Wow! You really did some work on that one. How pleasant to get such a thoughtful and meaty response! It's lovely when someone actually engages rather than the utilizing the parry/propagandize/dismiss approach or the clueless garden path one, just to mention a couple of my personal "favorites."
Differentiation
What if I said that there is absolutely nothing special about it at all, say you agreed - would that help you to solve this mess.
I think btw that to require a completely exclusive characteristic, something applicable only to healthcare, if that’s what you’re looking for, is to overburden reason and escape reality.
Re my question about differentiation, that was an exercise intended to stimulate some analysis. I was endeavoring to break through the following fatal impediment to thoughtful and constructive problem solving. I was more interested in the exercise than in the actual answer.
Coug: Do you place the worth of someone by how much money they make? (1)
Me: The answer is no.
Coug: You want single payer UHC then..
Surely the fallacy in that is obvious to you. Yet that is a very common attitude, although I had not seen it expressed so directly on this particular thread before. I suspect it's behind some of the responses, though. So, what I was trying to do was to disrupt that particular knee jerk as a way of stimulating more useful discussion. And partly because I'm just curious about the decision processes of those who are wired differently.
Peace of Mind and Choice
In the aggregate, the general population is simply ill equipped to evaluate the alternatives….wither choice and it’s not because they are stupid. I wish it were different but these are the facts on the ground. Either you acknowledge them or you don’t.
Let me start with some clarification on the choice thing. I didn't have in mind choosing what treatment emergency room doctors would use in the case of a heart attack. That's for the experts. The context for that statement was choosing an insurance policy. Yes, we do have different tolerance for risk, economic risk and health risk. Some of us eat organic food. Some of us smoke. Some of us get disability and long term care insurance and preventative or maintenance as well as major medical. Some of us skate on the insurance. There are lots of choice opportunities prior to that trip to the emergency room.
You were not convinced of the strength of this distinction when I brought it up previously, but that puts you in the rather awkward position of granting a benefit, peace of mind, whilst remaining unconvinced of it’s basis, the mitigation of an involuntary event.
What’s true and unavoidable is that people have different risk aversion profiles
I do relate well to the peace of mind issue. I remember how wonderful it felt, despite the dreadful circumstances, when my father went into hospice treatment. I was so relieved at having someone there to take care of things. No research to do. Few decisions to make and even those few were teed up for me. It was an enormous load off my mind. There's a down side to being so passive. You accept whatever you're given and it's not necessarily the optimum. In a hospice scenario, there's no real downside to that. The patient, after all, is going to die regardless. But for those of us who hope to live for a long time, there's a trade-off. We can go passive and trust the system to do a pretty good job for us, which it probably will. People who take the HMO route now often have that motivation. Or we can be assertive about our own care and put in the effort to optimize our prospects. The former gives us peace of mind. The latter may give us better results. I could see myself going for the peace of mind. I'm very hassle averse so I could decide to minimize my hassles and take the more passive route. Or not. Different tolerances, different choices. While I may choose the low-choice option, I don't think we should give up the choice to make that choice.
The theory suggests that we change our behavior when we have insurance, that having it leads to over consumption and therefore to wasteful expenditures.
Regarding you key premise about voluntary and involuntary, having had several days to reflect on it, I'm still not buying it. Certainly a heart attack is not voluntary, at least not directly. But going to the doctor with the sniffles is. Some people have to be half dead to see a doctor. Others go at the drop of the proverbial hat. Then there are the aggressive types, the ones who, when visiting the doctor, ask for three pills they've seen advertised and a full body scan. I get a couple of thousand dollars of blood work done several times a year and I have a new test in mind for this year. I'm not the only one.
Those that have insurance face low barriers to getting care, they will go at the first sign of trouble and problems are often taken care of before they blow up into far more expensive fully fledged medical emergencies
It's true that catching problems early can save money. If you look at from a strict cost perspective, it's not at all clear what the net is. Some tests are recommended because the diseases are common and the tests relatively low-risk and inexpensive. In other cases, testing everyone doesn't save money. In most cases, we don't know. Some diseases have early symptoms, others don't. Some diseases have no test. Some tests have lots of false positives, which creates its own expense. The long and short of that is that you can't generalize. I'd like to see more study in this arena.
Efficiency
It boggles my mind that in a country so focused on economic efficiency that this situation persists. It is a form of irrational economics if ever there was one. Govts provide health insurance because markets fail to do so efficiently.
Maybe your mind is boggled because you're tangling two different kinds of efficiency. I love efficiency, both kinds, but we really need two different words for it. On one hand we have what I will call streamline efficiency. I think that's what you mean when you talk about economic efficiency. That's when processes are, well, "efficient," in common parlance. Smooth, with all the steps crisp and necessary. Cost-effective. That's the kind of efficiency you get out of single payer. The processing runs like a clock and costs come down.
Then there's efficiency in the capitalist sense, called economic efficiency. It's a rowdy process. You have companies going in and out of business. Products coming and going. Decentralized. Lots of duplication of effort. Lots of extraneous activity, dead ends, DOA products. Quite the opposite of streamline efficiency. But this little kernel of capitalist efficiency produces wonderful quality and selection of ideas and products, innovation and responsiveness, not to mention big bucks. This is the exact opposite of what you get from centralized, streamlined systems. It seems a contradiction from the common-parlance term, efficiency.
If we choose streamline efficiency, we lose the innovation of the market. Our systems may be streamlined and cost-effectiveIf we choose market efficiency, we lose streamlining. Personally, and abstractly, as a war horse of a systems analyst, I adore the streamlining. And I love saving admin costs. But I am also a capitalist. I worry about the inevitable stodgy, bureaucratic datedness and second-rate products. I think the advocates of single-payer in their eagerness are losing sight of the consequences.
Supplemental
It appears that no-one is calling for a single payer system without the option of supplemental insurance.
Why do you suppose it's called single-payer if it's intended to have multiple payers?
In order for egalitarianism to prevail as a matter of principle it would have to show that additional choices (supplemental coverage) would in fact generate significant harm to others.
That's your ranking of values. Mine, too. Not everyone's. You don't have to have too many colloquies with folks who go on about the poor "deserving" the same treatment as the rich to get that. Not that folks aren't entitled to their own hierarchies of values. But we're talking about a system here that is designed by politics and that evolves with changing values. The key element for me is that all voters will pull benefits from the system but a minority will pay for it. When the majority is dissatisfied with the core system while others have supplemental insurance, they will either vote for costly increased benefits or deprive the "rich" of their privilege. Surely you learned about the goose and the golden egg at your mother's knee. The economics of this scenario have a strong pull toward cooked goose.
(1) Message 24376793 |
