Bioethics, healthcare policy, and related issues.
Among the many distortions and intellectual dishonesties that plague right-wing pontificating about healthcare ethics and policy is the constant pointing to (often hypothetical) drawbacks of policies they oppose as proof that those policies are unworkable or immoral, while exactly the same problem exists with the policies they do approve. In particular, opposition to universal healthcare often takes the form of nit-picking any possible barrier or difficulty that such programs would encounter without the slightest acknowledgment that the market-rationed for-profit system the US now has simply ignores its own gross deficiencies as if they didn’t exist – as if simply leaving people out of the system is not a problem, while having trouble treating everybody within a larger system is a fatal flaw.
The most egregious example of such falsehoods is the claim that universal healthcare will be “rationed” (meaning that no such system will pay for every imaginable treatment); for market fetishists, denying care outright to tens of millions of people is not rationing, and forcing hundreds of millions into overpriced insurance plans that ban entire categories of patients from enrollment, prohibit vast swaths of basic treatments, and then deny reimbursement for treatments they have actually contracted to cover is also not rationing, but creating a system that serves vastly larger numbers of patients more completely is rationing. But that’s just one well-worn delusion. They are nothing if not creative in coming up with new ones.
Today’s meme is that old bugaboo, the “doctor shortage“. (Some of us can remember times – more than one – when it was a “doctor glut“, and the right-wing economists who feared that, as well.) The right wing is just beside itself with worry that, under a scheme of universal healthcare, there simply won’t be enough doctors to go around. (Leading, of course, to . . . healthcare rationing!) Instapundit is convinced the problem is we don’t pay them enough. David Bernstein at Volokh thinks we should educate them less, so they’d have less school debt. Dr. Helen is convinced that the administrative hassles of healthcare are “going to get a whole lot worse with more government intervention” – apparently she believes that reducing the 30% overhead of for-profit insurance company administration would be offset by providing more and better healthcare to hundreds of millions of people, and figures that’s a bad thing. (It goes without saying that none of them thinks we should just subsidize doctors’ education and let them pay it back with service, so as to attract more people who actually care about practicing medicine and aren’t in it for the highest dollar. As Instapundit would say, “Naah, that wouldn’t make sense!”)
But, aside from the complete inability of of market worshippers to care or consider whether not rationing healthcare by profit margin would in any way improve the ability of people to actually get healthcare, there is in this case the gross hypocrisy of simply ignoring the entire question how this issue plays out in the market-rationed system these people all favor. (Remember that the problems the market doesn’t care about are not problems for the market; they’re only problems for systems that actually care about people’s needs, and thus are uniquely guilty for failing to solve problems that marketeers just don’t bother with in the first place.)
How is it the near-term supply of doctors is insufficient for a national healthcare system, but not insufficient for the market-rationed system we currently have? We’re talking about essentially the same number of doctors and the same number of potential patients – so if there aren’t enough doctors to go around under a system in which everybody has equal access to care, why is that not a problem now? Why haven’t the right-wingers who are so very, very (sincerely, no doubt) concerned that not everybody will be able to see a doctor immediately, when they actually have a right to do so, not concerned that not everybody can see a doctor at all, now, when they simply can’t afford to?
The answer, of course, is that they don’t care in the slightest whether or not people get the healthcare they need (especially those who have proven themselves unworthy by being unable to afford it). And they don’t really care whether there are enough doctors to staff a universal-access system, except to the extent that a potential shortage can be used as an argument against initiating such a system. If the actual impact of a supply/demand imbalance – the fact that some people can’t get access to a healthcare provider – mattered to them as a problem in itself, it would matter much more now, where some people have no access at all and most people are trapped in the hugely oppressive and constraining for-profit health insurance morass, than it would within some hypothetical future system which provides access to everybody, possibly with longer waiting times. But, again, the complete refusal of the market-rationed system to even attempt to do anything about the most helpless and desperate people trapped under it is of no consequence whatsoever, because if you’re ideologically wedded to profit-maximization for healthcare providers, you’re ideologically indifferent to actual healthcare for patients as a goal in its own right. But the idea of the great unwashed flooding your for-profit system and taking up the time and attention of the doctors you paid for, dammit, is both a real inconvenience (to you) and a moral offense (to the principle of purchased entitlement in a market environment).
2 Responses to “Luckily, For-Profit Healthcare is Perfect . . .”
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May 6th, 2009 at 7:09 PM
Because the free-market system lets doctors work in the specialities they want and to charge what they need to and politically-managed system wants to dictate what specialities doctors can go into and how much they get paid.
You can’t force people to go into medicine and you can’t force them stay in it. (Well, you could but I assume you don’t want to go that far.) Doctors can retire and people can decide not to go into medicine. They can decide to see fewer patients. Politically managed health care relies on price controls and price controls create shortages. Always, no exceptions. When the politicians decide to control the price of doctors they will create a shortage of doctors.
