Friday, September 07, 2007

Free-Market Fantasies

I’m in a debate right now regarding my Free-Market Healthcare for Dummies post. Some anonymous commenter continues to insist that adopting a pure free-market healthcare system would surely drop costs, while not dropping quality of service. You can read our long debate there if you want; though you won't learn much. In my latest reply, I wrote so much that I decided to make part of it a new post. That way, at least someone will understand what I wrote.
Oh, and just so you understand, Mr. Anonymous apparently wants to get rid of all government involvement in healhcare (though he's never explained how far he'd take this) as well as ending health insurance; which includes employer-based insurance. Instead, we'd pay for all regular costs ourselves and have catastrophic insurance for the really expensive things, like heart surgery and whatnot.

I find it unimaginable how a free-market advocate can possible suggest that we forbid employers from providing health insurance as a perk; but as I said in that other post, to understand conservativism is to debunk conservatism. Anonymous has done nothing to challenge that statement. Enjoy!

Pricing Doctor A

Anonymous - You have continued to ignore my requests for an explanation of how your system is supposed to work. While you have repeatedly given the basic explanation of Supply & Demand that too many remedial students accept as reality, you haven't actually provided any actual model for how this is supposed to work in the real world. So I'll just ask a few direct questions on how you imagine this would work.

First off, the free-markets rely on informed participants. If one side has all the expertise and the other side is clueless, the market will breakdown. That's just how it works. Yet, most people have no idea how much medical care should cost. So under your system, we’re completely at the mercy of the doctors and hospitals. If they say a procedure or extra item is essential for your health and costs X amount, are you in any position to doubt them? Of course not. So how exactly is this supposed to work for setting prices, if the consumer is entirely at the mercy of the supplier?

On the other hand, insurance companies and the government DO know how much healthcare should cost, and they negotiate their rates accordingly. Yet you somehow imagine that the free-market is failing for them, making them pay much higher rates than they should. So can you explain why these experts are getting bilked by the same system that you want to force uninformed consumers to blindly trust?

Secondly, how will we decide which doctors to see? Are you really going to base your decision on price? That’s insane. Even with TV’s and cars, we take risks that we’re paying too much for a crappy product. But medical care? How do you quantify that? How can you compare a doctor that charges $85 for a physical with one that charges $135? Maybe you’re getting something good for that extra $50, or maybe you’re getting ripped off. How can you possibly know? Price is meaningless. While I find it within my ability to judge if a doctor is good or not, I have no way of quantifying that into a cost-benefit analysis; as we’d need to under your system.

And are we supposed to go to different doctors, based upon which service we need? We go to Dr. A for his cheap physicals, but Dr. B for his cheap x-rays? This is how the free-market works for consumer products, as there's no problem with switching stores to buy different products. You buy your TV from Best Buy and your stereo from Circuit City, and there's no problem at all. This obviously doesn't work so well for healthcare.

And finally, do you actually expect people to get price estimates before emergency medical care? If my daughter falls, am I supposed to go to each doctor in the area and ask them how much the tests will cost to see if she has a concussion? Should I get separate estimates based upon all possible scenarios? Will I get a free estimate, or will they charge me to look her over first? Again, this is how the free-market works, but it doesn't work so well when your daughter's brain is bleeding.

Sticking with Doctor A

And in all cases, none of this will happen. I’m not going to base my child's medical care on cost. I’m going to find a good doctor and always go to that doctor, just like I do now. And that doctor will have different rates for different services and I’ll just be at that doctor’s mercy and won’t be able to compare prices at all.

But as things are now, I don't need to. My insurance company already took care of that when they signed the agreement with the doctor. The rates are set and I don't need to worry that one of his services might be too expensive for me. I just let the experts at my insurance company worry about it; that's what they're paid for. But in your system, I'm just going to have to take my chances that I can afford whatever service I might need.

And I'm guessing that you don't have a problem with this, as you don't have kids. Hell, I rarely see the doctor too, but you just can't avoid it with kids. So far this year, all three of my kids have had mandatory vaccinations, which require well-child check-ups. My six year old had a staph infection on her finger, ringworm on her head, and a bacterial infection giving her earaches and hearing loss. My teenage daughter had two sprained ankles and a twisted knee (all on the same leg). All this got taken care of without too much hassle (though the ringworm sucked, as she had a bald spot on her head which took awhile to grow back).

I have no idea how much these things cost. I guess I paid about $160 in co-pays. None of this was unnecessary. And when my teenage daughter came in for her vaccination and well-child check-up, her doctor remembered to check her ankle and knee as a follow-up to make sure she wasn't still having problems. That's how this is supposed to work. They accept Medicaid too.

