[jrmurad]

I'm not saying you're wrong that socialism is better than this mess but I will say that capitalism is better than this mess and better than socialism too.

Having health insurance provided by the State (i.e. you through your tax dollars after several layers of corruption and bureaucratic waste) does not guarantee quality of care. A competitive free market is more likely to develop better medicine.

[mixmax]

I think that empirical evidence is against you on this one. The US has one of the highest spendings on healthcare per capita in the world, while average life expectancy (one of the measures of a good health care system) is on par with Cuba. US yearly expenditure on healthcare per person is $4.500. In Cuba it's $100.

The American freemarket system clearly doesn't work very well.

Source: http://ucatlas.ucsc.edu/spend.php*

[fharper1961]

Thanks for the great link. The correct link is actually http://ucatlas.ucsc.edu/spend.php

The graphs alone should open the eyes of any who defends the current US system.

Of course Cuba and the US are both outliers. But realistically the US should be able to get results that are much closer to other first world countries.

[andr]

While spending per person in dollars may be higher, there is gross gross inflation in the health care sector, resulting in the hospital charging you $100 for a pack of Kleenex, because it's usually the insurance company that pays it.

[mixmax]

Yes - in this respect the American health care system has similarities to the unregulated capitalist financial markets, which is part of the problem.

I think that your comment splendidly proves my point.

[ajkirwin]

I'd argue that, on average, people act unhealthier in the US than they do in Cuba.

[jfoutz]

I'm first to agree efficient markets are fantastic at allocating resources effectively.

I'm curios though, how do you guarantee people who are sick/hurt/dying behave as rational actors?

I might be mis-remembering but i thought rational actors were a requirement, otherwise they would be to quick to give away money.

[jrmurad]

Honestly, I haven't heard the rationality factor applied in the case of healthcare so I won't try to answer you question but I don't want to duck it entirely because it's an interesting point. I know that children and the mentally disabled are handled specially in other cases for that reason. However, could you not apply the same argument to food (hungry people), shelter (exposed people), etc?

I think those who want socialized medicine have to justify aggression (initiating force through taxation, regulation, etc.) They also have to convince us that the masses (in the case of a democracy) can make better decisions than the individuals directly involved in each particular situation. They have to explain how people would be motivated to innovate in a system lacking competition and guaranteeing equality of outcome (this, is what I'm assuming is meant by "socialism", by the way).

I think these questions are of interest to us and the "hackers" of other disciplines... we want an environment where people are free to try new things. Mitigating the risk of failure should can also be managed by the market through insurance, which, getting back to the original point is privilege not a right because one has no "right" to the goods/services of another.

So, sure, it would be a great idea for everyone to contribute to a large pool for health insurance... but on a voluntary basis. Those who decline to or cannot pay will have to rely on charity if something happens. I can feel bad for them but I would not feel justified in putting my gun (or a tax collector's) to someone else's head to make them pay for it.

This is all assuming that both insurance and healthcare costs will both decrease dramatically when America rids itself of the heavy regulation of and handouts to the respective industries by going to either a completely socialist or capitalist system.

[ajkirwin]

I'm all for a 'big pot' and that if you put money in, you can then get money out.

But at the same time, I think that people should HAVE to put into the pot, or you end up with a Tragedy of the Commons. No-one pays, because they don't like to think they'll get sick.

And then when they do, well, it's too late.

(I should note that I am biased towards socialized medicine, being an aforementioned sick person)

[netcan]

Rational actors are more of an assumption then a requirement. Used in conjunction with carefully defining terms, this a powerful way that economists hermetically seal their theories.

rational = utility maximising utility defined by consumer choice

Basically, they pay anything because it's worth anything.

[yummyfajitas]

All this really means is that preferences are transitive. I.e., if I prefer a puppy to a wii, and prefer a wii to cabbage, then I prefer a puppy to cabbage. That's not an unreasonable assumption.

It's an easy topology exercise to prove that if preferences are transitive, then a utility function exists (I think you may also need to assume a countable number of goods/services).

[netcan]

Economists don't assume that preferences are transitive between people. But within one person, I think they do.

[netcan]

A competitive free market is more likely to develop better medicine.

Well, yes & no. A free market does develop good medicine in much the same way as it develops good everything else. But what you are usually measuring something essentially different when evaluating medicine.

