Relay-Version: version B 2.10 5/3/83; site utzoo.UUCP Posting-Version: $Revision: 1.6.2.16 $; site inmet.UUCP Path: utzoo!watmath!clyde!cbosgd!ihnp4!mhuxn!mhuxr!ulysses!gamma!epsilon!zeta!sabre!petrus!bellcore!decvax!genrad!panda!talcott!harvard!think!inmet!nrh From: nrh@inmet.UUCP Newsgroups: net.politics.theory Subject: Re: Re: Health Care, Wonderful Market fo Message-ID: <28200059@inmet.UUCP> Date: Thu, 5-Sep-85 03:24:00 EDT Article-I.D.: inmet.28200059 Posted: Thu Sep 5 03:24:00 1985 Date-Received: Wed, 11-Sep-85 04:20:51 EDT References: <1764@psuvax1.UUCP> Lines: 487 Nf-ID: #R:psuvax1:-176400:inmet:28200059:000:25509 Nf-From: inmet!nrh Sep 5 03:24:00 1985 >/* Written 1:20 am Sep 4, 1985 by psuvax1!berman in inmet:net.politics.t */ >/* ---------- "Re: Health Care, Wonderful Market f" ---------- */ >Warning: may be boring. >[concerning low costs of privite charities vs. high cost of the government] >> >People who make it hard to be helped get dumped >> >on the government. In Libertaria, people who make it hard to be >> >helped, schizophrenics being the most notable case (and there are >> >MILLIONS of them around, some of whom I know), still would be turned >> >away by private agencies. >> >Remember, the criteria for success for >> >private agencies tends to be the number of bodies they end up helping. >> >Any body that makes life hard on them would reduce the "success" rate. >> >> ................. Right now, those people do NOT have a choice regarding >> (say) welfare. People who would put such things in the hands of the state >> deny it to them. >> Is it a shame that AIDS funding is too low? Give them a few bucks. >> >There are two issues conveniently omitted. >1. Help (charity, wellfare) considered here concerns people who are > in this way or another incapacitated. Thus not only cash benefits > are needed, but also WORK: guidance, therapy etc. Charities have > voluntiers. However, I do not expect the number of voluntiers to > increase drastically under any system. In fact, the capabilities > of charities are often limited by the number of voluntiers, thus > they distribute only as much help as they can do it cheaply. Ho-hum. You seem to have missed little places like the Salvation Army, which does some of the stuff you're talking about, and certain religious and private charities which help do retraining. IF you are right, then work, guidance, and therapy should be provided. If you can convince others you are right, such things WILL be provided (they are now, on a limited scale). In a libertarian society, you need only to find one or two crazy millionaires to set up such a charity. In a more statist society, you must find and convince all the appropriate government bureaus. By the way, Piotr, lots of charitable concerns employ non-volunteers. >2. There are various needs which are not particularly popular. The > system proposed would determine the size of help available > according to current fads. Today baby seals are popular, tomorrow > starving Africans. If your case was not popularized yet (or > popularized 4 years ago and now forgotten), you can rot. > AIDS is a good example, since the victims were quite unpopular > for quite a while. Oh, Piotr. Give it just a LITTLE thought -- government is MORE sensitive to this than private charity. Most folks give to the United Way without making any special effort to find out, except in a general way, where the money is going. Of course, if it is PUBLIC money, then you can bet that the political popularity of where the money is going will be very carefully judged -- and if you don't have the right lobbyists, and make the right connections, you can REALLY rot. >> >>Of course, if you REALLY think that people a libertarian society would >> >>be less generous, you should bear in mind that you are saying that >> >>people tend to give less than a fifth voluntarily than they do under >> >>coercion, and that the poor have not been denied reasonable jobs >> >>by such things as minimum wage laws and licensure. Not a tenable >> >>position. You're also assuming that a large number of people will >> >>need charity -- remember Daniel Mck.'s very well-defended discussion >> >>of unemployment in libertaria. >The argument of McKiernan is that in the absence of minimal wage, >wellfare and licencing everybody would find employement (or starve >and cease to be unemployed anymore, I presume). Tsk! I don't recall McKiernan mentioning starving people in this context. >Then we have another >argument that everyone should pay himself for health insurance >(if he wishes one) plus save for his old age (or, equivalently, >support his folks). It amazes me that you can read! The TOPIC of discussion is charity under a libertarian society, and you're trying to imply that everyone, even those who are natural objects of charity are expected to pay for themselves. >The problem is that I do not see how with >current minimal wage ($6700 yearly) one can afford it. My family >insurance costs more than $2000 a year. Now, necessary savings, >shelter (shack?), clothes and food. OK, possibly I could afford >enough of liver, milk and bread for three