You, on the other hand, want to force me to worry about all this. You want me to call the doctor to ask about pricing before I go in. You want me to do a cost-benefit analysis on the bald spot on my daughter's head or ask my teenager to limp around school, hoping the pain goes away. Sure, maybe these treatments are cheap. But I wouldn't even know what treatment was necessary until they see the doctor. So you want me to go to the doctor, have him look at my kids, tell me what the price is, and if I can afford it, tell me what's wrong and what the cure is?

Thanks, but no thanks. I'll put up with this government "meddling" instead. I don't know what liberty they took from me, but I'll gladly allow them to if it means my daughter doesn't lose her finger or go bald.

Magic Markets

And have I ever said anything to suggest that I think we have a completely free market? Of course not. Have I ever suggested that services don’t get provided without the government or that only the government can set prices? Of course not. These are all idiotic things you ascribe to me. As with most conservatives, you can't imagine that anyone could understand this stuff without agreeing with you. So you assume we're all idiots and tell us what we believe, even when we insist that that's not what we believe. But trust me. I'm not stupid. I just disagree with you. It happens.

For your information, I am a firm believer in the free-market system. I know that it works. I’ve even explained how it works, far better than your “the markets will provide” fantasy. But it’s obvious that it doesn’t do everything and I’ve already explained this repeatedly. Is it good at getting us TV’s and cars? Sure. Is it good at providing needed services to people who can’t afford it? Of course not. It's not magic and can only work if people can sell things at a price that someone else is willing to pay. But if that doesn't happen, it doesn't work.

And yes, there are lots of countries that don’t have the regulations or government “meddling” we do. And they’re all crappy countries. But I could be wrong. Feel free to tell me about all the third-world countries with stifling environmental, zoning, and labor laws. Or third-world countries with expensive public education, healthcare, and entitlement programs. The fact is that all the good countries pay a lot for infrastructure that all the bad countries lack.

Civilization ain’t cheap. Nor is it without benefit. It's good for society to have healthy, well-educated kids. But as we see in third-world countries, there's no guarantee that these things will be provided. As they say, it takes money to make money. But if there's no direct profit in it, the markets will not provide.

Paging Dr. Walmart

As for your suggestion that quality care would be replaced with quantity care under a single-payer system, I will repeat again: IF A DOCTOR PROVIDED GOOD SERVICE, HE WOULD HAVE MORE PATIENTS. IF A DOCTOR PROVIDED BAD SERVICE, HE WOULD HAVE FEWER PATIENTS.

Because under my system, people have true free choice. They don't have to go to doctors they don't like. So a doctor with the “wham bam thank you mam” attitude will lose patients because they will choose to go to a different doctor. What is difficult to understand about that? If people can see any doctor that's in the plan, then they'll avoid doctors who give bad service. That's free choice. And believe it or not, many good doctors accept Medicare and Medicaid. Mine does. Yet somehow, you’re imagining that if we expand these programs that these doctors will drop out of the system? Huh?

In fact, you've got this entirely backwards. The real problem would occur in your system, because poor and lower-middle-class people could only afford the cheapest doctors. They would lack free choice. It is here where you'd see the “wham bam thank you mam” doctor. He can charge less because he sees more patients. Think Dr. Walmart. Under your system, Dr. Walmart would prosper and these people would get poor quality care. And no doctor who wanted to provide good service could compete with the price. And this would hurt the good doctors, as they'd lose patients. Again, my doctor is good and accepts Medicaid. Under your system, he'd surely lose patients, or he'd have to give worse service.

Having Both Ways

And what’s pathetically dishonest about you is that you’re now saying that if our healthcare gets too cheap that we’ll have waiting lines. Yet…that’s supposedly the beauty of your plan. That healthcare will get cheaper, but that we won’t lose services. Why does your system provide cheaper care that doesn’t deny people, yet you insist that cheaper care undermines my plan?

Either your plan denies service to people, or it doesn't. And if it denies service, it's Wealth-Based Rationing, just like I said it was. The less money you have, the less care you get. And if it doesn't deny service, then you have as many people seeing the doctor as I have; thus the "lines" you say I have. You can't have it both ways.

But as I said, you're just saying this because you’ll say anything you need to to make your point. And the truth is that your system would have fewer patients paying less money than my system; which would also hurt our doctors and hospitals. And our economy would suffer, as people would have more sick days and take time off from work to care for their sick kids. Freedom!

Revolutionary Changes

As for my suggestion that my system is just a slight modification to our current system, I say this because this is how we already do things. I’ve never had insurance that didn’t set prices with their doctors and most Americans have insurance. The only difference is that instead of insurance companies negotiating separate agreements with doctors, it would just be the government. And if they didn’t pay enough, the doctors wouldn’t sign the agreements; which would force the government to increase their rates. See, free-market system.

