Government, Health Care and (Gasp!) Competition…

health-care-costs-2Have you noticed that when the government becomes interested in something for you and works to be sure that you get it, whatever that is tends to become unaffordable? When only the brightest students went on to college, a lot of them had to work their way through–and did. Then, it was decided that folks had a right of some sort to higher education and government poured money and laws into that so it would happen. Now, a disproportionate few can afford college and working is no longer an accepted answer. The government’s solution, student loans, have turned a generation of grads (and non-grads) into indentured servants of sorts. That in turn, has cut into their ability to finance their retirement. And dumbed-down the colleges to achieve a more acceptable grad rate. Big help from government, right? Now that our living standard is dropping, fewer are marrying and having kids; those who do, are wondering how those kids will ever get to college. The condition after the government’s solution, is worse than it was in the first place. Reminds of an old Scriptural story about folks who cast out demons by calling on Beelzebub, a ‘cure’ that worsened the disease.

It’s looking as though health care may be another such as Obamacare rides in. Not only are administrative clogs holding up the work, with the employer mandate now held up for a year, but doctor shortages are predicted and the costs have jumped alarmingly, with insurance premiums ballooning. It’s getting hard to see how anyone with coverage to begin with, is going to be as well off as before, let alone the better off promised. And we all know that before the government regulated health insurance, a doctor would come to your house to see your sick kid and in rural areas, might have accepted a couple dozen eggs in payment. No, not kidding!

This ‘government effect’ is a universal in history we should have anticipated but somehow, another universal has been everybody forgetting it every time another government solution is on offer. There’s still another universal though when government doesn’t scotch it: it’s called, ‘the market.’ Whenever there is capitalism, opportunity calls up entrepeneurs to service it. Overpriced services are such an opportunity and one response is coming from pharmacists.

Pharmacy clinics explains the situation. Those walk-in clinics at Walgreen’s and CVS pharmacies–about a thousand of them so far–have been testing the idea. Per the report, they charge about a third what you might pay at the ER and half what your doctor’s office charges for comparable services, while the care is fully competitive. The testing has been so successful that they’re being expanded in number and in the care they provide. And as the story linked above points out, the health care industry (read: the government, now) needs to be scared pea-green of them.

See, they’re going to soak up all the easy, high profit, low risk volume business from the ER’s and doctor’s offices via price, access and service quality. Which of course, they should, with their better mousetrap model. But that’s going to leave the government’s servants and agents hanging in the cold wind of high-risk, difficult, already overpriced procedures without any easy money to cover them. Oops… How will the “Affordable” part of the Affordable Care Act be able to exist?

Historically, government isn’t fond of competition. It prefers overpriced monopoly, so long as it’s the monopolist. We note that private health care has been proliferating in Canada. Maybe the Canadians will legislate it out of existence or maybe they have by now, I don’t know. In the U.S. I expect regulation to increase the difficulty of opening clinics, but perhaps that’s too pessimistic.

Maybe instead, government will get the picture and deregulate the industry, returning it to private hands providing truly affordable care. Any bets?

About Jack Curtis

Suspicious of government, doubtful of economics, fond of figure skating (but the off-ice part, not so much) Couple of degrees in government, a few medals in figure skating; just reading and suspicion for economics ...
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41 Responses to Government, Health Care and (Gasp!) Competition…

  1. You realize that health care is a classic market failure, correct? The market cannot and will not work in health care.

    • Jack Curtis says:

      Health care as a market failure/ Can’t work? How so? I wonder whether that is not more a reflection of a predefined concept of what healthcare ought to look like, than an objective evaluation of its characteristics?

      • What does a market do, and with respect to health care, what does a market do?

      • Jack Curtis says:

        Those are subject to the nature of the market specified; U.S. health care is a constrained market, subject to government intervention. So in varying degrees, is much else.

      • Not really, a market is a market. How and what does the health care market really put a price on, independent of government intervention?

      • Jack Curtis says:

        Health care pricing is a (insane) mix of private, insurance and government influences that seem to defy economic rationality!

      • I’m going to be gone for a little while, so I thought I would provide more. A market is designed to allocate goods and services based on need and demand. This is a natural function that operates well in some cases. The problem is that with health care, the market does not work, cannot work, and should not work, unless we want the market determining the value of human life, which it does right now, just in different ways.

        Right now, if you get sick, let’s say it is a broken leg, you are faced with some questions of care. You likely have insurance that you either got from your company, or that you paid out of your own pocket. This insurance will help cover your costs and you will have your leg fixed.

        Let’s say you have company insurance. The company is invested in the expected return you provide the company, and provide insurance, or not, based on this fact. The more important you are, the better insurance you have.

