🚀 go-pugleaf

Walter Bright (bright@nazgul.UUCP) wrote:
: In article <1993Jan9.181008.11099@fylz.wa.com> fyl@fylz.wa.com (Phil Hughes) writes:
: /Walter Bright (bright@nazgul.UUCP) wrote:

: The idea of a free market system is that by attempting to maximize profits,
: the "invisible hand" causes one to service the needs of your customers.
: If you do not operate to please your customers, then you either go out of
: business or you get a law to prevent your customers from leaving.

Unfortunately, the service we want isn't being provided by the same
company.  We want health care and we get screwed by health insurance.
The alternative, HMOs like group health, seems a lot better than
insurance company and doctor being separate.  But an HMO means that
you don't get to pick your health care provider.

: /Ok, as I asked before, offer a better alternative.  I see no way that
: /adding another level of overhead in paying health care providers can
: /keep costs down.  Right now the insurance providers in the US only
: /have an incentive to maximize their profit.  Yes, there can be
: /competition but as long as their part is only overhead (they don't
: /provide service) you are not going to have any real competition.
: 
: I don't understand. You propose to have only one insurance company,
: in order to eliminate competition, but then say that the existing system
: has no competition (at least that is my impression of what you're saying).

There is competition in terms of who provides the service (the
doctors, etc) but, as the insurance companies don't provide anything
the end users want, there is no real competition.  Insurance companies
compete with each other in terms of offering the best deal to Boeing
but really aren't accountable to either the doctors or the patients.
(Yes, I realize that there can be pressure by both doctors and
patients but this is one level detached and I expect not particularly
effective based on personal experience.)

: /: /Now, does this confilct with free enterprise?  No.  Canadian doctors
: /: Yes. Legal monopolies are not free enterprise.
: /You ignored the point.  First, I was talking about health care
: /providers.  Doctors still work for themselves.  There is no monopoly
: /in the health care provider industry.
: 
: You advocate a monopoly in the insurance business.

Actually, I advocate the elimination of the insurance business.
If health care is a right it becomes the same as something like
roads.  We (the voters) pay for roads to be created and maintained.
The actual work is probably not done by the government but the
government oversees what is to be done and pays those who do it.

: /Second, the government does not have a monopoly on providing health
: /care.  Private insurance companies can, if the so choose, operate in
: /Canada.  The catch is that everyone gets basic health care and it is
: /paid for with "everyone's money".  But, if the Canadian "insurnace"
: /wasn't covering what is needed people are free to buy additional
: /insurance.  The fact that they don't supports the argument that
: /apparently the system provides what is needed.
: 
: This sounds similar to the private school problem we have in America. A
: customer who wishes to attend a private school basically has to pay double,
: once for the public school and then again for the private school. This gives
: a tremendous financial incentive to attend public school.

Similar but not the same.  First, we have both private and public
colleges. Private colleges exist because public ones don't offer
everything needed.  In Canada, if there was a need for additional
services, private insurance could address it.

Second, the desired service is health care, not health insurance.  In
Canada health care is provided by private industry but is paid by
government funds.  So this (where this refers to health care, not
insurance) is very much like getting to choose your own (private)
school and having government money pay for it.

: Of course, what is a life-threatening problem is not decided by the customer,
: but by the government. What happens if you disagree, or you die waiting
: for treatment?

Nope, it is decided by the private physician that you select.  Sure,
there is a limit to the number of situations that can be handled but
it is up to private physicians to make the determination.  To quote
one of the panelists, "In Canada we ration health care by need.  In
the US, you ration health care by your ability to pay."

: Yup. I see government monopolies in a futile search for "efficiency"
: and "social justice" as the wrong approach.

The "efficiency" question can be posed as follows:  We have identified
a system where there is an entity that contributes nothing to the
process except inserting 25% overhead into that system.  Decreasing
costs in other parts of the system (like changes to the FDA) may save
money in other ways but it doesn't eliminate this 25% overhead.  It
needs to be addressed.

As for social justice, the public needs to decide (as Canada did) if
they think health care is a right.  If so, then the government has an
obligation to insure that citizens have that right.  It is no
different from police protection.  Sure, it would cost less government
dollars (and probably less total dollars) if we all did own police
protection but it wouldn't be in the common good.

: /: o	Remove the monopoly power of the AMA to restrict the number
: /: 	of physicians.
: /I would expect that having more doctors would increase, rather than
: /decrease, average medical costs.  Not that I am a fan of the AMA but I
: /expect that doctors would "discover" all sorts of additional things
: /that people "should" have done.
: 
: Huh? Basic economics is that as supply goes up, prices come down.

If there is the same demand.  Doctors are fairly creative (like
lawyers).  Look at the number by bypass operations that have been done
that are now considered to have been unnecessary.

-- 
Phil Hughes - FYL - 8315 Lk City Wy NE - Suite 207 - Seattle, WA 98115 
Phone: 206-526-2919 x74      Fax: 526-0803
E-mail: fyl@fylz.com or nwnexus!fylz!fyl