Guessing game

[The Terrible Sweal]

... you assume that if Michael Jackson did not use the equipment, it would be available to save a life.  It ain't necessarily so.

Health care is a private good.  We cannot simultaneously see the same doctor.

A little contradiction there, perhaps?

Anyway, why do you conclude health care is a private good? Do suggest it has no connection to public health?

If you consider health care a scarce resource, you face the question: is it OK to our society that wealth should decide who lives comfortably and who dies in agony?

If we worried a little bit less about the injustices of health care reforms and worried a little bit more about not wasting resources, we may well be surprised to find that our health care system will be more equitable.

Evasion.

[kimmy]

"Fair", eh?  Now there is a loaded word.  Is it fair that Michael Jackson can pay to have his face ruined with equipment that could be saving a life?

Why should that line of argument only apply to healthcare? If you feel that it's applicable to healthcare, why should it be any less applicable to other fields of enterprise?

Is it fair that someone can by a $60,000 vehicle, when that sum of money could provide food and housing for many homeless people?

Is it fair that General Moters can manufacture these vehicles when those manufacturing facilities could be used to construct agricultural equipment that could save lives in less developed countries?

Is it fair that I Miss Trudeau is working at a Starbucks, when he could be using his effort to help the poor?

Ultimately, yes: our society places a value on giving people the freedom to choose their own path, even if their choices run contrary to "the greater good".

If you ask the cosmetic surgeon whether it's fair that he should be able to mangle Michael Jackson's grill instead of saving lives, I think he'd probably tell you that he improves peoples' quality of life. Turning a black man into a caucasian woman is not a typical example of what he would do. Burn victims and breast cancer survivors are probably grateful that some surgeons focus on cosmetic surgery rather than life-saving procedures. People who've suffered disfigurement through accident or violence. People born with hare lips or cleft palettes. People born with deformities that limit their social opportunities. These are clear-cut examples of why we have cosmetic surgeons. There are obviously more ambiguous cases. There are people who have no specific deformity, yet are so far from what our society considers attractive that their social opportunities suffer... so is it easier to rebuild society, or rebuild someone's face? If a woman is so upset about the size of her breasts that it has damaged her self-esteem, is there anything actually *wrong* with her getting implants? Who is to say it doesn't improve the quality of her life?

But instead of looking at the clear-cut cases, or even the grey areas, you reach straight for the absurd in Michael Jackson's halloweenish visage. (was the jaguar lady busy?) Overall, I suspect that cosmetic surgeons do a great deal of good, and I don't see that prohibiting them from doing discretionary surgeries is going to save any lives anyway.

-k

[The Terrible Sweal]

"Fair", eh?   Now there is a loaded word.  Is it fair that Michael Jackson can pay to have his face ruined with equipment that could be saving a life?

Why should that line of argument only apply to healthcare?

Maybe not ONLY health care, but (from a 'justice' perspective) health care because sickness and injury are not generally the reward of merit or demerit, but merely the afflictions of chance. Humans club together against the afflictions of chance (i.e. Nature) in order that we can compete on the fields of actual merit. By doing so we create (have created?) the conditions for a virtuous circle of prosperity.

Is it fair that someone can by a $60,000 vehicle, when that sum of money could provide food and housing for many homeless people?

With the caveat that I don't think this question is very telling on the question above, I answer this one with a 'depends'. It depends on whether the someone holds that buying power based on merit or not.

Is it fair that General Moters can manufacture these vehicles when those manufacturing facilities could be used to construct agricultural equipment that could save lives in less developed countries?

The answer to that question depends on where you choose to draw your circles of obligation.

Is it fair that I Miss Trudeau is working at a Starbucks, when he could be using his effort to help the poor?

Hmmm. Sort of a multiprong question there. Without any knowledge of IMT's activities, it boils down to this: Do I think the world economy is 'fair'? No. Do I think the Canadian economy is 'fair'? No.

... But instead of looking at the clear-cut cases, or even the grey areas, you reach straight for the absurd in Michael Jackson's halloweenish visage. (was the jaguar lady busy?) Overall, I suspect that cosmetic surgeons do a great deal of good, and I don't see that prohibiting them from doing discretionary surgeries is going to save any lives anyway.

Rather a long winded straw-man there. I don't recall ever suggesting remedial plastic surgery was not worthwhile. Sorry if you find my imagery too vivid.

[kimmy]

If you consider 'health care' to be an insurance system, the least expensive way to provide that would be that coverage be universal as this lowers administrative redundancy and shares risk widest.