        But let’s say you buy your own insurance. Then you have to pay what you can.

        The best bet you have is to get enough education and training that you are valuable to a company and they pay.

        In either case, however, there is a limit, ultimately based on individual worth. Some people are worth more, so their care is better, some are worth less, and their care is less.

        Do you agree? If not, why not?

      • Jack Curtis says:

        We agree; the fact of scarcity forcing allocation in human (and all other) life seems a given. And we agree too that the basic market is the sum of human interactions reflecting scarcity of a specific. That leaves us for discussion, what the means for allocation and its controlling principles, should be.

        In health care, human life is a factor certainly, so how is its market value to be set? Believers in a Creator tend to see human life as a priceless gift, to be protected at any cost. Non-believers seem generally to be more pragmatic and as you pointed out, assign varying economic and/or political values to different people. There remain nuances here, but for discussion, we’ll stick to the two primary views. To this point, I suppose that we agree; I have merely restated what has been said, if I understand it.

        So at bottom, the only questions are: Who decides? And: What are the decision criteria? If that is so, seems to me that you can allow either the market or the government to decide. With the market, you will by definition, get economics as that is how it works. With the government, you will get politics, for that same reason. And history shows that over time, the two tend to blend; politicians necessarily grab whatever handle on voter they can find.

        Thus, a pure market reserves expensive care for those who can pay for it and a government program reserves expensive care for those who have political value. Any method will exclude some from expensive care, it becomes a matter of whom is chosen to benefit. There simply isn’t enough of that care to go around. And when government is in the picture, we get enough less care to pay for the cost of the government as well as the cost of the care. To overcome that, the government has to sacrifice or rather, force the citizens to sacrifice, in some other area as an offset.

        So, since there isn’t enough to go around, who is the best allocator?

        I prefer the market; I dislike political decisions’ results in general. Most voters today seem to prefer the government, at least until ‘buyers’ remorse’ sets in…

        .

      • I discussed it here. The problem is that the market cannot address a macroeconomic imperative, but a nation can. This is why national health care is a necessity, because the market fails in a macro sense. And when competing against other nations who have a better standard of health care, the US will fail unless it can adjust.

      • Jack Curtis says:

        ‘the market cannot address a macroeconomic imperative, but a nation can.’

        This seems to me an assumption of that which was to be demonstrated. It’s unclear to me why health care, a service, cannot be allocated by either the market or the government, using their built-in economic or political criteria. Which should allocate becomes a preference, based upon the criteria proper to the allocator.

      • The big problem you are making is that you assume that the economic necessity for health is based on health care, which is the wrong orientation. Health is needed much like education is needed. An economy, particularly an advanced economy like the one in the US, needs educated workers. If we fail to meet the demand for STEM level graduates in the future, our economy will regress and crumble. This is why public education is so necessary, since we need workers from Maine to Los Angeles to understand the nuances of mathematics and engineering, to drive the economy forward. Education is as necessary as natural resources, sometimes even more so. The market cannot provide what is needed, since the market is myopic and short sighted. The market can price something in the here and now, in a localized sense, but education must be grown in long term planning. It takes decades to bring someone up to speed on real education, and this is something the market cannot effectively provide.

        Health is the same way. Health is needed, so people will show up at their jobs instead of being sick, and so they can work, and the market cannot provide health. It can provide answers once health is lost by simple supply and demand, but health, in a holistic sense, needs planning and preparation. It needs vaccines as children, diet education, checkups in the meantime, mammograms, etc… This is nothing the market could provide, since the market is effectively blind. It can say that based on the number of doctors, the number of machines, the number of hospital beds, how much a treatment should cost, but it cannot put a price on the need to avoid all of this by having preventative measures.

        These sorts of economic necessities can only be provided by a nation, not the market. This is the real rub, the fact that the market is really rather stupid. It does what it does well, but we cannot expect it to do everything, some human intervention is necessity. This is why even the most neoliberal economies on the planet, have forms of national health care. The US is the sole nation in the developed world that does not have universal health care, and this is obvious from how poorly we perform in all of the rankings.

      • Jack Curtis says:

        Health care services share some similarities with education; we agree. That the market can’t supply education, doesn’t seem likely to me. It did so before mass public education grew out of what the market had been providing; government moved in and foreclosed the market. Now, the internet opens new opportunities for that and the market, not the government, is in most cases, exploring that. Add to that, public education in the U.S. is doing a poor job of producing capable workers. Before extolling the public model, it seems to need some improvement. Note too that it costs too much, compared to other places with better results. (About double what private schools cost)

        The market is indeed blind; entrepreneurs are not and provide the eyes and brain for the market. The education, prevention etc. needed for health care will come easily and the internet and publishing will spread it…the same vehicles government will use less efficiently at higher cost, it seems to me.