people. Oops, I forgot >school for my son! Also, I forgot that my wage will be smaller >than minimal! (the implicit invocation of this arithmetic was >labelled "invoking fictional Dickensian horrors"). I think you've misquoted JoSH. I believe he said "[Litany of Dickensian horrors]". If you can't find the word "fictional" in that bracketed statement, you owe JoSH and the net an apology, and I'll expect it forthwith. The problem, Piotr, is that you are not listening to what people are telling you. Just for example, your complaint about the cost of medicine is based on the current costs of such a setup. It has been pointed out in detail how doctors control the AMA, which in turn employs the law with regard to "practicing medicine without a license" to keep the number of doctors artificially low, and thus the price is artificially high. More important, you would indeed be foolish to attempt to raise a family of four on minimum wage. Why not a family of 10? Or 20? The reason is that you would, I hope, exercise a certain discretion in bringing children into an uncertain world when the expectation is that you could not afford to feed them. Of course, misfortune may befall anyone, and they may not have had the chance to lay something aside just in case. WITH a minimum wage, you (and thus your family) may find it impossible to make money at all. Without it, you've a chance. With government charity, you may fall through this or that crack or be unable to fight your way through the bureaucracy in order to get money (I'm told, New York City copes with the problem of not having enough money to support all those that it is required to place on Welfare by putting up bureaucratic obstacles to getting the money -- the people who can't get all the way through the maze don't get the checks). >> >Again, there are millions of schizophrenics who don't have to live in >> >institutions. I don't remember Daniel's discussion. And I really >> >think people in a libertarian society would be as generous as other >> >people with similar after-tax incomes today. That sounds reasonable >> >to me. And I don't think most people I know are very generous. >> >> Go just a step further. Supply AND demand, remember? In our society, >> the Supply of money is limited by taxation. Demand for private funding >> is ALSO limited -- the government is assumed to be "doing something" >> (and it is, mostly inefficiently) and is put in charge of anything >> regarded as a public health emergency. In a libertarian society, >> the SUPPLY of money is greater (your after-tax income is raised to >> match your pre-tax income) and the DEMAND for those funds from >> private charities is larger. Why? Because the private charities have >> not been subsidized. They have stronger cases that the funds are >> needed, and needed locally. They also can do their part more efficiently. >> >Market forces indeed. More schizofrenics, >obviously, will cause more people to care about schizophrenics. >Why? Because in the economics course they teach that demand increases >supply. What about another economical law - supply generates demand. >More charitable contributions - more schizofrenics (another way of >cutting unemployement in Libertaria). I wasn't aware of any elasticity in supply for schizophrenics. Of course, there is in a public charity system elasticity in DEMAND, so that people meeting the criteria are paid, but in a private setup, there's a limited amount of money (and a limited amount of credibility). In a public setup, there's an unlimited amount of credibility. Don't believe it? Want examples? Surely. New York City, by the terms of a court agreement, is obliged to provide places to sleep for all of its homeless. All, regardless of how they came to be homeless, regardless of where they came from. >> >>Another example? Certainly. Kidney machines are rationed and >> >>subsidized by the government. There has been relatively little research >> >>on improving these machines because the whole thing is pretty closely >> >>regulated, there have also been pretty severe limits placed on access to >> >>those machines. For details, see Reason Magazine, August 1984. >> > >> >Boy, you're in a mess on this one. Government pays for kidney maintenance >> >because most kidney disease sufferers can't afford dialysis. So the >> >government created the market for kidney machines in the first place, >> >by making current technology affordable. >> > >> >> Tsk! When you go to the doctor, how much of the bill do you pay? >> I generally pay $1, because I have health insurance. Was the insurance >> federally subsidized? Nope, not as far as I can tell (modulo, of course, >> the ever-present tax arguments by which it may be argued that anything >> is subsidized). My understanding is that I'm paying for things like >> dialysis, should I need them, by pooling my risk of needing such things >> with other people. Need dialysis be expensive? > >As I noted before, the insurance is expensive. My insurance (according >to my employer) costs more than $2000 and I still pay the first $400 >for visits, plus unlimited for medicines. Since more than 10% of GNP >are