And there was a time that I didn't have employer-paid insurance, and so I didn't get insurance at all. But we were able to sign our kids up with the CHIP program, which I believe is part of Medicaid. And it worked just like our insurance does now, and was superior to some employer-paid insurance I've had. And so assuming you pay taxes, you already helped pay my kids medical care. Thanks!

And so I'm proposing just something more like that. Besides, we're already paying these amounts now, except our current system makes us pay more, as people are forced to wait until their health gets worse before seeing a doctor. Sure, we don't pay all of this as "taxes," but I've never really understood why that's such a dirty word. Paying money is paying money, no matter what you label it. But I fail to see how this is such a huge difference.

Your system, on the other hand, would be an entire revolution in healthcare. You'd force employer's to stop offering insurance. You'd deny insurance to millions and millions of people who can't afford it, including millions of children whose only mistake was being born to the wrong people. People would wait until they were very sick before they'd even find out what was wrong with them. Already struggling hospitals would go out of business, particularly those in poor neighborhoods. And even regular doctors like mine would lose business.

And again, you’ve explained nothing of how your system is supposed to work. It’s a fantasy. I don’t doubt that prices would come down, but services would go down too. We’d lose doctors. Hospitals would close. And we wouldn’t have the use of all their fancy equipment, which is where a large chunk of our spending goes. I’ve explained all this and you’ve done nothing but repeat your assertion that this wouldn’t happen. But how? Why would doctors come to our country if they could make more at home? How could hospitals remain profitable? How could our service remain the same? I can't see how this wouldn't be a disaster for us.

And for a benefit that continues to elude me. You say that you don't think doctors are the ones getting the huge profits. You clearly think insurance companies are getting overcharged. So where's the money going to come from? Who are the people sucking all the money now, which won't seriously suffer under your system? You never have explained that part. Again, I don't doubt that prices would come down under your system. I just fear that everything else would crumble down with it.

Again, I'm just asking for a slight tweaking of a system people use right now. You're taking a huge gamble that doesn't add up.

Edwards Obsession

And you really seem obsessed with Edwards plan, which supposedly forces everyone to have preventative care. I’ve barely seen anything on it, but would guess that the preventative care would only be mandatory for people who wanted to use the plan. So if you didn’t want to participate, you wouldn’t be forced to. What’s hard to understand about that?

Beyond that, I’m not really concerned with fantasy healthcare plans. Edwards isn’t even in political office and I don’t have the highest hopes that he’ll get the presidential nomination; though I wouldn’t be incredibly surprised. But I have no interest in discussing a fantasy healthcare plan that would most definitely change before it became law, even if Edwards got elected president, which is a big if. Again, I don’t see why you’re requiring me to defend a plan I’ve never even seen. This would make sense had I defended his plan. But I don't even know what it is and fail to see why you keep bringing it up.

And if we had a voluntary government-run healthcare program that you were forced to pay for, wouldn’t you prefer that the participants had preventative treatments, rather than waiting until it got expensive? Wouldn’t you rather pay for a physical and heart medicine than a triple by-pass surgery? Wouldn’t you prefer that cancer was detected in the early stages, rather than waiting until it became harder to treat? And if a bird flu outbreak occurred, wouldn’t you prefer that these people saw the doctor as soon as possible, rather than having them wait and infecting more people?

I know you’d prefer to not have such a program, but if we had one, would you prefer it to be cheaper or more expensive? Of course, these are all problems with your system too. People won't get annual physicals. They won't pay for heart medicine they need. And they'll wait until they're on their deathbed before they decide to pay for treatment. While it's cheaper to fix health problems early, the short-term financial picture will cause most of them to wait.

As I said in my last comment, I don't think you're a dumb person. But your obsession with the free-market cure-all is dumb and making you say some ridiculous things to justify your opinion. As I said, I like the free-market. I know that it works. But it doesn't always work, and in this case, it certainly doesn't. For healthcare, we obviously need something more.

I guess you disagree, but most American consider healthcare to be an essential service and it's expensive. We both have plans that would reduce costs, but only one of us guarantees service. As I've said repeatedly, there are countries where people are forced to pay for their own healthcare and education and retirement; and it usually means that they won't get any of these things. America deserves better.


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Mumphrey Bibblesnæð said...