        Your market is a dumb ox that only government can direct but that is not my market. Mine is dynamic and constantly changing to fulfill those wants perceived by some as opportunities. The market put the buggy whip makers out of business and enriched the automakers, the government had little to do with it. Today, they would still be making buggy whips with government subsidy to please the buggy whip union. (a little hypervolic I admit, but it makes the point).

        Those CVS and Walgreen’s walk-in health clinics are a case to examine. They are only a few years in existence, are now around a thousand locations and expanding. They charge much less than standard prices at doctor’s offices and ER’s. The Business Insider article cited them as a huge threat to governmental health care because it cannot compete with them. They have mushroomed into a perceived market opportunity. The government meanwhile, is tripping over its own feet trying to get Obamacare under way…

        So, I prefer the market (my market, not yours) and you may prefer the government. Your government, on top of all else, uses compulsion to enforce its edicts while my market has to rely on individuals’ preferences toward competing products. Again, I prefer the market…

        We seem to proceed from rather different premises. But any time you care to point out perceived fallacies of fact or theory, I will welcome it

      • You cannot compare an educational system in 1770, 1870, or even 1970 to today, since the globalized nature of economics is a more dominant force today. A child in Maine needs, by economic necessity, to be as educated as one in San Diego, and this necessity demands some common standards, since both children could be working for the same tech firm in the future. The market cannot predict this, and neither can an entrepreneur. People can. You also say “your market” and “my market” which is a silly distinction. The market is simply the market, though there is an inability to recognize failings in it. The market is replete with failings, education and health care are perfect examples, but so is the military. The market is not dynamic enough to provide electrical engineers, since it takes 16-20 years to train a good electrical engineer. The US is going to fail as a state, I think it is a foregone conclusion but some people hold out hope, precisely because its educational system is being starved.

        I joined the military at the age of 18. I gained a practical education that was second to none. I traveled the world, and really saw how things operated in other areas. I changed career fields twice. I went to get an undergraduate degree from one of the best schools in the US, a graduate degree, another graduate degree, another graduate degree, another graduate degree, and I have two more planned for the future. I should be able to end my professional life with maybe 7 graduate degrees, I have been in school for most of my life (I incidentally have not had a real vacation in maybe two decades), will be in school for another two, but the overriding desire was to be marketable. This was a conscious decision, however. The market did not and could not drive me to that decision, since it was unnecessary per market standards. My wife is constantly asking why I am getting ANOTHER degree, and the real reason is fear of being unemployable. I have graduate degrees in the sciences (several), humanities, engineering, and business (two fields), but I am concerned about my family, so I keep going back to school. Today, however, I am extremely marketable, and when people are scrambling to find jobs, I can usually find one, even if it is not in the US, which it sometimes is not. The market could not prepare people for the collapse until the collapse happened, and by that point it was too late. Someone else needed to prepare people, and the US is not doing it. So when businesses move out of the US, people will just follow, we are in an age of labor mobility, and those who are left behind will wither on the vine. This is the real fear.

        Health care is the same. The US may have the best health care in the world, but most people do not have access to the best health care in the world. The average American would be better off in any number of different countries when it comes to health care. You keep saying “it seems to me…” because it allows you to avoid the responsibility of study, you can say what you like and the truth or lack thereof is insignificant. You stated…”the same vehicles government will use less efficiently at higher cost, it seems to me” but you cannot explain all of the examples that contradict you. Every developed nation in the world, and many not quite developed ones, including those with economic systems that you claim to like (Singapore for example) have national health care, with lower costs, and better results in terms of public health metrics.

        If it seemed to you that the government cannot be more efficient at less cost, how is it that so many are? Why is the US so far behind in terms of education, health, public functionality, etc…

        HBO has a new show out (second season) called the “Newsroom” and it is unabashedly liberal, but makes some interesting points. In the series premier a reporter is asked why the USA is the greatest nation in the world and he bluntly says that it is not. Part of the quote is “…there’s some things you should know, and one of them is, there’s absolutely no evidence to support the statement that we’re the greatest country in the world. We’re 7th in literacy, 27th in math, 22nd in science, 49th in life expectancy, 178th in infant mortality, 3rd in median household income, number 4 in labor force, and number 4 in exports….”

        Before you claim that Ayn Randian economics (which is really weird since she was never an economist, and actually a terrible businessperson) is the answer, why is it that the US is being beat exactly by the people that are doing what we are told NOT to do? It is the people who are being Socialist (not really but most people do not know the definition of that word) who are slowly but surely beating the US in every metric, but no one will address this, or even explain why the obvious evidence is wrong, which most claim it is, when other systems keep getting better and ours continues to get worse.