But obviously healthcare is more than just an insurance system. The healthcare system is also a production facility (in a sense) that requires massive capital to build and maintain.

If you consider health care a scarce resource, you face the question: is it OK to our society that wealth should decide who lives comfortably and who dies in agony?

Isn't reducing the scarcity of the resource the most logical answer to the problem? People who support increased private participation in the health system believe that it will spur investment in the facilities and personnel that we need.

Suppose-- hypothetically-- that I've won the Super-7 and I've got 12 million dollars sitting around burning a hole in my pocket. (let's hold that thought just a while longer. ) I hear on the news one night that the wait-list for MRI scanning is ridiculously long, and putting peoples' lives at risk. A bright idea strikes me.

I phone up Siemens and ask them to send me one of their shiny new MRI machines, I lease a little building just out of town. I incorporate Kimmy Imaging Inc, offer stock options to lure some experienced techs from the US, and we're in business.

So, how have I affected the greater good? Well, I've just increased the infrastructure of the healthcare system by several million dollars. I've added to the capacity of the system-- we can now perform more MRI images than we could before. Even if only 10% of the people on the waiting list for MRIs can afford my rates, the waiting list for MRI services gets shorter for everybody. I don't see how any of this hurts public healthcare.

If you consider health care to be a 'public good', economics tells us it will never be adequatley provided by the market alone.

Who said we're talking about the market alone?

-k

[kimmy]

Is it fair that someone can by a $60,000 vehicle, when that sum of money could provide food and housing for many homeless people?

With the caveat that I don't think this question is very telling on the question above, I answer this one with a 'depends'. It depends on whether the someone holds that buying power based on merit or not.

If someone has earned their $60,000 through only the most meritudinous of activities, they should be able to spend it on a ridiculous SUV... but not on surgery to save their own life?

-k

[The Terrible Sweal]

If someone has earned their $60,000 through only the most meritudinous of activities, they should be able to spend it on a ridiculous SUV... but not on surgery to save their own life?

Right.

[Argus]

Why do you find this horrible?

It may be hard for tories to grasp this, but many people think allowing someone to suffer or die simply because they don't have a lot of money is not fair or desireable.

Oh how noble you are. But uhm, it's okay to let them starve to death, right? Or freeze to death in their cheap little shacks?

Oh yes, yes, I know, we provide them with the bare bones basics. But we all know that their meals are nothing like the feasts of the rich, and their subsidised or welfare housing is crap compared to the rich man's mansions. Nobody seems to believe we should try and equalize things between the rich and the poor in what are the absolute basic neccesities of life. So why do you fixate on medical care and try to somehow suggest it is evil for the rich to enjoy better health care?

And just what do you imagine you can do about it?

There seem to be masses of people out there who are determined to stick to our present failing system, no matter what, out of some kind of bizarre sense of envy and resentment towards the rich -

Doesn't it seem about 100% more likely that they think that way out of a desire to ensure care for themselves and loved ones? Why must you impute 'envy' were sensible self-interest is a sufficient explanation?

No. I'm talking about the left wing political activists, such as those on this board, who fight frantically against the slightest introduction of private health care with the same, tired old bleating complaints about the rich buying better medical access (as if they didn't now!) and us changing to an "american style" system where the poor will "suffer and die because they don't have a lot of money".

Europeans have a mixed health system which does not have the long waits ours has, which provides excellent medical care for all. Yet no one ever bleats about us trying a "european style" health care system. I guess that just doesn't have the same fearmongering ring to it.

[August1991]

Many people would be surprised to learn that according to a recent study, the third-leading cause of death in Canada - behind cancer and heart disease - is medical mistakes.

Last year the Canadian Medical Association Journal published a University of Toronto study that examined data involving more than 3,700 patients at 20 hospitals in five provinces.

Among the findings, the study revealed that:

* As many as 23,750 patients die each year due to "adverse events" (defined by researchers as "unintended injuries or complications resulting in death or prolonged hospital stay that arise from health care management.")

* About one in every 13 patients admitted to acute- care hospitals in Canada during fiscal year 2000 experienced one or more adverse events.

* About 37 per cent of these errors were highly preventable.

London Free Press

One reason Canada spends less on health care than the US, measured by percentage of GDP, is that Canadian doctors don't face malpractice suits to the same degree as US doctors. IOW, US doctors must take more costly precautions to avoid errors.

