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The Rich Should Get Better Healthcare

And what's more, the rich should get better education too.

Why? Simply put, because that is how technological innovation happens.

The reason, for instance, that life expectancy has risen in the last century is simple: because the rich were able to buy better care.

Unfortunately, not many people can connect the economic dots to understand that. Instead, they are blinded by class divisiveness and a desire to achieve equality even if it is not economically sustainable.

Greg Mankiw touches on this in his latest post, Should the rich get better health care?

Some excerts:

Technological advance is making state-of-the-art health care increasingly expensive. In any kind of national health system, some treatments will, by simple cost-benefit calculation, be deemed too expensive to provide to all citizens. But does that mean those of above-average income should be excluded as well? Should they lose basic benefits if they choose to pay for these marginal services with their own money?

If you say yes to this last question, as the U.K. health service has, here is a related one: Should a parent who hires an after-school tutor for his child be barred from sending the child to the public schools?

Some people like to think of health care and education [as] basic human rights. Maybe they are. But they are also normal goods. That is, the income elasticity of demand is positive. It is hard to escape the conclusion that the right cost-benefit calculation for providing the good depends on the income of the consumer.

Achieving both efficiency and equality in the provision of these goods is impossible.

created by babbleman on Feb 25, 2008 at 08:49:34 am     Comments: 16

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Comments ... #

I made the same point in this post last August. Its nice to know that me and Harvard economists are on the same page:

The disinformation I see being distributed is 1) the system is broken and 2) the system is unfair and 3) that because of 1 and 2 there is a crisis in the number of people uninsured. These three arguments are used to remove the system from the private market and grow the government.

I don't believe that the system is broke and, even if it was, there is no way the government can fix it.

I think there are two key components to access to healthcare now that are making this an issue, and neither are the "fault" of the industry. One is the cost of technology and two is the cost of government.

First, technology is accelerating. More and more every day we are inventing mind blowing new things. But it is not cheap to do so. Just because a $15 million XYZ spleen machine can exist doesn't mean that a person that makes $15,000 a year has the expendable income to pay enough to support the capital cost of inventing and manufacturing it much less the operational cost of getting it used on him.

Now for those that don't think of the economic mechanics first, this immediately seems unfair because the benefit received from this machine involves people's health and, literally, their lifespans - so the issue becomes far more emotional than rational. If the machine in question was a $15 million yacht, for example, most of us would accept as reasonable that a fast food employee would not be riding on it. But the XYZ spleen machine - that seems different - emotion takes over and says that the fast food employee should be riding it.

But that's the problem - that difference is only the emotion. The economic mechanics are exactly the same. All the emotion and class hatred in the world will not change the economics. Most importantly - all the government intervention in the world won't change it either.

What's important to note is that the health, nutrition and life expectancy of Americans at the lowest levels of wealth increase year after year and continue to do so. If that's a broken system - I'm in.

What we have is the ability to discover and manufacture things at a rate that outstrips the ability of a portion of the population to fund it. But what's the alternative? Not invent the stuff? If we just take the XYZ machine away, then no one will have it and it will all be fair again, right? That's option one. But I'm sure no one would want that.

So, option two is to require the producer to sell it for less. Option three is to require that some of the customers pay more so that others pay less. Of course, neither option two or three will happen in a free country. So if the government comes in to "fix" this "problem" it will be a combination of two and three. So what is the outcome of this? The less money the producer receives, the less his return. And the less his return, the less attractive he is to investors. So with less investment, he ends up inventing less stuff. The more money the higher paying customers pay, the less they have invested which means less stuff gets invented also. So how is it that options two and three are any different than option one?

The second issue is the cost of government. So why can't some people afford health insurance? Hmmm. Well, direct taxes at all levels of government plus corporate taxes and the cost of tax code compliance embedded in the cost of goods approaches an average 60% of individual income. I wonder if that has anything to do with it?

So first, a particular ideology grows the government to the point that it takes 60% of our working effort, then they turn around and act surprised that some people can't afford health care. So they blame the healthcare industry and propose to do what? Increase the government lol. That's some serious disinformation right there.

posted by babbleman on Feb 25, 2008 at 09:03:50 am     #



By this line of sick and twisted nazi logic, the rich should kill all of the poor. Your logic fails to realize that the rich got rich off the backs of the poor too. I think the 3rd reichers are still looking to recruit. We can be a country that truly believes in a cluture of respecting an preserving lives, or we can continue on the path that only benefits those who stand on the shoulders of the people who work their asses off for little reward.

posted by prime3end on Feb 25, 2008 at 06:37:00 pm     #



Capital intensive routines don't mean anything. People with cash are seen as marks all the time. How do you know the rich aren't getting trimmed a little better than Joe uninsured?