        Sure, the NEA is not the golden arrow for solving the education dilemma, but neither are charter schools, since charter schools will leave a lot of people out that NEED education, not because I particularly care about them as people (I do, but that is not the reason) but because I recognize that as an economist the US economy NEEDS these people to be educated enough to work. We need to know that from Maine to San Diego, the education level is high enough to support growing industry. It does not need to be PhD level, but High School+. And if we cannot achieve this, business will leave for places that can and will, and those places are out there. We do not need public, national education because it is great to educate people, but because we need a national economy, and that demands the education.

        We do not need a national health care system because it is moral, we need it because others who have it are trouncing us, and business will leave if we do not get our act together. If German employees are healthier, they can be more productive. It costs a company less to pay for health care in Germany through their taxes, and they get more. Or use Singapore as an example. Or any number of different countries. This is a problem.

        This is the BIG problem, you’re not actually a Conservative. You probably never have been. Conservatism has a definition, and it has been used as a catch phrase for so long that most people who don’t actually study it, do not know the definition. Conservatism is not an ideology, it never has been. Conservatism is actually anti-ideology. It is a dampening mechanism. Conservatism is mostly pragmatism. If the US is making steel, and Germany found a new way to make steel, a Conservative would not object because it is foreign and there is an ideology that we should maintain American ways of doing it, they would simply adopt the German way of doing things. But today ideology is dominant. We cannot look at a German health model because it is called “socialist” (which it is not, but people do not know the definition of that word either) and ideology says that socialism is bad, even if the German way may be better. American schools are failing, but rather than look at schools that are doing well around the world, we’re told to adopt the opposite approach to education that these schools are using. For some reason what works everywhere in the world, will kill the US, and this is called Conservatism.

        I’ve read Marx, I’ve read Keynes, I’ve read Hayek, I’ve read Freidman, and I have read some Ayn Rand (she is a TERRIBLE writer, it is just awful to slog through, her prose is very bad), and I have traveled the world. If something works, I do not care that Marx may have thought it up, or Freidman, or Rand. I am actually the closest thing to an actual Conservative you have likely ever met, but there is no way I would fit the modern (incorrect) definition of right-wing Conservative. I am just not afraid of the government (neither was Edmund Burke for that matter, but then again I’ve read him too, which I have yet to meet an actual claimed Conservative who has) if government can do the job better.

      • Jack Curtis says:

        1. We seem to share pessimism about the condition and direction of the American economy. 2. We seem to differ re the market; I see the market as merely people in the aggregate. Some of those are entrepreneurs, who see needs as opportunities and proceed to fulfill them, marshaling assets to do so. That is a very nimble process compared to a government reaction. And a market entrepreneur is by occupation, more likely to perceive a need before a politician does. He is motivated by the possibility of benefit; the politicians awaits the development of political benefit, a larger scale, longer term and less common goal. The market naturally fulfills needs it can reach; a long gestation is no barrier. Proceeding from high school grads, it takes four to six years to certify an engineer; good whiskey or fine wine may require the same span; so do cattle raised for meat. Cal Tech is a private university… 3.Government is slow to recognize and act to fulfill needs, its actions are distorted by politics and it is inefficient for the same reasons. Worse, once it moves in, it often forbids competition, thus foreclosing progress and efficiency supplied in the market.

        Your resume’ has some similarity to mine; I’ve various though fewer, degrees and certifications and never discontinued education, in and out of school. I stopped working for employers and opened a professional practice to eliminate the vicissitudes of employment rather than becoming a polymath. We both seem to have sized up the market and conducted affairs to match ourselves to its opportunities as best we have seen them; I believe that’s what people do, that makes the market work. I see the market as a sort of big probability distribution; we are statistics within it. A recent Business Insider article shows that America’s 55 -65 year old holders of advanced degrees aggregate to the world’s 3rd largest such group; our 25 – 35 year olds place us at 16th rank. The article says that high school grads are so badly prepared, colleges can’t make much of them. Our real total unemployed exceeds the 7.8% u3 statistic by a good deal (shadowstats.com) and has, I think, largely been bribed quiet by government benefits. They young are more unemployed than the older folk, with bleak prospects as the technical competence of the workforce is an increasing factor. Machines are about to replace field labor and restaurant kitchens; the need for low skilled workers is shrinking. And government is pricing energy, transport and other necessities upward for all. It isn’t an optimistic picture for me… Health care is a service and therefore, an economic good subject to scarcity. There will never be enough for all. The market rations economically and rewards enlarging the customer base. That seems likely to deliver the maximum benefit to the most people. Think Wal Mart. The government delivers political rewards subject to corruption and freezes progress by eliminating competition. It rations by political values. The market delivers better care to wealthy folk; the government delivers better care to politicians and wealthy contributors.