medical services, it seems to be right. No wonder, at leat 25% >of population cannot pay for they insurance. Again, you'd find this sort of thing cheaper in a libertarian society. Of course, if you were really badly off, you'd have to depend on private charity. (Probably mostly in the form of foundations for helping out people in relatively specific situations, just as scholarships used to be at older schools). >> [from a libertarian magazine] >> Dutch physician Willem Kolff, the inventor of the dialysis >> machine in the 1940s, told me he was shocked to learn of the >> high cost dialysis machinery being used on an experimental basis >> in the United States when he immigrated here in 1950. Intent on >> altering this situation, Dr. Kolff continuously pushed to reduce >> costs. By 1968 he had modified Maytag washing machines into >> dialysis machines at a fraction of the cost of machines then in >> use. The same year, he sent 21 people home with machines and >> two months worth of supplies for a total cost of $360 per >> patient. >> >> Or consider how the system stifles equipment innovations. >> Kidney-machine inventor Dr. Kolff has now developed a portable >> dialysis machine that would enable patients to travel, work more >> easily, and generally lead more productive, normal lives. But >> Kolff told me that he is unable to get any American >> manufacturers interested in making the machine. >> >> The problem is uncertain demand. Prototypes have been made for >> $6000 each -- the same cost as American machines used in >> dialysis centers when purchased in volume. Although Kolff's >> machine could provide dialysis patients with more-satisfying >> lifestyles, neither nephrologists, equipment makers, nor >> facility operators have much incentive to introduce their >> patients to the machines, since it is not clear how they would >> fit in to ESRD reimbursement provisions. So Kolff has gone to a >> Japanese manufacturer to supply him with prototypes. >> [Reason Magazine, August 1984] > >I suspect that there is as much reason in Reason Magazine as there is >truth in Plain Truth (a fundamentalist monthly, which makes feats like >explaining the election results in Australia with quotes from the >Scripture). That's nice. What you SUSPECT, and what you are willing to back up with (say) history from some other source would seem to be two different things. In the meantime, you'll find that sleazy rhetoric linking "Reason" with "Plain Truth" is mostly self-defeating. >The numbers presented here do not add up. First, Kolff makes a dialysis >machines Maytag washers and sends patients home with machines and two >months worth of supplies for a total cost of $360 per patient. >I would like to see Maytag washing machines that cheap (and what >about supplies, were they ordinary detergents?). Tsk! I would love to see 1968 dollars (360 of which were spent per patient) available now. READ what the other person writes, and apply just a little thought before replying, Piotr. You'll humiliate yourself a little less that way. To be specific: it's clear from the quote above that we're talking $360 in *1968*. One 1967 dollar (which I hope you will agree was about the same as a 1968 dollar) is worth about 3.06 1984 dollars (source, Information Please Almanac, 1985) for "all items", or about 3.73 1984 dollars (for medical expenses). This would make the 360 dollars into about $1080 1984 dollars. Looking in my 1985 Consumer Reports Buying Guide, I find that a cheap washing machine costs about $450. (pp 70). The only Maytag listed is a little more -- about $565 (it was, by the way, the top scorer). Assuming that the motors (or whatever) in they Maytag were used, and that the only new mechanical implements were the bags shown in the article (as well as filtering equipment), I think that the inventor of the dialysis machine could come in under budget. Of course, we don't know what a washing machine cost then, but I invite you to do just a little research before replying. >Then portable machine (portable washing machine?) that would cost less >than $6k. If they would be that cheap, there would be enough of wealthy >patients who would like to have them. That would create sufficient >market. Would it? Sufficient for what? Who knows about this? Would such machines be legal? Would even a fairly wealthy user buy a somewhat better service if the government will give a service to him free? Only if his marginal gain is greater than his marginal cost. Put it another way: would you put in your own pool if the government put up an acceptable one next to you and charged very low for its use? Only those who would MUCH prefer the private one would do so. >It is standard that the inventor is very optimistic about his design. >If this optimism is not shared by profit oriented manufacturers, the >chances are that they were right. On the other hand, the Japanese firm HAS built the prototypes. In fact, the article goes on to say that that Maytag refused to sell more machines to the inventor because of the uncertainty surrounding the question of Maytag's liability in the case of a failure. >Another flower of reason from