How 'bout some stats?

Scientology is built on the same lame elitist ideology. It costs, $360,000+ to get through their clear thetan BS. It supposedly makes them healthier, more enlightened, etc.

Expensive health care doesn't mean wise/effective health care. The ability to afford costly experimental drugs and pageantry with better health care is a weak correlation at best, but more likely completely unfounded.

It's pretty much pandering apologist thinking.

posted by charlatan on Feb 25, 2008 at 08:23:03 pm     #



Elitism, pandering, stats?

I'm not going to supply stats or proofs for fundamental supply and demand. You can take econ 101 for that.

The point is painfully simple. If government control of the market reduces demand either because people are literally not allowed to buy superior products or because the premium structure is so progressive that they simply can't, then the supply will not happen. Ie, the rate of new things being invented goes down.

Who is going to take the risk to build the next lifesaving technology if people who can afford to buy it aren't allowed to buy it or are taxed so heavily they can't buy it? No one will - they can't - there is no demand to pay for it.

Is this really that complex - can't either of you have a dialogue at a rational level?

posted by babbleman on Feb 25, 2008 at 08:35:51 pm     #



Look, you can socialize anything. But at some point you have to recognize fundamental economic principles of efficiency.

Socialize it - but do so knowing that the cost is less innovation.

If you want to be compassionate but less innovative fine. But don't go around telling people that you can run a socialist state with the same economic efficiency that a free market has.

posted by babbleman on Feb 25, 2008 at 08:41:24 pm     #



Money will dictate what healthcare will be delivered under a nationalized plan. By necessity the government will impose limits on certain procedures. In fact, Oregon has already started doing this with their state health plan. Let's take dialysis for example (hypothetical only):

The government says it will not provide dialysis to anyone who is over the age of 65, has another organ system failing, or has a life expectancy of less than 5 years.

Person X who is 70 years old and in renal failure makes $40,000 a year. Person Y is 70 years old and in chronic renal failure but (thanks to wise investing and saving) has accumulated a nest egg of $2,000,000. Neither person will qualify for governmental aid in receiving dialysis since they are both over the age of 65. However, should person Y be prohibited from purchasing dialysis at a cost of $5,000 a month just because the government won't pay for person X to receive dialysis? I don't think so. The goal of providing equal healthcare to all shouldn't come at the expense of person Y, it should come by increasing the access to care for person X.

posted by HeyHey on Feb 25, 2008 at 11:06:12 pm     #



I'm not saying to socialize anything. Does criticism of theoretical free markets imply socialism? How many flavors of economics are there again? Just 2?

I like numbers. I like efficacy rates. I like double-blind studies. I like legitimate scientific method.

I would rather nip it all in the bud and for everyone to demand legitimate labels on all foods, clean food, clean water...
It follows that most food-borne disease, malnutrition, allergies etc. would fade perhaps into extinction. Chances are you're eating MSG, hormones, pus, bacterial/viral infections, chemical additives without consent and incomplete/imperfect knowledge. All these wreak havoc with your health and/or mood. And in standard contract law, (which is essential to any economic system) such agreements are illegitimate.

Things we take for granted are essential to good health. Some working limbs, an active mind, and the means to exercise and nourish them. Not drugs, not perpetual treatments, not health insurance, not the latest fad medicine....

If Michael Jackson wants to sleep in an oxygen tank...when did hooking yourself to machines equal innovation and good health again?

Rosemary Kennedy might have been better off being in a poor family:
http://en.wikipedia.org/wiki/Rosemary_Kennedy#Lobotomy

posted by charlatan on Feb 26, 2008 at 01:04:33 am     #



I'm not saying to socialize anything.

Oh, then sorry. This post is about socialized medicine - so you must have ended up in wrong place by accident.

posted by babbleman on Feb 26, 2008 at 07:24:21 am     #



First--I agree with babbleman that the rich should be able to buy "better" healthcare and education.