        I’m no Libertarian; their diagnosis and complaints of government impress but they have no prescription that I can see. And you’re quite right; I’m no conservative. Call me a pragmatist, maybe, though not on matters of morality.. And we differ on the theme according economic success to the rest of the world’s various economies compare to the U.S. I see Europe imploding via unsustainable spending just as here. Russia is staggering alone on its oil and gas, south America is not financially stable nor is China; Japan has begun to reflate (a 180 degree turn) and the Yen is tanking from it. There are no separate economies anymore. LIBOR is now run out of the New York Stock Market. And our Fed is pushing all the others around, to one degree or another.

        I think we don’t differ a lot on very much; primarily, on a preference for a free market vs government as a primary actor in economic affairs. Of course, that’s a big one!

      • It certainly does not take 4-6 years to make an engineer, it takes 16-18. Most people need 12 years of Elementary, Middle, and High School. Some people need more than 12.

        But once again you ignore governments that ARE nimble and responsive. You are ignoring the myopia associated with the drive for self-interest. The entire point of government is to do what the collective cannot, for the betterment of the society. This is why education is important, why infrastructure is important, why healthcare is important, because these are needed for the society, and more importantly the economy, to function. This is the lubricant in the engine, the engine cannot function without it, and your theory is to allow the engine to self-lubricate. But no one thinks this, but us.

        This is the problem. Every developed nation on the planet has national health care…but the USA. And their health care standards beat ours consistently. How can this be ignored? If “Health care is a service and therefore, an economic good subject to scarcity. There will never be enough for all” then why is it there seems to be more available elsewhere. Why is the USA 33 in life expectancy? Number 1 and 2 are Japan and Switzerland. Both have national health care. Neither country shares an ethnic similarity, so it could not be in the genes. Neither shares a common diet, so it could not be dietary. Neither location is similar, so it is not geographic.

        Why can other governments deliver what the USA cannot?

        Your commentary on world economics is once again a “The way I see it…” comment without much understanding. Greece is hurting the EU, but you ignore the countries that are doing well. South America is a developing continent, but is still doing far better than you are giving them credit for. Japan’s experiment is certainly not over, and can hardly be judged. There is so much out there that you are not taking into account.

        Your criticism of the Fed is really lacking some basic understanding of how these forces operate.

        You are continuing to ignore the rather blatant holes in your arguments, either because you do not know they are there, or you do not want to admit them, but the solutions you are advocating are completely opposed by the evidence of operability elsewhere.

      • Jack Curtis says:

        Ir seems to me that the first 12 years don’t make an engineer; a high school grad may pursue many different choices in college. So I assigned only the specifically applicable years to being an engineer. If you prefer to add the K-12 experience to the specialty, I won’t argue.

        Hmnn…I think you’ve outlined an area of profound difference in our viewpoints very well here:

        “The entire point of government is to do what the collective cannot, for the betterment of the society”. For me, this is an illusion. We agree that self-interest is myopic but it drives an entrepreneur to satisfy the needs and wants of the maximum number of others in order to maximize his gain. And the market, balancing all the millions of needs and wants, provides the greatest opportunity to an entrepreneur who can identify and satisfy the largest numbers. The basic function of the market for me, is to assemble individual self-interests into a communally productive function. It is able to provide a socially useful output from aggregated selfish, individual inputs. I think that it is a natural human activity, as I also see government to be.

        A bureaucrat however, in order to dedicate himself to the common good, will need to be a saint since his political milieu and individual self-interest don’t reward him for common-good goals as I see it. In fact, the contrary seems true. And efficiency cannot be expected with the inevitable corruption in government. So there, I think, is our primary difference of opinion. I know of no ‘nimble and responsive’ governments’ though admittedly, some are better or worse than others in those regards.

        Generally, an entrepreneur must get things done; a bureaucrat must keep his boat from rocking and satisfy his political bosses. They are usually, different kinds of people for those reasons.

        I don’t see health care as defined by longevity. It is only one measure and depends upon more than health care. Japan and Switzerland for instance, are very stable monocultures of very long standing while the U.S. is a melange. This affects life spans. But you imply that I hold our health care up as a model; I don’t. Nor do I believe that handing it to government will deliver improvement; the opposite is the case for me. I see too much government in it already.

        You are entitled to your opinion of the financial condition of this and the other countries I listed; I have stated mine after some investigation. In five years’ time, we’ll know the facts past argument. Until then, opinion will have to do.