Reason Magazine. Have you ever read it? Are you prepared to challenge it's text with anything but wind? >> "But Popeo, the son of a working-class family, was offended by his cases >> at Interior. Handed the responsibility for enforcing health and safety >> regulations often capricious and petty in nature, he found that his >> opponents in court were often struggling entrepreneurs. The last straw, >> Popeo related in a recent interview, was when he found himself seeking a >> court injunction to 'close down a one-man mine operation because the >> owner didn't have a two-way radio to talk to himself, or a stretcher to carry >> himself out of the mine if injured.'". [Reason Magazine, Sept., 1985, pp 48]. > >So the proposal is to make it legal to operate an underground mine >without any safety measures? You've neatly excised the motivating quote from above. The argument was that courts looked at the intent of law and were very reasonable at the federal level. Not true. To reply to your question, however, it would indeed be legal to operate an underground mine without any safety measures. Just as it is now legal to eat ground glass or attempt to drink the atlantic ocean. >What if it would be two-men mine? >Are you proposing to abolish all safety regulations? Is the cheaper >coal worth additional deaths? Oho! Quite a question: I would put it up to the owners of the lives at risk. You feel that the government knows better than they what risks they "should" take? Remember, I don't object to the government saying: "This is risky, you shouldn't do it" -- I don't object to their neighbors saying "fellas: what you're doing is stupid and we won't sell you any more blasting powder until you fix things up". All I am saying is that the owner of a life should be able to decide, without force or fraud, how he wishes to risk it. >Possibly, work related accidents would >help to eliminate unemployement in Libertaria. I suppose so -- by causing companies to hire safety experts, more careful inspectors, arbiters (in the cases of fraud), doctors, and, (though not as often as in our society where the government gets off scott-free after allowing people to breathe asbestos dust) morticians. >Again about dialysis. Suppose we cut the government funding. > >> And would thousands die? One doesn't hear about it in the case of >> hemophiliacs: >> >> The effect of these portrayals [dramatic appeals to the US >> congress about kidney failure] should not be minimized. There >> are, after all, other catastrophic disabilities that affect as >> many people and cost as much to treat as kidney failure but >> don't lure as much government money. Richard Rettig, professor >> of social sciences at the Illinois Institute of Technology, >> notes that the taxpayers are not footing the bill, for example, >> to treat hemophiliacs, whose numbers exceed those with kidney >> failure. The central symptom of hemophilia is serious bleeding, >> and Rettig figures that a quarter of all hemophiliacs "require >> continuous replacement of fresh whole blood, plasma, and >> clotting concentrates," a therapy at least as expensive as >> dialysis. >> >So what happens to uninsured hemofiliacs? Presumably, thousands die. Well? Anything to back up your presumption? Some reason to think that the people who've seen their children die from such conditions would not contribute (later, when they are able to) to funds that would help them? >But this issue is not disscussed in the quote (from Reason Magazine?). >The real problem however is that we cannot support all terapies which >are technologically available. Thus only the cheaper are selected >(cheaper does not mean cheap). This is certainly true if the GOVERNMENT controls things. Private individuals will see varying trade-offs between side-effects and money, and (of course) be able to support varying trade offs. Governments (or in the case of libertaria) private charities, will opt for the cheapest therapy, given their own notions of acceptability. >Will we be able to support hemophiliacs, >there will be another group. Does it mean that saving lives is not >recommended in any case. It means that if you think something should be done about disease, poverty, pain, and loss, then one should do something about it, but one has no right to FORCE a neighbor to do what one thinks is the best thing. >> >And besides, government's not a bad market, either, if it operates a >> >proper bidding process. >> >> That is a pretty big "if", O mighty evaluator of markets. In the >> particular case of ESRD aid, the government offers a fixed fee for dialysis, >> regardless of what costs were. The result? It's very profitable indeed to >> run dialysis outfits, and new technology is not evaluated properly because of >> the uncertainty of how the government will treat it. >> >> In fact, I've answered this last statement of yours as if you'd said >> "the government doesn't do too badly at the market, either, if it operates >> a proper bidding process." To answer what you actually wrote (which >> I believe to be a mis-phrasing) the government is an AWFUL market -- one >> of the reasons why it's hard find