Well, that sure was some back and forth on that other post.
I think it just goes to show how conservatives work. They fling bullshit around almost at random. I don't think they're really hoping much of it will stand up to scrutiny, though if any of it does, that's just a bonus; rather, they're only tring to goad the liberals into a game we can't win.
A conservative will throw out, say, 15 claims, all of them untrue and all of which can be shown to be untrue, and which NEED to be shown up as the lies that they are.
So the liberal sets out to do that. He can get through, maybe, 3 or 4, or even a few more if lucky, before losing track and getting all muddled. Then the conservative can jump all over him for getting some niggling little thing wrong here or there. This tack has the added benefit for the conservative that, even if the liberal can easily prove all of the conservative's points to be wrong, after a while, any bystander will just get peeved and it'll seem like the liberal is just nitpicking.
We saw this back in 2000. Every time Bush would tell some lie, Gore would have to stop and explain why it was untrue, and often it would be complicated to explain, and Gore would seem like a fuddyduddy, while all those listening would fall asleep with their eyes open, and then the press could titter and make fun of Gore for being like a persnickitty schoolmarm.
Conservatives (as we know them in the U.S. today) are just poisonous to a democratic society

Anonymous said...

you say i want to "end health insurance" and then have "catastrophic insurance for really expensive things, like heart surgery and whatnot" - so which one is it? the latter is... health insurance. these are mutually exclusive, and i never argued for the former. please do your best to not misrepresent my views. perhaps you could get a job at fox news though.

i do not think there HAS to be a separation of health insurance from employer as a perk, however i think the field should be free of government intervention and equal. health insurance from an employer is tax deductable, from an individual it is not. regardless of which, this should be equal. because it is not, this is why health insurance moved away from the insured entity and to the employer. you insure your car. you insure your house. why is it such a wild idea that you should be the one insuring your body? this is how things used to be as well. here is a short article on the history of HMOs -

i would also like to point out a very good site -

this guy has a video on medical savings accounts (more individual control/responsibility) and i believe overall he is an advocate of UHC. however he is not without faith for a free market solution (as you appear to be) either. i think he does believe it would work, if we were able to keep the government's filthy hands out of it, but he is skeptical of that being possible today. i think he also advocates UHC but relies heavily on technology being able to save us from inefficiencies. i don't think he mentions anything about quality in the things i have seen. i actually think UHC would be fine, maybe even better, initially - but the inefficiencies will grow and continue to do so and the quality of technology implemented today will really not matter 20 years from now, when they are still using it. i think he places far too much faith in technology - which is my career.

free markets do rely on informed participants. and overall they will be the ones leading the prices to where it should be. you act like you going to the doctor's office is going to be paris hilton going to the forex market. why do you state that they are clueless? in the other thread, you draw an analogy between a financial advisor and an investor, and how the investor needs the advisor to allocate money appropriately. what about the investors that choose their own investments without a financial planner? you say that i need a medical expert to help me choose things... i agree, and wonder what i would call this person. oh yeah, how about... doctor? as far as setting prices, i would expect initial prices to be fairly reasonable and volatile. i do not expect it would take long for them to settle where they should fall.

how do insurance companies and the government know any better what healthcare should cost? everything in the current system is just charged to the max allowable. the government has no idea what a pill of tylenol or a hip replacement should costs. you say they both know how much something should cost - then why would the current system say a heart operation costs 150k while the government is going to come and say no, that's 10k? how would the government arrive at that 10k? can you tell me how you think the government would determine the cost of a hip replacement?

how will you decide what doctors to see?
how do you determine which dentist to go to now? what tv/car you buy? what house insurance company you use? you'd decide which doctors to see the same way. at least i would. you make it sound like you need the government to hold your d*ck while you piss.

for your different doctors for different services, sure why not? you go see one for his expertise at something. you drove to best buy for your tv and circuit city for your stereo. why not dr. bob for the physical and dr. jill for the x-rays? shoot the places i can remember going now (the last time i went and had a physical) had a couple people on staff and i just saw who was available anyway. does it really matter which one takes your x-ray? if it costs a little more somewhere it's up to you whether the trip is worth it.

for your scary daughter's brain bleeding scenario, sounds like something that health insurance would cover to me. if you just brought her in and needed some time/stitches that cost $100 at hospital A and only $80 at hospital B and you were at A, well suck it up chief. i don't think the system should be fundamentally changed so you could save 20 bucks. or because of whatever amount you have as your insurance deductable.

that's fine if you only go to doctor A no matter what. but he will attract people through competitive prices, and other people will switch doctors. so don't worry, he won't be able to charge you just whatever he feels like, because he's still going to be living within a competitive free market, and he's not above the laws of the market.

regarding the story about your kids, if you knew what was wrong maybe you could shop around for expertise. if not then go to your general care doctor. choose to go see an expert or not after their diagnosis. your doctor and that competing one will have a reasonable spread of the cost of treatment. some people will deem it wortwhile and others will not. i really don't think the disparity will be in the hundreds of dollars or whatever you are imagaining. you'd pay your charge or you'd pay the deductable for something that cost enough to go into insurance and be done with it. this is not a wild idea. nor is it a new one, it is how health care used to work. every little thing was not charged to insurance.