      • Actually I had taken two semesters of calculus, and one of high school physics when I graduated the 12th grade. Scientists and Engineers certainly need a strong base that comes from primary and secondary education. Rat on the Constitution Club blog bragged that he did not understand High School trigonometry (despite the fact that this is taught in Middle School), so I am not sure where you are getting your data.

        Secondly, you continue to ignore the reality in the world. It is not just Japan and Switzerland. The US is 33rd in life expectancy. This is not because “the U.S. is a mélange”. The sheer diversity and number of nations that are surpassing the US belies this POV, but you are ignoring it. If you want to make a valid argument you need to interact with the data, but for every claim you make there are a number of countries disproving your assertion.

        Investing in a national health system has worked better for 32 other countries, but for some reason it will not in the US.

        Why?

      • Jack Curtis says:

        Yeah, high school has dumbed down along with universities on average… I think, as a result of the political imperative of pushing more people ‘successfully’ through the system. Math and science seem generally to have resisted the trend.

        You seem to continue attributing positions to me that I don’t hold. U.S. health care, for instance, is no model for anyone. Nor did I claim that the plethora of peoples accounted for the national average life span; it is however, a significant factor among others, another of which is healthcare.

        It seems significant that unrest is foaming up again in Italy over the government’s current reductions in healthcare spending. I fearlessly predict more of this in other places; if you lived in my neighborhood, I’d buy your lunch this time next year, if t doesn’t.

        I’ve read that teaching things like trig in middle schools is being eliminated under the new ‘common core’ uniform national education standards being imposed on public schools. I’ve not verified that news report; I hope it’s no so but it does fall onto the political trend line, along with dumping the ‘No Child Left Behind’ mandated testing of students that Congress is processing. (With GOP behind it.) Testing makes the schools look too bad, I suppose.

        Given the effort that goes into quality and reliability of our manufactures and many retail services, it’s interesting that educators should feel entitled to immunity from such measurement, seems to me. And I’d wager that, were they not government and unionized employees, they would not hold that position…

      • The Italians I know, and there are a lot of them, are generally VERY happy with their healthcare. The current strikes should be considered in context.

        As for schools, have you been in one lately. My wife is a teacher, and I see how much she works, for terrible pay, and nary a parent bothers to show up to help….ever. So we get the system we pay for and invest time in, leaving teachers to do far more than anyone would normally expect from anyone…

        What do you expect?

      • Jack Curtis says:

        Italians, if you followed the link supplied, are reacting to reductions in health care; a parallel with Sweden’s earlier cuts. They have exceeded their resources so the government is reducing the care. The people are re-learning about political promises, something Italians, of all peoples, should know. They aren’t complaining about their care, but about its reduction.

        What do I expect re schools? Given that they are government institutions, I expect exactly what we see.

      • Italians are reacting to almost anything. This should still be understood in context. Italians have MUCH better overall care than most Americans, so their objections should be understood in this context. Since I have lived in Italy, I have some insight into this.

        Why can governments outside of the US provide such great schools?

      • Jack Curtis says:

        I imagine Italians would go out and demonstrate if they had no complaints, just to keep in practice. But I can’t imagine an Italian lacking complaints…

        But benefits have been reduced in Cyprus, Greece, Sweden and now, Italy and if my thesis is correct, that will spread to most of Europe, including eventually, Germany.

        Schools are another subject Most appear to me, inferior to our sorry U.S. institutions. Those consistently superior seem to be in Asia and in western Europe. Many of those use a stratified classification system, with superior schools for the better (or better connected) students and less intensive education for the masses. American egalitarianism has prevented formalizing that in the U.S. though it is available informally for those who can pay for it.

        I note that, historically, the U.S. was a leader in education and in the U.S. California was a leader. Both are in sorry state today, a marked change attributable in my view, to progressivism in education and normal government/union attributes. The schools seem to me to suffer from some of the same maladies as Detroit. But I note that what they are doing, training worker-citizens to function obediently for government, has always been the stated goal of progressivism, elucidated clearly by Dewey and others. I believe that the schools are doing what they are intended to do and doing it fairly well, though at too high a cost. But it is impolitic to admit that, so they don’t. And they are inefficient and cost too much reflecting normal attributes of bureaucracy.

        When faulted for poor education, they happily admit it because it always comes down to more money and more people, the inevitable government reaction…

      • I can assure you, having lived in Italy, Italians will go out and protest at the drop of a hat. Nevertheless, you need to understand their complaints in context of the difference between what their health care system provides, and what others provide. You are not comparing apples to apples.

        Also benefits decrease and increase, depending on the situation, but your thesis does not allow for the significant difference between these nations and the US. This is a problem. If you wish to have a valid thesis, it must adequately account for all variables.

        Your perspective on schooling is flawed by what I suspect is a lack of exposure. You should get out and see how others do things, before criticizing.