If you consider health care a scarce resource, you face the question: is it OK to our society that wealth should decide who lives comfortably and who dies in agony?

If we worried a little bit less about the injustices of health care reforms and worried a little bit more about not wasting resources, we may well be surprised to find that our health care system will be more equitable.

Evasion.

This is not evasion at all. I mean that if we were more concerned with making the system work better and less obsessed with making it "fair", we may well find that there would be fewer "adverse events".

... you assume that if Michael Jackson did not use the equipment, it would be available to save a life.  It ain't necessarily so.

Health care is a private good.  We cannot simultaneously see the same doctor.

A little contradiction there, perhaps?

No, I don't think so.

We cannot both see the same doctor at the same time, but there's also the possibility that neither of us will see any doctor at all. Your comment about Michael Jackson assumes that if a doctor doesn't work for Jacko, she'll work for someone else. I'm saying that the real story is in finding out why doctors show up for work in the first place. You are thinking about "fairness". I am thinking about "efficiency".

[TS, your long discussion with Kimmy about the $60,000 SUV is ultimately about fairness.]

Anyway, why do you conclude health care is a private good? Do suggest it has no connection to public health?

Good point, TS. Communicable diseases make health care a private good with positive externalities. I think a leg cast is a purely private good though.

[The Terrible Sweal]

Oh how noble you are. But uhm, it's okay to let them starve to death, right? Or freeze to death in their cheap little shacks?

There is only one thing I can say to that: ??????

Nobody seems to believe we should try and equalize things between the rich and the poor in what are the absolute basic neccesities of life.

Again: ?????

LOTS of people believe that, me among them.

So why do you fixate on medical care and try to somehow suggest it is evil for the rich to enjoy better health care?

For your answer, read this very thread.

[The Terrible Sweal]

If you consider health care a scarce resource, you face the question: is it OK to our society that wealth should decide who lives comfortably and who dies in agony?

If we worried a little bit less about the injustices of health care reforms and worried a little bit more about not wasting resources, we may well be surprised to find that our health care system will be more equitable.

Evasion.

This is not evasion at all. I mean that if we were more concerned with making the system work better and less obsessed with making it "fair", we may well find that there would be fewer "adverse events".

If we were more concerned with efficiency we could become more efficient. If we became sufficiently efficient do you think we could eliminate scarcity? If not, the we still have the fairness issue.

Communicable diseases make health care a private good with positive externalities.  I think a leg cast is a purely private good though.

I ask you to consider the possibility that an untreated broken leg might mean a little league team without a coach, or a family without a provider.

[August1991]

Communicable diseases make health care a private good with positive externalities.  I think a leg cast is a purely private good though.

I ask you to consider the possibility that an untreated broken leg might mean a little league team without a coach, or a family without a provider.

And if the baker doesn't bake bread, I won't eat. But bread is still a private good.

How much would the little league team be willing to pay so that their coach can show up for the game?

Externalities become a problem when they are not included in the price.

"... family without a provider... "

I am willing to agree that families, not individuals, take many decisions.

Or do you mean that there will be rich families and poorer families. Are you again talking about "fairness"?

If we were more concerned with efficiency we could become more efficient. If we became sufficiently efficient do you think we could eliminate scarcity? If not, the we still have the fairness issue.

No, we won't eliminate scarcity - but believe me, the choices of someone living on a sidewalk in Calcutta are not the same as someone on welfare in downtown Toronto. Scarcity refers to the fact that what we want invariably exceeds what we can have. ["A man's reach must exceed his grasp, or what's a heaven for" - Robert Browning]

"Still have the fairness issue?"

I meant to argue simply that if we as a society aim for "fairness", we probably won't get anywhere near to it. And we'll cause a tremendous amount of waste in the process. On the other hand, if we concentrate our minds on not wasting - making the health care system work well, then I suspect the end result will be quite efficient and surprisingly fair too.

I agree that my argument is not obvious at all.

[The Terrible Sweal]

Communicable diseases make health care a private good with positive externalities.  I think a leg cast is a purely private good though.

I ask you to consider the possibility that an untreated broken leg might mean a little league team without a coach, or a family without a provider.

Externalities become a problem when they are not included in the price.

Isn't that the definition of externality?

Or do you mean that there will be rich families and poorer families.  Are you again talking about "fairness"?

No, public goods. The value to society of the good health of its members exceeds the sum of the value accruing to each of the members. (Noting that the indivdual values are included in measuring the social value obtained.)