you have assigned blame for failures today to the free market. and then say the free market is not a viable option because of these failures. i state that reform and allowing it to be an actual free market would improve the situation, because the true blame does not fall on the market, it falls on the government. yet you use the same argument, and point out the same failures today. your blanket statement of free market failure implies that you think we actually have it today.

does the current free market lack availability of care to the poor? most certainly. but with reform more of the poor could afford it. with more affordable care people would have more money and charitable contributions would go up as well. for anyone that still needed access to care they could attain it through these charitable organizations, or through local government assistance and subsidies. where a dollar goes much further than a dollar at the federal level. and this does not introduce a fundamental change to the entire system, destroying the free market and taking another step closer to a welfare state.

your 3rd world countries example is silly. maybe i should start a list of 3rd world countries with socialized health care that i don't want to live in. since you brought it up in your 3rd world country paragraph, i'll again point out that the US spends the most per student on its public education. yet many 3rd world countries score better - because they have a freer market and competition.

"As for your suggestion that quality care would be replaced with quantity care under a single-payer system, I will repeat again: IF A DOCTOR PROVIDED GOOD SERVICE, HE WOULD HAVE MORE PATIENTS. IF A DOCTOR PROVIDED BAD SERVICE, HE WOULD HAVE FEWER PATIENTS."

let me explain this again. you are ignoring quality of care in the price here. you are simply claiming that more patients = more money. quantity. in a rationed system you can see examples all over the world of waiting times, so i have no idea why you think that would be any different here. a quality doctor is likely to spend more time per patient too. it won't matter if 5000 people want to see him if he can only see 15 a day. or if the "bad" doctor only has 1000 people looking for his time. the simple fact is more patients seen = more money. if bad doctor is rewarded for quantity not quality, and demands exceed his ability to provide service (very likely scenario) he is going to be rewarded for ushering people right through. i'm not saying he'd be truly such a bastard to treat these people as cattle, but the drive for the reward would still be one that was driving for, at minimum, less time per patient, and the possible sacrifice of quality of care.

it is pretty funny how you think you have free choice in your system, when i have 1 choice for a health insurer, 1 choice for prices, and under edwards apparently, 1 choice for frequency of visits. you can paint it any color, so long as it's black! hope the waiting line isn't too long for that last remaining choice you are allowing yourself to have in this system.

your dr. walmart as free market example is weak. under the system i stated above you are already encouraging the wal-mart mentality you have the same thing. only in the free market you can still reward for excellency, whereas that component is lacking or minimal under you government fixed plan. yes under the free market the people with more money will get better treatment. and know what? under hr676 they would too. look at canada. don't want to wait in line? come to america. need an expert in this? come to america. don't want to wait in line, don't want to travel? go to private care in canada. we would still have private care in the US. and private insurance. and if it was more profitable, it would probably have the better doctors too - so there's another hit to the quality of your care. if i was in this system, i'd just have the added bonus of the government taking my income and distributing it as they saw fit for the betterment of public health care (which defines socialism). i thought america was founded on freedom, capitalism, and personal responsibility. you are never, ever, ever going to be able to get rid of "wealth based rationing" as you put it. especially in america. also note that in all of these other places that you mention - quality in america is the same or better. america does not have a quality problem, it has an availability problem. so don't tell me that moving to one of their systems is unlikely to have any effect on quality.

cheaper care under my plan and under your plan are quite different. mine is putting prices where they should be. and yes demand will go up, but i am still spending my own money, frugally, as stated in your other post. you deny that people spend their own money more frugally than other people's, but i don't think it takes much common sense to see past this. cash bar vs. open bar at a wedding, done deal, you know which one is going to demand and cost more. as prices go lower especially artificially low and with no onus on personal fiscal responsibility the demand will approach infinte amounts. france used to provide 100% healthcare and the system was being raped. now i believe it is at 30/70 split. this is a basic economic concept that you keep denying.

it is really odd how you think of the government as 1 entity being a free market. while there would still be private insurance, i don't think they'd have power to do affect these basically fixed government prices. it is a massive monopoly at best if you can liken it to a free market. you know what i wouldn't mind, is a government insurance company. maybe i should be promoted to doctor anonymous for this thought. as many taxpayers as they want can contribute to government health insurance. the government can then enter the free market (lets still follow my suggestion and, you know, truly make it free) - now the government can provide health insurance. it can help the market set prices, and as one of the larger entities, have a lot of sway. it's also not run for profit, so in theory their price would be much lower. and we'll see private companies lower their prices as well. they could still profit through better service/operational costs. damn that is a good plan! i'm actually free to choose who i go with, it's still free market, and the government isn't even stealing any more of my work product. frick i must be a genius.

stop making up these straw men, i wouldn't deny an employer's ability to stop offering insurance, i'd merely level the playing ground for them. people already wait until they're very sick to go to the doctor, and they'd continue to do so. there are many factors in this aside from cost. i have no idea why you make this claim about the whole healthcare sector taking an economic downturn. in places where a free market system is allowed, the economy booms. look at america before big government. look at estonia for the past decade. why do you think quality would go down in a free market system, when it has proven to drive it up for many things outside of health care? and socialism for things has proven to drive it down? what makes health care so different than education? or geez, products or anything? innovation, competition, quality all flourish under the free market there, what makes you think health care is a magical exception??