You could say that a free market system should produce more medicine. But (as free markets do) this is distributed unevenly among the population. that's OK when you are talking about shoes. Your free market will produce more shoes then a nationalised shoe industry. But a lot of those will end up in the closets with 20+ pairs or in the form of $500 shoes. Same with medicine.

The US is a good place to go if you want $10m surgery. But if you are measuring public health: life expectancy, infant mortality, death from preventable diseases, & such a $1 at the bottom goes a lot further then $1 at the top. The gains made from flattening the system, generally outweigh the lost effeciency.

[SapphireSun]

Hmm I've thought about this a bit, and it strikes me that while yes, it does seem to make sense that we should have medicine for everyone, we should also have an area where there is pressure to perform. Essentially what I am positing is that the US should remain a nonsocialist area so that we innovate and provide the necessary advances because eventually they will filter down and become affordable by the average person. In the meantime we could make it easier for people to leave the country if they prefer to live under a socialist system. This would be counterbalanced by most of the rest of the world having that flat system you referred to. It's a compromise. On the other hand, let's assume that my dear reader has no soul and will thus not vituperate me for the following idea: Modern medicine has been around for like 60-80 years which is essentially no time at all. In the space of that time, major advances have been made that have not yet filtered down to the bottom. If you take the long view, in 100 years the stuff we thought was a $10M miracle today might be a trip to the doctor's office with a 20 dollar copay then (think robots). So what's really important is not curing every poor person today, but advancing the field to cure the poor people of the future. The trick to surviving is to try not to be poor and/or get insurance.

Essentially, this is a highly tangled problem and a simple solution won't do.

[davidw]

> Essentially, this is a highly tangled problem and a simple solution won't do.

Bingo. There's a nice discussion of just a bit of the economics involved in health care in "The Undercover Economist". It's really a very complicated subject because it is not your typical market for something like shoes, to use someone else's example. Pure capitalist systems will leave at least a few unfortunate individuals to die or suffer from easily/cheaply curable diseases. Pure state run systems throw out all the useful information that a market provides and introduce inefficiencies of their own.

[netcan]

a few unfortunate individuals What percentage of Americans do not have access to adequate health care?

You guys keep thinking about this as if the economy existed in a world where buzzwords & their associated connotations are absolute. You are not choosing between US 2008 & 1963 Soviet Russia. The most radical model likely to ever be proposed in the US is something like the UK's.

The system tries to provide internal pressure to reform (just like big companies do). There will probably be a decline in mean medical care from an economic utility standpoint (to the extent that term has any meaning - I think very little) There will be a dramatic improvement in health to the bottom 25% -30% resulting in huge gains to life expectancy & similar indicators.

As a bonus that the fear Americans have of being left without health cover will lift.

Capitalist evangelists of various sorts are always quick to point out there are no good example of command economies performing well. That's fair. But there are plenty of examples of 'socialist' health care systems that work. They perform well on any meaningful scales at a cost lower then the US's. From Cuba (an outlier but a very interesting one) to the UK to Japan. Pick one.

[davidw]

Read the book. It's highly recommended, and makes all the points you do and then some, and even points out an interesting compromise model that attempts to cover everyone, but still maintain some of the good effects of having a free market.

[wheels]

I'm not going to get into this debate here, I'd suggest checking out some info and then seeing if it fits with your assumptions. Page 200 here ranks worth health systems:

http://www.who.int/whr/2000/en/whr00_en.pdf

[yummyfajitas]

I don't think that table means what you think it means.

Table 10 on page 200 measures "attainment", which is something along the lines of (actual health improvements due to health care) / (best possible health improvements given spending level). That's a very different quantity than quality of care, which is what the original poster was talking about.

(It's actually more complicated, education levels are somehow worked in and details are described elsewhere.)

Rankings and indices are great, but it helps to know what you are actually ranking.

[mseebach]

I think it's important to clarify that there are two layers in this. Paying for health care and providing health care.

IMO, there's a good case to be made for a baseline of mandatory basic healthcare (i.e. no dying in the streets, no choosing food this week over a visit to the doctor), which should be tax-funded for families below a certain income threshold.

The other end of the stick is the hospitals and doctors themselves, and there is absolutely nothing that suggests that they become more efficient or cheaper, if they are made public employees. Quite the contrary, I'd argue.