anyone who still believes in the government >> setting all prices. The problem is that a government doesn't have available >> the information to set prices correctly, which results in >> incorrect prices, which results in misproduction. >> Very socialist economies tend to set their prices to reflect politics, not >> engineering reality, which is one reason why they have to make it illegal >> (for example) to feed bread to cattle (the price of bread is lower than >> that of the corresponding amount of grain). >> >> >Then the lowest price competitors get to sell >> >to government, and if there's competition, prices will go down. >> >> This would be true enough, but what has happened in this case is that >> the government offers a fixed price, so there is no pressure to >> charge the government less, so prices stay just where they are. >> This ties in nicely with the recent discussion in net.politics of the >> increasingly more complex specifications for airplanes -- the government >> has indeed put things out for bid, but the specs often limit competition, as >> do political requirements (I'm told that the Soviet rifle has much better >> performance when dirty than does the American, but do can you see >> the American government buying, say, knock-offs of that design?) >> >Rifle example shows that government may work better or worse. >Sometimes it does it pretty bad. However, there is no way one >can introduce market principles everywhere. >As rifle example shows, Soviet military tends to have lower costs. >According to the market reasoning (unblemished by petty political >requirements), we should hire the Soviet Red Army for our defence, >with tremendous savings. Tsk! The rifle example shows that ONE government may work better or worse than another. READ before you reply, O dense one! >In a pure market system everything is a commodity. Health is a >commodity, personal safety is a commodity, elementary education >is a commodity, freedom of speech is a commodity. Granted, >wealth should have its rewards. Having wealth, I may afford >superior health care, good protection, my voice is better heard. >But how large should be the penalties for lacking wealth? >Third-world-like medicine? Substandard education? What else? >What would be the force keeping the fabric of society together? > It's been pointed out time and time again that people in a libertarian society are just as dependent on each other as people in other societies, and that libertarians would not have it otherwise. The penalty for not having wealth in a libertarian society is that you may be dependent on the voluntary charity of others before you can work your way up in a society full of opportunity. >> >>>I agree with Piotr. I'd rather believe in people than believe in >> >>>libertaria anytime. >> >>> >> >> >> >>That's quite a statment for someone who seems to be advocating the >> >>welfare state..... Do you believe in people, or do you believe in >> >>people with the right chains on them? >> > >> >In the absence of decent moral education, I believe in people with the >> >right chains on them. >> > >> >Tony Wuersch >> >{amd,amdcad}!cae780!ubvax!tonyw >> >/* End of text from inmet:net.politics.t */ >> >> That last sentence was so priceless that I thought I'd leave your >> signature right next to it. It's so nice to know that you'd like to >> give people a "decent moral education". The thought of my (hypothetical) >> child getting one of which you'd approve gives me the shudders. > >When convenient, you prefer not to see the sarcasm. I saw no smiley face ":-)" which would have indicated sarcasm. Nor did Tony's comment strike me as sarcastic. >On the other hand, >what is your morality? You believe in a society where the ill have nots >have two choices: be pleasant to the haves (they may give me some >charitable help), or die. This is quite far off the mark. As I pointed out, there's plenty of reason to believe that even the hard-to-help would be helped in Libertaria, if only by people who'd had friends and relatives who were similarly afflicted and understood the need. It IS true that libertarian society enforces a certain degree of pleasantness on those who wish help from others. Denied the option of stealing from people via the state, you must be more pleasant to deal with than alternative forms of charity, but this doesn't mean the actual objects of charity (schizophrenics, say) must make the pitch. Some people can survive without most human contact, and thus may become as unpleasant as they wish. I don't care, for example, how pleasant the fellow is who owns a vending machine I patronize -- so long as the candy is fresh, and I lose no money. I don't care how unpleasant the fellow is who is ringing the bell for the Salvation Army -- so long as he doesn't actually make it difficult, I give. >No government intervention in this interaction. >Let market forces teach the poor to be pleasant. Look, Piotr, try, just try, and understand what the other fellow is saying. The poor need not be pleasant -- people who are concerned about the poor must be, or the people who wish to give must understand. No more than that.