great deal of those costs by taking the time to shop around for my medicine and double checking the advice I am given. This leads me to believe that taking the time to think things through is something that is still rewarded by the market.
BlueSprite 14:57, 2 December 2008 (EST)
- You know, just about every nation in the European Union (plus Canada) have succumbed to the Dread Spectre of StalinCaretm, and most of their citizens who've visited (or resided) in the US don't think our system is working very well in comparison.
- Interestingly, having lived in Europe for 8 years, I got to know certain failures of socialist health care systems very well. For instance, competence, at least in the country I lived in, was generally not well regarded, on average. Long wait lists were common (probably still are, but I don't live there anymore). What the country in question did well was providing GP level care to everyone on an economic basis. But if you think there aren't serious problems with health care systems in Europe, I invite you to dig deeper. There are problems, many of them are not inherent to the US system. BlueSprite 18:58, 2 December 2008 (EST)
- Free Market Economicstm breaks down a bit when dealing with healthcare, for a simple reason: WE ONLY LIVE ONCE. If my car turns out to be a lemon, I can trade it in or roll it off a cliff. If I come down with Midline Lethal Granuloma, there isn't much I can do except hope Jerry Falwell was wrong, but it'd be nice if I could die in agony without having to bankrupt my family along the way.
- I don't see how living once affects any particular argument. Medicine is a scarce resource. Medical equipment is generally scarce, and so is the opportunity to use it. Similarly with doctor's time. Who gets what can be solved by eliminating/mitigating the individual's right to choose, or by free market competition. Medicine, medical equipment and professionals are not the only thing that humans must have in order to live that is scarce. BlueSprite 18:58, 2 December 2008 (EST)
- Fun fact: If they were private citizens, neither Dick Cheney nor John McCain could get health insurance. How come Socialized Medicine is good enough for them, but not us Filthy Commoners?--Gulik 16:23, 2 December 2008 (EST)
- Cute, but not convincing. BlueSprite 18:58, 2 December 2008 (EST)
Socialised Medicene V Nationalised Healthcare?
I think it really boils down to how the healthcare system should be run. Does it work better under a private ownership system or under state control? Socialised medicene occurs when the state bears the cost of healthcare - but doesn't directly provide the service, except in some circumstances. I think France opts for this. Nationalised healthcare is when the state controls the supply of healthcare to the people - although in most cases, private systems work parallel to the public system, undermining it somewhat. In the case of Britain.
Personally, in the US case, it would have to be a case of socialised medicene as the government couldn't possibly allocate the resources to full nationalisation, and neither would it be in their ethos (Despite the recent 'pragmatism' towards financial institutions.) MarcusCicero 06:44, 1 December 2008 (EST)
Not the government
The first thing you have to consider about a government is that, regardless of system, no government can ever be fully "just", which leads to the first problem of a negative before the argument can even get started. Even if a just government could be formed, eventually, that government would be filled with self-serving people, rending the previous "just" label irrelevant. Because of this, I believe it is not the government that should be what provides the healthcare, but rather the current hospital system that should continue providing the already existing healthcare.
The problem with the existing healthcare is the costs that are incurred upon people in the system. As per capitalism, hospitals are forced to charge those absurd prices in an attempt to make up for the cost of malpractice insurance and frivolous lawsuits. My honest belief is that the best way to provide medical coverage for all is not to have the government provide it, but have the government regulate insurance companies and allow the dismissal of frivolous lawsuits, which would allow the cost of medical treatment to decrease. --V
- A government full of self-serving people can still be just, so long as there's some sort of system for making them accountable to everyone else, so that it's in their best interest to be just in order to keep their job. But there's nothing like that, is there? On the other hand, the private companies have no incentive to be fair except that put on them by the government and competition (and given their size, competition is difficult, and complete information almost impossible), so even if it's privatised it comes back to whether or not the government is just. Wazza (Not Wazzock, Wazza)Approach the Presence 16:45, 1 December 2008 (EST)
- That is very true, a democracy is, at its core, accountable to the people, and the people are supposed to regulate corrupt officals by not re-electing them. The problem is that even in a democracy, officals become bent. Even when we manage to elect a clean offical, how long do you think the voice of the people lasts against the paycheck of lobbyists? When was the last time the House of Senate or Reps expelled someone for poor conduct, such as, say, the aforementioned bribery or abuse of power? Call me a pessimist, if you wish, but a government naturally leans towards unjust, or at least, corrupt, and it is this corruption that makes me unwilling to trust a particular government with regulating healthcare. --V
- If I'm going to have a soulless, uncaring bureaucracy deciding whether I live or die, I'd rather it be a soulless, uncaring bureaucracy that doesn't stand to make better profits by letting me die in agony. --Gulik 16:56, 1 December 2008 (EST)
