The Health of the Healthcare Marketplace
From the TPM front page:
But let's assume for a moment, that it will destroy the marketplace.
Marketplaces are good for a few reasons: (eventually finding) efficient allocation of resources, a mechanism for consumer feedback, etc[1]. Markets will exist whether or not they are government sanctioned. Government enforcement of consumer protections and contracts between private parties helps lessen the risk for market participants, but even without those protections black markets thrive.
However, there are markets which the government not only doesn't sanction, but actively seeks to destroy. One example is the market for people and in particular child prostitution. We all agree that even though we like free markets, we like personal liberty more, and we believe that slavery is immoral, and children should be protected above all.
Markets, like governments, are good only in as much as they serve the people; they are not an end onto themselves. The core principle underlying it is the idea people should have as much freedom from government interferance as is possible. Buying and selling goods and services is one of those things that people do with their freedom, and markets are created and nurtured as a consequence. But the People ultimately define the terms under which the market operates.
If there is a choice between a health care marketplace and the health of the population, i think it is clear which we need to choose. If the market is a detriment to society, then something should be changed.
There is surely a danger in a system which is controlled from the top down (a planned economy, although one might be tempted to compare the current system to a top down control by various health care companies). Markets are a good way to deal with that danger, but they're not the only one.
Our lives would be a lot easier if we could say, free market always, or command economy only. It takes away all the hard thinking and the difficult choices about trade-offs between competing interests. Everything can be reduced to slogans and chants.
The foundations of our government though are built on the idea of striking the right balance [2], and it is a tradition we should continue.
In anycase, the demand for the current kind of healthcare marketplace has hit rock-bottom in the meta-marketplace of marketplaces. Except for antiques collectors and afficianodos of kitsch no one is buying. There are better products on the market.
[1] I have no poli-sci or economics credentials and it shows.
[2] For example, The Articles of Confederation gave way to the Constitution, the bicameral legislature with split responsibilities, separate but nominally equal branches, etc.
Sen. Richard Shelby (R-AL), speaking earlier this month on Fox News, called President Obama's plan the "first step in destroying the best health care system the world has ever known." A public option, Shelby added, would "destroy the marketplace for health care."I'm pretty sure this is completely false. The first statement is laughable, and most everyone has a first-hand example of how the health care system has failed them. The second statement is also false. Obama has gone to great pains to ensure that there is a place in his plan for private health insurers, (much to the consternation of some of us).
But let's assume for a moment, that it will destroy the marketplace.
Marketplaces are good for a few reasons: (eventually finding) efficient allocation of resources, a mechanism for consumer feedback, etc[1]. Markets will exist whether or not they are government sanctioned. Government enforcement of consumer protections and contracts between private parties helps lessen the risk for market participants, but even without those protections black markets thrive.
However, there are markets which the government not only doesn't sanction, but actively seeks to destroy. One example is the market for people and in particular child prostitution. We all agree that even though we like free markets, we like personal liberty more, and we believe that slavery is immoral, and children should be protected above all.
Markets, like governments, are good only in as much as they serve the people; they are not an end onto themselves. The core principle underlying it is the idea people should have as much freedom from government interferance as is possible. Buying and selling goods and services is one of those things that people do with their freedom, and markets are created and nurtured as a consequence. But the People ultimately define the terms under which the market operates.
If there is a choice between a health care marketplace and the health of the population, i think it is clear which we need to choose. If the market is a detriment to society, then something should be changed.
There is surely a danger in a system which is controlled from the top down (a planned economy, although one might be tempted to compare the current system to a top down control by various health care companies). Markets are a good way to deal with that danger, but they're not the only one.
Our lives would be a lot easier if we could say, free market always, or command economy only. It takes away all the hard thinking and the difficult choices about trade-offs between competing interests. Everything can be reduced to slogans and chants.
The foundations of our government though are built on the idea of striking the right balance [2], and it is a tradition we should continue.
In anycase, the demand for the current kind of healthcare marketplace has hit rock-bottom in the meta-marketplace of marketplaces. Except for antiques collectors and afficianodos of kitsch no one is buying. There are better products on the market.
[1] I have no poli-sci or economics credentials and it shows.
[2] For example, The Articles of Confederation gave way to the Constitution, the bicameral legislature with split responsibilities, separate but nominally equal branches, etc.