There is already shortages of doctors who take medicare because of the low pay, the paperwork and the threat of fines and imprisonment. There is every reason to suspect that the problem will get worse if we expand the medicare system even farther.
Gosh we’re evil. Honestly, I don’t know how I get to sleep at night. Oh, right, I lull myself to sleep by imagining all the people I’ve killed by denying them medical care.
Of course, I could try to justify myself my explaining that I have a complex understanding of the long term role that freedom, flexibility and innovation play in saving lives but even though you don’t understand my arguments that would be okay because you know I’m really just an evil person. I could try to point out that there isn’t any significant difference in health outcomes between Americans quasi-free system and more politically managed systems but again you know that would be just a rationalization because in the end I’m just hate people and want them to die.
I suppose the best I can hope for is to someday be as good and great person as you. Maybe then I stop worrying about all the complexity in life and just trust big brother to take care of it all.
Seriously, you’re a shining example.
May 15th, 2009 at 4:06 PM
Because the free-market system lets doctors work in the specialities they want and to charge what they need to and politically-managed system wants to dictate what specialities doctors can go into and how much they get paid. You can’t force people to go into medicine and you can’t force them stay in it.
You don’t seem to have any idea what the question even is.
The objection to a national health plan (in this case) is that there aren’t enough doctors to treat everybody, if everybody has access to a doctor. But the number of doctors available under such a system (in the near term) is the same as the number we have now – for the next 5 or 10 years they’ll be the same doctors. If there won’t be enough then, there aren’t enough now – but nobody offering that as an objection to a national system seems to think that’s an objection to our current system. The reason is that demand for doctors’ services is manageable now because many people simply never get to see one. But the complainers don’t care. They see more widespread access to healthcare as a bad thing because it may increase their personal waiting times – the fact that other people have no access at all now doesn’t matter to them because that only affects those other people. Which is because they’re evil mothers.
As to your claims about how the system operations, they’re nonsense. No one has ever seriously proposed a system of nationalization of medical education and healthcare institutions in the US, or that doctors would become government employees. Every seriously proposed plan, including the relatively unambitious Obama plan, consists entirely of piggy-backing on the existing private healthcare system and providing some sort of nationalized reimbursement system, with greater or lesser degrees of subsidies. (It’s basically a vast boondoggle for the insurance industry, but it’s the best we’re likely to get.) The supply of doctors is, and will continue to be, controlled by doctors themselves, managed for their own benefit, not that of patients.
As to whether doctors will choose to accept reimbursement under a government-sponsored plan, as always, they are free to make that decision for themselves, and patients will be free to go outside the plan to pay even more for the care they already can’t afford, if they want to. It’s entirely up to the doctors how much they want to charge, and how much paperwork they want to do. The fact that most patients can’t or won’t pay them everything they want to do as little as they choose, and that therefore most doctors will have to work inside an affordable system, is hardly the system’s fault – it’s the free market in action!
As to the motivations of the people opposing universal access, free-market slogans can be discounted as a matter of course. There are no real free marketers, except for all those rich businesspeople and rugged individualists who had the moral backbone to actually follow through on their threats to “go Galt” when Obama was elected (oh, wait . . . none of them did . . .). When the free marketers stop taking no-bid government contracts, using subsidized rail and roadways to ship their products, stop paying politicians to open markets for them by military force, stop clamoring for constant subsidies and tax breaks and tariffs and giveaways of every kind, pay market rates to graze their cattle on public land, pay market rates for their irrigation water, refuse government price subsidies for their corn and butter and wheat and everything else, and pay full income tax on their capital gains, stop constantly running their own businesses into the ground and demanding taxpayer bailouts to pay themselves for their own incompetence, I’ll at least consider paying attention to what they say about “the market”. (Of course, they’ll all be bankrupt and on the dole at that point, so, luckily, we’ll be hearing a lot less of it.)
Instead, I choose to focus on the fact that opposition to universal healthcare access invariably takes the form exclusively of letting a lot of people suffer and die so the better-off can maintain their privileges. That tells me everything that matters about the people favoring such a plan.
And, finally, further on the question of free-market self-delusion, do note that what you think you know about freedom, complexity, and whatnot is, in fact, a crock – in the sense of being entirely at odds with reality. There are vast disparities between US health statistics and those of other industrialized nations, the most important being that in the US the range of outcomes in most categories is much broader – the worst off are much worse off than elsewhere, because here, unlike every other similar country, our worst off are left out of the system entirely. As to the upper end of the range, the US is competitive in some categories, worse in others. But it leads the world in being the only country that can afford to treat people who need it and chooses to let them die – and is content to put that decision in the hands of the people who are not at need, and whose greatest complaint about the matter is, by their own description, that not killing as many people through neglect will be inconvient for those who now benefit from that.