"And if we had a voluntary government-run healthcare program that you were forced to pay for, wouldn’t you prefer that the participants had preventative treatments, rather than waiting until it got expensive? Wouldn’t you rather pay for a physical and heart medicine than a triple by-pass surgery?"

in america, i shouldn't be forced to pay for. but let's go through this system. you are absolutely right! i want to catch things earlier and keep those people healthy. so i would prefer that they had preventative treatments! i don't want them to wait until it gets expensive. so mandatory 6 month check-ups sound good. actually let's make it every 3 months, that will be really good. i also no longer want to allow these people to smoke, smoking is like, way bad. also these people should be made to run 2 miles every other day. they are not allowed to eat greater than 60 grams a day or go to mcdonald's more often than once a day either. how does that sound to you? does that sound like freedom in america? or are those ridiculous ideas? because they are following your logic. if you don't want to follow them this far then you are going to have to abandon those principles at some point. hmm who decides where? you might want to smoke, but i think smoking produces no good at all and should just be banned from the country. who gets to decide that point though?

well obviously the government, but as to who *should* decide there is no answer. it's a stupid idea, better health through tyranny. it's like the patriot act and military commissions act, homeland security, etc etc. going on now - increased saftey through limited freedoms. maybe some day we'll be super safe, just have no freedoms. like one big prison, fun!

"As I've said repeatedly, there are countries where people are forced to pay for their own healthcare and education and retirement; and it usually means that they won't get any of these things."

yet you support social security, which i am being faced to pay into, and i will see little if any benefit at all. i would much rather try the truly free market solution and subsidize care at the lowest levels, than to force a service that is gauranteed to all and additionally gauranteed (or, for your sake, heavily likely) to become inefficient, fix incorrect prices, and lower quality.

Doctor Anonymous said...

mumph, i see more bullshit from biobrain, arguing against things i haven't said. or just plain wrong, like the efficiecies of large businesses. my job is basically going to large organizations and making them more efficient. i see businesses processes, technology, people, everything at these large organizations. and the only reason they are taking on half the projects is to compete with other large organizations. to me it is common sense for a business person, but who has the expertise in this argument alone? me or bio, who works for small businesses and works from home? yet he cannot even concede to that point. and government is the largest and least efficient business of all.

read this, one of the billion examples.

you guys imagine a large non-competitive organization starting and even more crazily, staying efficient. that is utter fantasy.

Doctor Biobrain said...

Doctor Anonymous – I went ahead and posted my response to your comment as a new post:
Again with the Healthcare

But I wanted to respond here to what you wrote to Mumphrey on how you were pitting your IT experience against my accounting experience. On top of my BBA in Accounting and training as a CPA, I’ve worked for the federal government, a city government, a private university, and all kinds of for-profit companies, from a booming software company with more employees than it knew what to do with to a small bookkeeping firm that only had three employees.

And then I decided to use my CPA license to work for myself out of my home to avoid unnecessary overhead, by helping small businesses with their bookkeeping needs. And for that, I get insulted by a dude that sets up computers and imagines that he knows how to run the company. Great.

Look, I never suggested that my experience makes me an expert in business management, though many of my clients treat me as such. And I've certainly never suggested that large businesses have no disadvantage. But for you to pretend as if the disadvatnages outweigh the advantages is simply dishonest.

Perhaps the disdain for your customers is warranted, but at least these people can afford you and afford better systems. Most of the small businesses I see use out-dated equipment and many of them can't even afford a regular bookkeeper. Even the ones with decent profits still prefer to squeeze every last ounce out of dying equipment. That's how they have profits. I have one client who's changing offices and their bookkeeper had to call me from the owner's cellphone all week because the regular phones are still at the old office. And they're fairly prosperous, for a small business.

Sure, Exxon requires a large army of accountants to keep track of their accounting, but at least it's being tracked. Many small businesses can't even do that. Trust me. I've had to go through their "books" to clean it up afterwards. These people could be totally ripped-off and they'd never know. While I understand why you're pretending things are otherwise, you're fooling no one and only hurting your integrity. Again, I understand that size has disadvantages, but nobody would do it if it didn't payoff.