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Off-topic, but: Is there a way for the tpm software to tell you when you have received a reply to a post or comment? It seems like you have to keep checking for replies. The effort required to keep up with things quickly kills conversations on buried entries it seems.
June 29, 2009 9:28 PM | Reply | Permalink
Your statement, "If the market is a detriment to society, then something should be changed", pretty much says it all. Now if only we had a body of legislators up to the task.
June 30, 2009 10:37 AM | Reply | Permalink
Maybe they need to be (metaphorically) hit over the head with the fact:
"Which is more important to you: a health care marketplace or the health of the people?"
They, of course being politicians, will want to say, "we can have both!"
But you have to force them, and ask if they really really believe that having a healthcare marketplace is as important as having healthy people?
Personally, i think that an actual marketplace which serves the customer will lead to better outcomes.
But the health of the people is more important. The healthcare marketplace's merit is solely due to leading to better outcomes for people.
In other life or death situations, the government lays down ground rules. Consider airplanes: there are a huge number of regulations laid down by the FAA and the incredibly thorough investigatory system of the NTSB. The FAA has routinely been dragged kicking and screaming by the NTSB into making rules that have lead to incredibly reliable aircraft and air transport operations. They have managed to achieve a really incredible safety record.
The marketplace didn't do that, the FAA lead by the NTSB, dragged the airplane manufactures and airlines to make changes to increase safety.
(Insert health of airlines argument here; but my point isn't to use it as a model, but to demonstrate that when people are at risk, the government should and does intervene).
Health care itself is similar, and insurance--the ability to actually get health care--should be considered every bit as critical.
June 30, 2009 12:26 PM | Reply | Permalink
The actual physical health of the population aside, the thing that I really don't get is how through implementing any of the proposed plans, we intend to not only control healthcare costs but to in fact reduce them. In the end, it seems apparent to me that we need an outcome based assessment of current treatment protocols, as well as local and regional cost anomalies. Then we need to implement changes that reflect more effective/efficient treatment as well as efforts to reduce inflated local cost anomalies. I don't see anyone in congress addressing any of these issues, and their proposals seem to be so much window dressing on what in the end is the most dysfunctional healthcare system in any OECD country. And that doesn't even address the built in duplication of services in our multi-payer system and the resulting inflation of cost from that. If in the end, they propose to consolidate the various insurance options under a single payment protocol in order to streamline billing/etc., what is the difference between that and a single payer system, except that it would be inherently less efficient and uncontrollable?
June 30, 2009 5:27 PM | Reply | Permalink
the various interest groups are still jockeying for position and trying to frame the debate. i've seen little more than rhetoric, and i think Obama is going to have to provide more leadership in order to get a bill that actually does anything useful.
i can see splitting the issue into roughly two parts: providing coverage and cost controls.
overall i suspect the plan will have to be implemented gradually, beginning with getting everyone covered. i would even be happy to see a law passed saying that healthcare reform would be phased in, (within the next two years say), and explicitly stating that regardless of the structure of the reform, the goal is to get everyone basic health coverage (good coverage not these high deductible major medical only sorts of things...preventative care, prenatal, rx, etc).
This legislation should also pass some stop gap coverage to take the burden off people, (especially the working poor). Finally, it would have a deadline requiring congress to enact more permanent coverage.
Based on this law, a panel of medical experts could be created. They would be tasked with comparative outcome analysis, regularizing practices, forms, etc. This group would meet continually to assess the state of the program, the state of the art in treatment and therapy, and would determine what is most effective, and make recommendations to modify the program to make it more effective. a separate or co-extensive group for costs and administration could be established as well etc.
(Rather than standing between the Dr and patient these guidelines would provide the Dr with advantages, by showing him the best and most effective methods. There will be an understanding though, that the Dr has the autonomy to deviate in order to do what's best for the patient).
This would setup a process to make sure the system gets better and cheaper and more effective continuosly. It also makes it a tad easier on the front end, since we don't have to do all the heavy thinking right at this moment.
I'm sure there are a whole lot of ways of going about effective health care reforms. But i agree, that no one has addresssed the mechanics of a system. I suspect the law itself will be vague. Worse comes to worse, we can pick the country whose system we like the most and just copy it.
In the end, i suspect we're going to be disappointed with the legislation, but we have to try *something*.
June 30, 2009 7:11 PM | Reply | Permalink
I agree. Esp. with your first and last paragraphs.
June 30, 2009 11:58 PM | Reply | Permalink