Comments Elsewhere

Bjartmarr: Finally, we need medical tort reform. Asking juries to determine whether a doctor was negligent just doesn’t seem to be working out very well, as awards are fairly unpredictable. My friend proposes that patients with grievances instead take them up with a medical grievance board made up of physicians. These doctors would decide if the doctor who performed the procedure was indeed negligent, and would award damages out of a state-supplied fund. Doctors would not pay damages for their own negligence (eliminating the need for medical insurance), but a doctor who erred too egregiously would have his license revoked.

Oh, great.

I’ll bet this would work out just about as well as it does in cities where people have to take their complaints of police misconduct to a “community relations board” which is itself packed with police representatives, and where the costs of civil rights settlements are taken from taxpayers rather than from the offending cops.

If your goal is to get a group of professionals to deal with people in a responsible, accountable way, then it strikes me as foolish to put the sole power to rule on grievance claims into the hands of those who have a professional interest in dismissing or minimizing complaints against themselves and their colleagues.

For deciding these kind of claims, a plain old jury trial is just about the worst system possible, except for all the others.

Myca: If you oppose universal health care and you do not explain clearly by what mechanism you will give medical care to poor people, you will be banned.

Well, I will give medical care to poor people (other than myself) by continuing to do what I already do. I scrape by on about US $13,000 a year and I give about 1/3 of that to groups that provide direct economic and medical aid to other poor people (Direct Relief, abortion funds, Planned Parenthood, battered women’s shelters, rape crisis counselors, etc.). I’m able to give that much partly because I don’t have any children to care for and partly because I have wealthier family members that I know I could ask for help in an emergency. But even without those advantages, I’d be able to give this kind of money more comfortably if it weren’t for the government’s constant draining of my resources through taxes to pay for red tape, corporate welfare and armed thugs. In any case I do think that I, at least, am doing something more to own my beliefs than just waving my hands around. As for explanation and defense:

Myca: I’ve heard over and over again that our current system is not a free market, and that’s cool, but then it’s incumbent on the person claiming that a free market would provide healthcare to those without money to show precisely how that would happen, because I don’t see it.

OK, but that’s not what’s been argued so far. What keeps happening is a comparison between something horrible that happens, or almost happened, under the U.S. state-corporatist system, and what would happen under some other state-socialist system of healthcare. But comparing the characteristics of one tightly-controlled government-regimented system of healthcare to those of another tightly-controlled government-regimented system of healthcare illuminates very little about how a free market would work, because neither of the options under comparison has very much to do with free markets. If you want to argue that state-socialism is better than state-corporatism, fine, but you should leave the free market out of it. If you want to argue that a free market in healthcare would still have features that make it worse than state-socialist healthcare, that’s fine too, but it requires some further argument that hasn’t yet been given in any detail.

As for the beginnings of an argument that you give in this comment:

Myca: Roughly, because the free market has no mechanism in place to provide health care to people who are unable to pay for it.

I’m not convinced. Because, well, of course it does. The “mechanism” is the same mechanism that exists in state-corporatist or state-socialist healthcare systems: people who are unable to pay for healthcare themselves can get it by getting other people to pay for part of it or all of it. The question is what means of getting other people to pay for it are available–and whether these means are voluntary or coercive.

Any State-run system of medical care that you happen to like could, in principle, be provided by voluntary mutual aid on a free market. The State has no special ability to make medical care “free,” or to summon up money from nowhere to pay for it; for the State to cover the medical costs it has to get money, labor, or supplies from somebody else, and whatever the State takes could be given voluntarily. Suppose that you like the way that money is collected and distributed in the French medical system; then on a free market, nobody is going to stop you from creating a nonprofit French Mutual Society for Medicine that uses the same bureaucratic mechanisms to collect, allocate, and pay out money. The only limitation is that, whatever system you cook up, you cannot force people to pay in, and you can’t force people to use your system for their own healthcare costs.

You might claim that unless everybody is forced to pay in, there wouldn’t be enough money to go around. But consider the billions of dollars that are voluntarily pissed away every two years trying to elect a slightly more “progressive” gang of weak-kneed establishment politicians, and what might happen if those resources were redirected towards direct action rather than electioneering and lobbying. Let alone the amount of money that might go to healing people rather than killing them if individual people, rather than belligerent governments, had control over the dollars currently seized in taxes.

You might instead claim that even if there is enough money to go around, this kind of model puts poor people at the mercy of donors for their healthcare. But I could just as easily respond that using the State to cover healthcare costs puts poor people’s at the mercy of the political process, which certainly offers no guarantees that the least powerful and least connected people in a society are going to get what they need, or even get decent human respect. In either case, people who aren’t very powerful need to organize and struggle to protect their interests from people who are more powerful than they are. The question, again, is what means of struggle are (1) morally preferable, and (2) strategically effective.

I don’t think it’s crazy to see voluntary, bottom-up mutual aid as both morally and strategically preferable to top-down political regimentation. Voluntary mutual aid may not actually produce a healthcare system that looks much like the nationalized healthcare systems common in western social democracies, but I think that the differences would largely be for the better: less bureaucracy, more alternatives, and more control in the hands of the patients themselves. Unlike the corporatist system in place today, medical costs would be drastically lower, thanks to the removal of the government-created monopolies and cartels that currently control every aspect of the insurance, medical, and pharmaceutical industries. And unlike the corporatist system in place today, medical costs might be covered not only by charities or churches or bosses (gag), but also through grassroots associations such as mutual aid societies and labor unions. (There is some actual history here; lodge practice medical arrangements in the U.S., U.K., and Australia used to provide healthcare to working-class folks at a rate of about one day’s wages for one year of healthcare, before the growing trend was halted and obliterated by the politically-connected medical establishment, with the backing of the State.)

Hope this helps.

r@d@r: … high drug costs can be attributed to the cost of advertising.

High drug costs can be attributed to many things. But among the most important factors are certainly the government-created, government-enforced patent monopolies on new drugs. When the government forcibly suppresses market competition from generics, this unsurprisingly tends to create monopoly pricing.

Myca: … our current system is abso-fucking lutely sadistic and nonsensical.

This is certainly true. But what has it got to do with “how the free market works”?

There is no free market for healthcare in the United States. The systems whose merits are being compared and debated are two different styles for government regimentation of the practice of medicine, one of them state-socialist and the other state-corporatist. In the former, the State directly controls payment and administration in every aspect of healthcare. In the latter, select cartels, heavily privileged, heavily regulated, and heavily insulated from competition, controls much or all of the work of payment and administration.

Maybe something more like the former system is better for many people than something more like the latter system. But there are specific historical reasons why, for example, and why most people depend on their bosses for health insurance. But these reasons have a lot to do with specific government actions (wage controls during World War II, for example, and ongoing tax incentives for employer-provided health insurance plans) and not much to do with market dynamics. Whether State-regimented healthcare is better on a corporatist model or better on a socialist model, none of it says much about the virtues or vices of a free market in healthcare, since that is not yet one of the options that has been brought up for consideration.