Doctor Anonymous said...

bio, i have no idea how you came come to such ridiculous conclusions. it is literally taught as business fact in school that a larger an organization gets, the less efficient it is. i question your definition of efficieny as you likened it to "success" earlier, and they are simply not the same thing.

my parents are both accountants, my father is partner in a firm he started. they both agree with me completely. it is not just my IT experience as you claim, as that would just be how they did IT tasks. as previously stated i have also seen many a business process, and many an employee. this is not even an arguable point. i'm sure any reader you have with half a clue in business agrees with me.

don't call me dishonest when you don't even answer the question i posed and tried to answer myself. what advantage do you think your large price fixing government organization will have? i think you believe the fallacy that a larger organization always gets the best prices. of course, that doesn't matter if you fix the prices anyway. so now what is your advantage of this large no compete organization? bureaucracy? please, AGAIN, what advantages are there???

Doctor Biobrain said...

Doctor Anon - There is no point in me explaining anything because you just won't listen to it. You have ignored everything I've written on the problems that small businesses face. You pretend as if large businesses always fail to small businesses and refuse to concede that there are any advantages to large organizations. So I'm not even going to attempt to write a lengthy explanation for how this system would work, simply to have you ignore it as you do everything else I write. Besides, it would rely on you understanding how our current system works, yet it's quite obvious that you have no idea.

You are clearly acting in bad faith. You ignore my points all the time while insisting that I respond to every one of your points, including the ones I've already responded to. You're not looking for an honest debate. You're just screwing around while imagining that you're actually engaged in debate. But believe it or not, there's more to debating that just repeating yourself. You're actually expected to listen to the other side and to back-up your arguments. Instead, you just keep tossing out new ones without having explained anything.

As Mumph said, you throw handfuls of absurd claims and expect me to refute every one of them. And you're just so sure that I can't have a good response that you imagine I must not have given one. And you're so sure that my plan can't work that you won't even try to understand it. So there's really no point at all for me to explain it. You're not looking for me to give you a working health plan. You just want something more to attack. And I see no point in that.

Mumphrey Bibblesnæð said...

I have to answer the things Doctor Anonymous brough up about third world countries. Unlike Doctor Biobrain (I assume) and Doctor Anonymous (I also assume), I have lived in a third world country. I lived in Honduras for 2 years and go back almost every year. Now I know not all third world countries are alike, and I'm making generalizations here, but I've been to Niucaragua and Guatemala as well (also El Salvador, but that was only for 3 days, so I don't think I saw enough to make any intelligent claims), so I'm going to blather on a little, which is, after all, my speciality. (I also understand that I'm making assumptions about both of you; if you've spent any significant time in 3rd world countries, then by all means set me straight.)
All right, Honduras has very little in the way of socialized medicine. Actually, as far as I know, it has none. Well, guess what? It's not all that easy for people to get medical help. For the rich, they have no trouble. They go to the good doctors in Tegucigalpa or San Pedro Sula, or, if it's something really bad, they go to the hospital in Miami. For the poor, well, they muddle by as well as they can, and hope nothing too bad happens to them. If it does, they're pretty much out of luck. The one good thing most Hondurans have going for them, even the poorer ones, at least in the smaller towns, is that the way they live their lives is in many ways much healthier than how we live ours in the U.S. They get much more fresh air, time outside, and exercise, and they eat a lot more fresh fruit and vegetables, which comes from nearby. On the other hand, they are far more at risk for having some kind of catastrophic accidents, as health and safety regulations in Honduras are mostly nonexistent or not enforced.
All in all, I'll take our inefficient "socialist" system here, where at least I (I'm lucky enough to have insurance) can get good heath care if I need it. In all truth, I could get fairly good help down there when I needed it (which I did from time to time), but I neverhad anything worse than a bad intestinal infection a few times and a truly incapacitating urinary tract infection once (a word of advice: if you're a guy, stay away from U.T.I.s. They can be excruciating for us). Also, I was an American, and I could call my parents to send a little extra money my way when I needed it, so I could afford the doctor, who wasn't too pricy by U.S. standards, but was out of reach for many Hondurans, many of whom inthe countryside and outskirts of the smaller town (mine was 5-10,000), live altogther outside a money economy, living by subsistence. Actually, my doctor would take payment in kind from poorer patients, and would sometimes forgo payment altogether if they really couldn't pay, but that isn't usual.
Anyway, the Honduran health care system is rather incredibly efficient, at least from a selfish libertarian way of looking at it: if you can't pay, you don't get help; if you can, you do. Pretty efficient, I guess, but not too great for a lot of Hondurans, who are, after all, and it seems a lot of libertariansforget this point, people, too, just like me or even any rich libertarian.
As for schools: Honduras has public schools, but you know what? the government lacks the money to run enough schools for all children. Great, huh? There are private schools in all bigtowns and many smaller (3-10,000) towns, but not enough: far too many Honduran children never get to go to school at all.
All in all, Honduras seems likeit would be, in many ways, a libertarian's dream: the government has too little money to provide many services, many of which more civic minded folks among us would think of as essential services. Well, here's a surprise! This libertarian wet dream is no great bargain. I'd much rather my society have some way to get ALL essential services to everybody who needs them. I don't have any big problem with the government doing it; the government's job is to serve its society, after all. I don't mind paying taxes for it, either. I don't feel ill used when my tax money goes to subsidize some services for people who otherwise couldn't afford them. That's what we have to do in civilized society. That's what civilization is. I know I've been lucky. There but for the grace of God go I, I try to remind myself when I see somebody barely scraping by, or not getting by at all. I haven't earned much of the good life that I've been lucky enough to live: I had good parents, both of whom went to college, and both of whose parents also went to college, and who were reasonably well offmy father had a good job. I never chose my parents, or their backgrounds; that was all luck. Neither did I get to choose where to grow up, a town with truly outstanding public schools. I never got to choose that my father was on the faculty of a good college, which gave me a scholarship when I went to college.
I've been lucky; I don't mind giving something up so others less lucky than I have been might have a shot at bettering their lots. I truly can't understand why so many libertarians are so greedy and selfish that the begrudge so badly the little help the needy get in this country from their taxes (and mine and everybody else's).