        Your criticism of Dewey is equally as flawed. How is it that the ridiculously liberal, socialist utopias of the rest of the developed world are surpassing the US, if progressivism is to blame? It would seem that the MORE progressive are doing better, but you ignore this data.

        Why?

      • Jack Curtis says:

        My hypothesis is a simple one; so far, observations seem to me to support it: Most of the world’s major governments have lost control of their finances; that is taking down the world’s financial system. That’s simple, isn’t it? And we will certainly see whether it’s correct.

        I will repeat: I don’t see U.S. health care as a model. It is very good on some hings, less so on others, as seems also true elsewhere. Canadians may see their primary care physicians quicker than do we but they prefer to come to the U.S. for surgery, MRI’s and various specialties.

        In education, the U.S. was a world leader; its recent decline parallels the imposition of Progressivism onto the older system, that already leaned that way. If one is to understand the situation, it is necessary to understand that decline; merely pointing to the gap is insufficient. A recurrent premise, that governmental finance, health care and now, education are uniformly better elsewhere (I presume, Europe) does not accord with my observations… I’d need to know the rationale for that before deciding whether to accept it.

      • You seem to be unaware that Americans are leaving America to seek medical treatment elsewhere. Google Medical tourism MRI Scan and you get a whole list of companies shipping Americans overseas for medical care. To places where the citizens get it for free.

        Nevertheless all proponents of neoliberal health care must face up to the staggeringly unquestionable success of nationalist health care elsewhere. Why is it everything that is supposedly bad for America, works so well elsewhere.

        Italians are upset that some of there benefits are being cut, but these benefits that remain would be a godsend for most Americans, who will never see them.

        Can you explain why socialist policies in medicine, education, social care, have such great effects elsewhere when they would fail in the US, if they were ever tried?

      • Jack Curtis says:

        Canadian medical tourists visit the U.S. to find unavailable services; they are cutting long waiting lines. U.S. citizens are primarily, saving money.

        But the premise that government supplied services ‘work’ in those other places is unsupported by their current financial conditions in most cases. Their systems aren’t viable, as the Greeks and Italians are dealing with at the moment.

        There are glossed-over nuances too; what will happen as the E.U. must increase its defense spending to replace the departing Americans? And thatn on top of a declining world economy. Too many governments have overpromised their real resources and that is coming home now.

        It seems that maybe, after government hits some specific size, its impact on the economy becomes economically negative and many of the worlds’ governments have reached that point. That would make an interesting study…

      • But this is all wrong. Their medical spending is far less than ours, and is a problem only in that increased medical care inevitably leads to longer lives, and more medical care, all of which is one reason why medical care is a market failure.

        But you keep saying it does not work, while ignoring all of the evidence that it does work. Longer life, lower infant mortality, better level of health, etc… and all at decreased costs. The sustainability is an issue associated with considerable success, not with failure.

        If our system does anything well, it is fail, allowing lower lifespans, meaning less health, with higher costs.

        How can you argue otherwise considering the evidence?

      • Jack Curtis says:

        Perhaps we aren’t communicating. 1. I don’t extoll U.S. healthcare; it is poorly managed and too expensive by far. Mostly, a reflection of governmental interference. 2. I don’t argue the quality of various countrries’ systems’ WHO ratings are politicized and all such are arguable. Canada ranks well above the U.S. but the substantial health tourism is the reverse of that. Britain ranks well above Canada on much less spending and it is Britain that is seeing serial major healthcare scandals these days. Add that factors used in WHO ratings for instance, are very broad. Longevity is a product of much more than health care as one example. 3. I advance two concerns and none of those you attribute to me. My concerns are first, government controlled services, including healthcare, are costly and inefficient while tending toward poor quality compared to what is attainable without government. Second, that current government spending levels nearly everywhere aren’t viable and must shrink, very much including healthcare spending.Sweden, Greece and now Italy are already into that; the trend will continue and increase, in my opinion.

        So: You believe that other places provide better healthcare than does the U.S; so do I. I don’t know that you believe this will continue indefinitely; I believe all are and will be reducing such programs of necessity.

        I think you attribute to me arguments I have not advanced.

      • I don’t think the problem is that we are not communicating, it is that your statements are completely wrong, and have no factual basis. For example…

        “Canada ranks well above the U.S. but the substantial health tourism is the reverse of that.”

        The problem is that this statement is frequently used, and it is completely wrong.

        http://www.aarp.org/politics-society/government-elections/info-03-2012/myths-canada-health-care.html

        The problem is not necessarily with your opinions, but that your opinions are not based on any facts.