- And where does this "Government Can't Do ANYTHING Right" meme come from? With Libertarians it makes some sense, since they think The Free Market is God's smarter younger brother, but with Conservatives (most of whom are in favor of wars and the death penalty), you get the amusing situation of people who trust the govenment to kill, but not to spend money. --Gulik 16:56, 1 December 2008 (EST)
I think thats an innately unfair caricature of conservatives. The Conservative coalition has always been based on the principle of equality of opportunity and the 'self made man' ideal. I will admit it doesn't help their appeal when a corporate billionaire spouts these grand principles, from his family background of obscene wealth. MarcusCicero 18:15, 1 December 2008 (EST)
- Is it really equality of opportunity if you're sick all your life from not getting proper treatment as a child? Wazza (Not Wazzock, Wazza)Approach the Presence 08:25, 2 December 2008 (EST)
- Well, you're just getting the opportunity you deserve. Remember, if you're poor, it's because God hates you. --Gulik 14:39, 2 December 2008 (EST)
- Which is the main difference between classical liberals and neoliberals. They both, however, would not support getting healthcare to poor people, which is why I'm a modern liberal. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:04, 2 December 2008 (EST)
- I call straw man =| I doubt there are many people that would say that poverty is a result of the hatred of God. In any case, Equal opportunity refers to opportunity before the law, so yes, if you're sick all your life, it's still equal opportunity. BlueSprite 19:11, 2 December 2008 (EST)
- They're out there. As I said, it's an old view, but some people still support it. In any case, we were joking, you joyless, selfish bastard. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:23, 2 December 2008 (EST)
- I call straw man =| I doubt there are many people that would say that poverty is a result of the hatred of God. In any case, Equal opportunity refers to opportunity before the law, so yes, if you're sick all your life, it's still equal opportunity. BlueSprite 19:11, 2 December 2008 (EST)
- Which is the main difference between classical liberals and neoliberals. They both, however, would not support getting healthcare to poor people, which is why I'm a modern liberal. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:04, 2 December 2008 (EST)
- Well, you're just getting the opportunity you deserve. Remember, if you're poor, it's because God hates you. --Gulik 14:39, 2 December 2008 (EST)
Another Question
If we accept that 1) everyone should have a right to health care, and that 2) there is a shortage of health care, and that 3) wealth is not an appropriate reason to discriminate between who gets access and who does not, then on what basis should we discriminate? BlueSprite 19:11, 2 December 2008 (EST)
Veil of Ignorance
I'm sure some of you have heard of this philosophical concept. The idea is, there's a veil behind which you can go. While you're behind it, you can completely reorder society in any way you like, but you will be ignorant of where in society you will have to live when you come out. In other words, you can organise things so that it'll be great for rich people, because you're a rich person when you go in, then come out and find you're living in a slum. It's used for determining what the fairest kind of society would be, without bias from your own position in society (hopefully). WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:04, 2 December 2008 (EST)
- I am familiar with this concept. There are two basic answers to this: a society in which everyone has the same amount of things, and a society in which everyone is afforded the freedom to alter their circumstances. I find the latter more appealing, since the former denies freedom. BlueSprite 19:14, 2 December 2008 (EST)
- Or the third option, the one practised in most states: a society with a robust social safety net (providing people with other options if they fail in the practise of their freedom), robust social services (so that everyone is healthy, well-fed and has access to resources in order to use their freedom) and also the freedom to follow your own path. NZ, where I come from, has national healthcare AND private healthcare, the former being available to all, and the latter offering better service for a higher price. We also have a lot of entrepreneurs, using their freedom to do what they want to do in life. My brother in law is one. He's also a strong supporter of the liberal side of our government and willing to pay higher taxes to support our social services, because he knows that if he was poor, he would want those to be there. He's not poor and so he has other options, but he can feel these strange human emotions called empathy and sympathy and so support things that other people need even at slight expense to himself. I, the rest of my family, and a lot of people I know support this view. It works, too; NZ is doing pretty well right now, despite the economic problems. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:22, 2 December 2008 (EST)
- Please refrain from implying that I do not have feelings. I know little about the case of new zealand, but of course I have to concede that it was an oversight on my part that the choice is not discrete and twofold, but rather a continuum bounded by the extremes I mentioned. Of course, the question then is exactly how much of which do we use and for what. That is a complex question. At this time, I'm not prepared to argue that a solution should be 100% free market. Neither am I willing to accept something that is 100% or even mostly socialist. My purpose thus far in arguing has been to counter many arguments that have been made against the free market that I found were simplistic. Clearly there's room for common ground here, but I'll need to consider my position more carefully if I were to enunciate a clear view of exactly what I think is a good balance. BlueSprite 19:28, 2 December 2008 (EST)