I meant to argue simply that if we as a society aim for "fairness", we probably won't get anywhere near to it.  And we'll cause a tremendous amount of waste in the process. 

So you arrgue that to avoid waste we must accept unfairness. I'm not quite so pessimistic, but I think your position involves a practical problem apart from my factual dispute. It is this: How do you socialize/sensibly incentivize those who you propose to neglect? What's in it for them?

On the other hand, if we concentrate our minds on not wasting - making the health care system work well, then I suspect the end result will be quite efficient and surprisingly fair too.

It is either fair or it's not, surely.

But anyway, if you don't make fairness an objective, there is no innate reason that efficiency gains will contribute to fairness.

[August1991]

Externalities become a problem when they are not included in the price.

Isn't that the definition of externality?

If the baker doesn't show for work, I don't get bread. But then, I don't have to pay the baker either. So, what is my loss?

More likely, I'll go to another baker (or the little league team will find another coach) and so then, what would be my loss?

No, public goods. The value to society of the good health of its members exceeds the sum of the value accruing to each of the members. (Noting that the indivdual values are included in measuring the social value obtained.)

I cannot imagine any situation where the sum of each individual's valuation would ever exceed society's valuation. I am also curious to know how you plan to make your sums.

The typical problem with public goods is that individually, we value them more highly than the amount we say we are prepared to pay to get them. But this is not the defining characteristic of a public good.

Health care is a private good because we cannot see the same doctor at the same time and a doctor can in general exclude you from receiving her services. (One exception, which you noted, is that if she treats me for the flu, you benefit from a lower likelihood of being infected. IOW, she can't exclude you from receiving her services.)

It is either fair or it's not, surely.

Fairness is certainly not black or white. And frankly, it is hard if not impossible to find a functioning definition of "fairness". Incidentally, the word "fair" translates badly into other languages. The word "equality" at least has a clear math definition.

But anyway, if you don't make fairness an objective, there is no innate reason that efficiency gains will contribute to fairness.

That's where I disagree. Our health system is a good example. The Soviet Union is another example. By aiming for fairness, we waste alot and we don't even get a fair system.

So what "innate reasons" explain why a goal of efficiency leads to fairness? Well, I think if we aim for a "fair" or "equitable" health system, we quickly find that each person is different and so we can't really give everyone the same thing. In practical terms, a hospital administrator has to decide whether to renovate the psychiatric unit or the maternity ward. How to decide? In making those choices, the administrator will quickly affect the question of why doctors show up in the morning.

If we concentrate on getting doctors to show up for work, we'll probably find the choices between maternity wards and psychiatric units much clearer.

[cybercoma]

Someone let me know when the government is going to start handing out food. I understand charities have begun doing this (and they also cover extended healthcare costs...imagine that) but let me know when it becomes fair that everyone put money in the big federal pot so they can ration out food supplies.

[The Terrible Sweal]

Externalities become a problem when they are not included in the price.

Isn't that the definition of externality?

If the baker doesn't show for work, I don't get bread. But then, I don't have to pay the baker either. So, what is my loss?

Sorry, August, but I'm getting a 'does not compute' on the baker analogy. Explain?

No, public goods. The value to society of the good health of its members exceeds the sum of the value accruing to each of the members. (Noting that the indivdual values are included in measuring the social value obtained.)

I cannot imagine any situation where the sum of each individual's valuation would ever exceed society's valuation.

Isn't that what I'm saying?

Health care is a private good because we cannot see the same doctor at the same time and a doctor can in general exclude you from receiving her services.

That's not my understanding of a 'non public' good. A Pubic Good is where the vaule of it exceeds the price at which the market will provide it. Any other goods are assumed to be 'private goods'.

It is either fair or it's not, surely.

Fairness is certainly not black or white.

What is a fair outcome may vary with circumstances. But still, anything is either fair or not. 'ALMOST fair' means 'not fair'.

But anyway, if you don't make fairness an objective, there is no innate reason that efficiency gains will contribute to fairness.

...So what "innate reasons" explain why a goal of efficiency leads to fairness? Well, I think if we aim for a "fair" or "equitable" health system, we quickly find that each person is different and so we can't really give everyone the same thing. In practical terms, a hospital administrator has to decide whether to renovate the psychiatric unit or the maternity ward. How to decide? In making those choices, the administrator will quickly affect the question of why doctors show up in the morning.

If we concentrate on getting doctors to show up for work, we'll probably find the choices between maternity wards and psychiatric units much clearer.

And how does that bear on fairness?