        You talk about government involvement, but this is a canard. Take the Heritage Foundation’s Index of Economic Freedom, the US ranks as number 10, and all of the countries above the US have national health care. Why is it that the neoliberal concept of economics that is being utilized to a greater extent everywhere else in the world, allows for national health care?

        Is it that neoliberal economics are being ignored in this instance? Or is it that there is an understanding that a well functioning economy needs healthy people of all classes to allow proper operation?

        Your repeated assertion that “government controlled services, including healthcare, are costly and inefficient while tending toward poor quality compared to what is attainable without government.” is completely contradicted by any and all available facts. Nothing supports this decision at all other than an insistence that it is your opinion, which is actually pretty damning to your opinion.

        It does not appear that you have put even the slightest amount of effort into informing this opinion, while continuing to hold onto it as if factually absent opinion were a thing to cherish? I honestly do not understand it.

        If you want to discuss Sweden, Italy (where I happen to be this second), or some other country, please be as specific as possible, what is being cut, why, and what are the repercussions. It seems that you take any cut at all as evidence of support, without understanding these issues in context and their actual implications.

      • Jack Curtis says:

        I said more Canadians come to the U.S. for treatment than the reverse. Canadians come to beat the local wait times; most Americans travel for lower prices.

        http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/leaving-canada-for-medical-care-2011-ff0712.pdf : http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/publications/waiting-your-turn-2012.pdf

        http://reason.com/reasontv/2013/01/29/free-trade-health-care

        Interesting that medical tourism to poor places has become an organized industry, world wide, serving people from Europe as well as North America. The two drivers appear to be cost and wait times generally though service quality and availability are part of it. The magnitude of this and its widespread sources of traveling patients, suggest that medical care most everywhere in the ‘Rich World’ is less than optimum…

        The links I provided re Sweden are an interview with a Swedish government minister and an analysis by the Economist, they seem to me to be suitable ‘facts.’

      • According to your documentation, 46159 Canadians go abroad for health care. This is .1% of the population. This is considering the fact that significant portions of the Canadian population live adjacent to American medical access.

        By comparison, 6 million Americans go abroad every year, which is 2% of the US population.

        20 times more Americans go abroad than Canadians, so what is your point? Americans would STILL be better off with the Canadian system, than vice versa, using this metric.

      • Jack Curtis says:

        The point is that Canadians go to find better service (shorter waits and unavailable procedures) at greater expense to them; U.S. patients go to find cheaper service. This could be put: The U.S. system offers more options and quicker care, but it is too costly for too many. The Canadian system offers fewer options and slower care but it is more affordable. That may help explain why the percentages of medical tourism differ, though both are low enough to make any conclusions questionable sams research. For which system is ‘better’ it seems a question of what one’s goals are. I don’t think either is anywhere near optimum because in each case, too many political considerations have intruded.

      • Except none of this is true. Some people will always opt out of any system, so the negligible amount of Canadians going abroad is dwarfed by the number of Americans. In every metric, it would be better for the US to adopt the Canadian system, but you could never admit this. If nothing else, you would be lynched by your ideological base.

      • Jack Curtis says:

        It is true as the links provided testify that Canadians go abroad for unavailable services and Americans, for lower prices. That doesn’t say either place has a system superior to the other; such a conclusion depends on one’s standards.

        You accuse me of being a prisoner of some ideological group; I could do as much for you but that is to me, superficial argument out of place in factual analysis. I have found no group that seems to me to represent me nor have I any need to find one. I’m sure that you have biases and don’t doubt that I have them; one must work with what is available.

      • But you have emphatically stated ” Canada ranks well above the U.S. but the substantial health tourism is the reverse of that.”

        Except this was completely untrue. Health tourism is statistically negligible in Canada, and the medical care that does occur is likely the result of Canadians in the US who need immediate services and go to the local ER.

        You said something completely untrue, which had no evidentiary support, and which was disproved after very little research.

        Can you explain the error?

        How about you present these facts on the CC blog, under your own name. State the truth. You assumed Canadian health care was sub-par, you assumed Canadians were trying to get away from their health care system. They were not.

        All of the evidence, all of the metrics, all of the facts point to one very simple fact. America would be better off with the Canadian health care system. Even if the Canadian system is not perfect, it is worlds better than Americans have now.

        How well will this statement based on the available facts be received? I do not really care who disagrees with the facts, be they right or left, because I did the research and studied the subject, and I know my position is correct based on the evidence.

        Very few people who share your POV have ever cracked a book, or bothered to put a millisecond into research.

      • Which interview are you referring to, specifically?

      • Jack Curtis says:

        The Swedish Finance Minister

      • ??? Could you be more specific?

      • Jack Curtis says:

        Sorry, but more specific concerning???

      • I am not seeing an economist article mentioned here, or a Swedish minister?

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