- You're espousing a view which has been succinctly boiled down by someone I admire as "I want the freedom to be rich, and you can have the freedom to go starve". It's hard to see where empathy comes into your view. In NZ, taxation is I believe somewhere between 30 and 40 percent. From that the government maintains a wide range of social programs including interest-free student loans (a nice compromise between paying for all tuition and making people pay for the benefits of education themselves). There's a social security program which, admittedly, is often abused by people who don't wish to work, but cutting it off probably wouldn't make them work, and a lot of people who genuinely need it rely on it too. I'm not going to say our system is perfect, but everyone's housed, no one starves, there's general access to healthcare and education and you have the freedom to do what you want with your life, within the limits of the law. We sometimes get accused of a nanny state, but it's better that people get looked after than that they try to find a way to look after themselves. The crime rate here is fairly low. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:39, 2 December 2008 (EST)
- Again, I know little about NZ, clearly it will benefit me to look into it. In the meantime, I will address the personal insult. I clearly do have feelings, or I wouldn't ask you to respect them. If you're rational, then this should be obvious to you. Instead, you hope to imply that my having feelings should bring me around to your point of view. This is clearly silly. To illustrate, while my view can be boiled down to what you said, it can also be boiled down to: "I want the freedom to get rich for both of us, knowing that freedom implies responsibility, and the risk of failure, because I do not wish to have things stolen from me by individual or by state." Surely we can agree that we'll get a more interesting debate if we leave the bile of personal insult out of it, no? Unless, of course, you're not interested in debate, but rather in an opportunity to subject those you hate to clever quips. BlueSprite 19:50, 2 December 2008 (EST)
- You're espousing a view which has been succinctly boiled down by someone I admire as "I want the freedom to be rich, and you can have the freedom to go starve". It's hard to see where empathy comes into your view. In NZ, taxation is I believe somewhere between 30 and 40 percent. From that the government maintains a wide range of social programs including interest-free student loans (a nice compromise between paying for all tuition and making people pay for the benefits of education themselves). There's a social security program which, admittedly, is often abused by people who don't wish to work, but cutting it off probably wouldn't make them work, and a lot of people who genuinely need it rely on it too. I'm not going to say our system is perfect, but everyone's housed, no one starves, there's general access to healthcare and education and you have the freedom to do what you want with your life, within the limits of the law. We sometimes get accused of a nanny state, but it's better that people get looked after than that they try to find a way to look after themselves. The crime rate here is fairly low. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:39, 2 December 2008 (EST)
- Please refrain from implying that I do not have feelings. I know little about the case of new zealand, but of course I have to concede that it was an oversight on my part that the choice is not discrete and twofold, but rather a continuum bounded by the extremes I mentioned. Of course, the question then is exactly how much of which do we use and for what. That is a complex question. At this time, I'm not prepared to argue that a solution should be 100% free market. Neither am I willing to accept something that is 100% or even mostly socialist. My purpose thus far in arguing has been to counter many arguments that have been made against the free market that I found were simplistic. Clearly there's room for common ground here, but I'll need to consider my position more carefully if I were to enunciate a clear view of exactly what I think is a good balance. BlueSprite 19:28, 2 December 2008 (EST)
- Or the third option, the one practised in most states: a society with a robust social safety net (providing people with other options if they fail in the practise of their freedom), robust social services (so that everyone is healthy, well-fed and has access to resources in order to use their freedom) and also the freedom to follow your own path. NZ, where I come from, has national healthcare AND private healthcare, the former being available to all, and the latter offering better service for a higher price. We also have a lot of entrepreneurs, using their freedom to do what they want to do in life. My brother in law is one. He's also a strong supporter of the liberal side of our government and willing to pay higher taxes to support our social services, because he knows that if he was poor, he would want those to be there. He's not poor and so he has other options, but he can feel these strange human emotions called empathy and sympathy and so support things that other people need even at slight expense to himself. I, the rest of my family, and a lot of people I know support this view. It works, too; NZ is doing pretty well right now, despite the economic problems. WazzaHello? Is there anybody in there? Just nod if you can hear me... 19:22, 2 December 2008 (EST)
2¢
Presumably one would have no qualms about providing health and welfare support for one's husband/wife & children? How about parents, grandparents, brothers sisters? How about nephews & nieces? Nephews'/nieces' wives/husbands? The friend or guy next door who falls and injures himself leaving his family unsupported? You see where I'm going? When do you stop, assuming you've started?
Also don't forget "rich" is a comparative term - it needs "poor" to remain valid. In a decent society everyone would be "rich", as far as health care is considered. So the problem shouldn't arise.
In the kind of libertarian society seen many times in science fiction, the "rich" live long, healthy lives in walled enclaves served by the ravening hordes of "poor". If that's what you want then good luck, but it's not my ideal world. ![]()
and marmite 20:21, 2 December 2008 (EST)