Doctor Biobrain said...

Been to Honduras?! I've never been out of the country for the night. I wouldn't be able to find Honduras on a map of Honduras. The most I've done were two daytrips to Mexican bordertowns. As far as I know, the only purpose of foreign lands is to get trashed. Too bad Bush seems to have the same impression, except he’s the one doing the trashing.

Thanks for the input. It's as if libertarians don't even acknowledge that third-world countries exist. These guys think a third-world country is any place that doesn’t accept American Express. Even his reference to third-world countries having better education was surely a mistake. He's comparing us with industrialized nations, not third-world nations; but I guess these guys only have two categories: America and Not America.

And whenever I suggest that there are places that have freer markets than us and that no one wants to live there, he keeps thinking I'm talking about America. I don't understand. Perhaps when he's complaining about our poor education system he's speaking from firsthand experience. I guess I'd be bitter too, if I were him.

Doctor Anonymous said...

bio, you aren't going to give me one because you probably have the same problem as me. i'm honestly trying to think of a true advantage for this case, and i cannot. you pretend to have so many, yet respond with a paragraph to my request for one yet list zero. of course big companies have some advantages over small companies. i never said they didn't. but i did say they were less efficient, which is absolutely true. i'd love for you to find me some expert opinions stating that big companies were more efficient, and that government was efficient. how sad is it that you believe something that common sense states is untrue?

"You pretend as if large businesses always fail to small businesses and refuse to concede that there are any advantages to large organizations."

no liar, i never said that "large businesses always fail" and no liar, i did not refuse to concede that there are any advantages to large organizations. your biobrain may be decent for cpa math but i am unimpressed at its reading comprehension abilities. i stated in this case there are no advantages, please give me some, i can't think of any, and you repeatedly rant, lie (as above) and ignore the request.

i don't ignore your points, i walk through your comments paragraph by paragraph and respond to as many that actually make sense. then also correct your mispresentations or lies about me. i'm sorry if you think something like the above is an absurd claim while being common sense in the business world.

obviously me posting against you and you posting against me is a waste of time. you are too dense to see the vast drawbacks of this system, in a time in which the countries you admire are ever more embracing free market solutions. and i don't fall for your clueless assumptions about business or economics. so there we have it. i hope to never have it proven in this country, but if we do go to socialized care, i will be quite annoyed at the bite into my pocketbook but take some slight pleasure knowing that you will get to watch the system fail in quality and unforseen costs year over year.

Doctor Anonymous said...

mumph, i am not an economist but do think your argument is more of a capitalism vs. socialism than something regarding just health care. i have no idea about honduras, if the rich are just completely exploiting the poor, or if there is simply nothing available to spur economic growth. if you want to look at capitalism vs. socialism in a country that does have economic value then you need to merely examine communist russia vs. russia today. estonia itself had much of it's policies set after the president read milton friedman's "free to choose" and simply assumed this was how western cultures were run. since these policies were enacted estonia has had some of the most amazing economic growth of the decade. i do not know what their health care system is like there. i do know i would prefer to live in a country founded on capitalism rather than socialism.

as far as curing the ills of honduras, i do not know anything about the country or its history. i assume there are proposals on how to improve things and i doubt they would be more of the same, as it appears to be a welfare state. i think the implication here is 'socialism is needed because so many are poor' - perhaps arguable is 'so many are poor because of socialism'.

i'm out to dinner and off this thread forever. bye.

Mumphrey Bibblesnæð said...

Can't say I'm too sorry to see him go...