But as a followup question--the two examples cited (the "English Patient" and patients X and Y)---if the British healthcare system works in such a way to deny someone to purchase above and beyond the basic coverage, then that is certainly a bad aspect. Also, if Oregon healthcare works this way--again, no good. But why does a single payor system (Medicare for all, for example) have to work this way? My guess is, it doesn't.

Second question---in a Medicare for all system, won't the innovation factor continue? After all, patents will not go away.

posted by Chris99 on Feb 26, 2008 at 10:14:21 am     #



...if the British healthcare system works in such a way to deny someone to purchase above and beyond the basic coverage, then that is certainly a bad aspect.

Just a clarification - the British healthcare system does not actually outlaw the purchasing of premium care. However, if you do purchase premium care on top of the basic care, you are denied the benefits for the basic care. So it is like one step below the most extreme scenario which would be the outright outlawing of buying new / premium goods. In that extreme case, theoretically, all innovation would stop completely.

But why does a single payor system (Medicare for all, for example) have to work this way?

It doesn't. Mankiw pointed to the extreme egalitarian approach of the British system to provide a stronger contrast to the effect of reducing demand and how that also affects supply (ie, innovation).

Second question---in a Medicare for all system, won't the innovation factor continue?

Yes, as long as people still have the money and the desire to spend it on new / premium things - then the new / premium things will be made.

However, even with Medicare, the demand will be less than an unregulated market and thus technological innovation will be less. The reason is that the premium for Medicare is indexed on your income. The more you make, the more you pay. So some are paying more so that others can pay less. This is fine, but what it means is that, for those paying more than their share, there is less income available for them to buy the premium / new things. Therefore, the demand for the new things is being depressed which will in turn depress the supply.

Again, as I said above, this is not the end of the world. But everyone should be aware of these dynamics and understand that the economics of socialized healthcare depresses innovation.

So, in high level terms, the range looks like this in terms of the effect on demand for innovation:

Unregulated - max demand
Medicare - less demand
British system - even less demand
Outlawed purchasing - no demand

posted by babbleman on Feb 26, 2008 at 12:04:56 pm     #



The British don't outlaw private health insurance plans or private clinics. Canada, however, completely outlawed anything private until the last few years. I believe it was in Alberta that the provincial courts ruled that the prohibition on private healthcare was unconstitutional when a cohort of breast cancer patients brought suit against the government. Alberta has since seen a dramatic increase in private insurance and healthcare options. The other Canadian provices still have some semblance of the prohibition since the court's ruling only applied to Alberta.

Oregon also does not outlaw private healthcare access. It just refuses to pay out state funds for certain patients who are deemed to old or sick to significantly benefit from treatments.

posted by HeyHey on Feb 26, 2008 at 12:13:18 pm     #



btw, this is what economists call "market distortion". In its natural behavior, money chases the highest return which creates demand which creates supply all of which means growth. How efficiently this happens (ie, how well money can know the highest return and how fast it can achieve it), the higher the velocity of growth.

However, when that normal behavior is altered by forcing some amount of the money to chase lower returns (ie, paying for goods for people who don't cover the cost themselves), then the velocity of growth slows because the efficiency has been reduced or "distorted".

posted by babbleman on Feb 26, 2008 at 12:19:13 pm     #



That you morons believe that a rich mans life is worth saving and a poor mans is not, is the shit that revolutions are made of. I've never heard more vile assertions in my life. Applying lying ass "free market" talk stupid bullshit to a human life isn't even human, let alone christian. I advocate that the rich should have NO healthcare, because the pollution of their greed driven products and poisonous mandates on our lifestyles are killing Americans. Stuff that in your idiotic free market think pipe and puff on it with your White Owl.

posted by prime3end on Feb 26, 2008 at 12:40:26 pm     #



What I think is being said is that there is more money apologizing and grazing from the behinds of the wealthy, then there is solving actual pressing problems.

In terms of a narrow(minded) scope, there's no arguing against it. In terms of real human progress, justice, democracy, etc., well um.... that's what economists unable to deal with such realities call externalities.

posted by charlatan on Feb 26, 2008 at 12:58:49 pm     #



Sometimes you have to be able to laugh at yourself....

posted by Ace_Face on Feb 26, 2008 at 03:35:38 pm     #



LOL, really good Ace...

posted by McCaskey on Feb 27, 2008 at 12:34:39 pm     #