According to a study that even the New Republic’s Jon Cohn admitted he
thought was probably exaggerated, being uninsured killed 18,000 people
a year this decade. Methicillin-resistant Staphylococcus aureus, on the
other hand, apparently kills 19,000 a year.
That’s from Megan McArdle, who continues:
Non libertarians can, of course, go along wishing that we would have
national health care and a War on Infection. But it’s worth asking
yourself: in a world of scarce resources, where you could only have
one, which would you choose? And by what principle?
The fact that I have read very few sentences today does not diminish the stellar quality of these thoughts.
I agree. Lets go to single payer health care, and use the savings to fight a war on infection.
What a dishonest post. Tyler, you have to be kidding me. I am not even a
single-payer advocate though i think there should be some form of universal
coverage, but how can you with a straight face present this false choice
between universal health care and fighting infectious diseases? Please,
leave the political hackery to Greg Mankiw and his ilk…
yoyo is right. McArdle is a hack.
Lots of insult and denial have we here. No one is saying that reform X (whether it be single payer or something else) vs. fighting infection is *the* choice, in fact quite the contrary possibility is presented. Just admit the inconvenient fact: “It is quite possible that my favored health care reforms aren’t nearly the best way to help other people. But I promote them anyway because [fill in the blank].” Depending on what you put in the blank, you still might think it is better to promote your preferred reforms. But they won’t sound nearly as efficacious or as noble as before. The critics in this comment thread are reacting exactly as people do when they feel their relative status has been knocked down a notch. Which it has.
Public hospitals could always enforce a necktie ban. This would make more sense, though.
Robbi’s comment is honest and insightful.
To me natioalized healthcare for Americans as charity makes little sense because:
We already have Medicaid and because a few thousand dollars spent in a very poor country will help the people there more than a million dollars spent here on healthcare.
Those must have been the only two sentences you read today. Neither makes much sense, or follows logical rules. False choices, comparing apples & oranges.
Robbl’s post might be insightful.
But after reading such comments, it’s easy to understand why Greg Mankiw closed his comments section down recently.
I didn’t take it as a false choice. It’s a hypothetical situation to force you to think about your relative values. Why is the political push for a war on infection not as large as the push for universal health care? That’s what question the second sentence seemed to point out.
After reading such odd negative comments, my guess is that one person is signing them with different names.
angus sums up the stupidity:
“pretty funny ’cause I read this and thought to meself “hey Angus, that McArdle might be much better than I’ve been thinking, I need to give her another chance”.
but then I thought again and agreed with talboito: Choose? Hell no! I want more of both!”
I can’t believe someone posted this on an economics blog.
Not many people are really answering the question posed by Mcardle. Most thinking people should have a hard time choosing. Despite being a libertarian, I am a former liberal, and having a soft spot for some sort of national medical program comes with the territory. My thinking goes that the long run benefits of a completely free market system MAY outweigh the short term welfare costs. But its hard to say really. In the medium term they may balance each other out.
And to quote a movie (Fight Club), “In a long enough time frame, the survival rate for everyone falls to zero.” So really we are balancing out long term and short term effects. The answer to the question shouldn’t be obvious enough to you to post a comment claiming some sort of truth 5 minutes after Tyler posted. I doubt we should ever be able to answer.
Quoting an earlier poster, “I agree. Lets go to single payer health care, and use the savings to fight a war on infection.”
Let’s have single payer food, single payer auto insurance, and single payer housing while we’re at it because the government has such a fantastic track record at delivering quality products at a reasonable price.
I’m just curious how the moment you add the words “health care,” people start falling for ridiculous arguments that they would reject out of hand in any other context.
Preventing death is not the only success measure of a healthcare system. Silly comment, to my mind.
markets have failed for decades to provide universal health coverage.
You write that like it’s a bad thing… Seriously, that’s a decidedly unpersuasive argument to a libertarian community.
To help you better understand a libertarian audience, the secret formula to libertarianism is the following two assertions/beliefs:
my preferences != others’ preferences
forcing others to use their resources to satisfy my preferences is immoral
From those, all else follows. For example (among other reasons such as the inevitable imposition on personal liberties) Universal Health Care (UHC) fails to garner libertarian support because we realize a) not everyone wants it amd b) it requires the confiscation of others’ resources to make it happen.
So even if UHC were more efficient (which it’s not, but that’s a factual disagreement), libertarians still wouldn’t support UHC because of the loss of liberty.
Back to the original post topic, many libertarians (and this includes me) hold the belief that the push for UHC is driven not by compassion for the plight of others, but by a desire for socialism. As evidence to support this belief, we note that there are numerous other things which could be done at lower cost and, more importantly, less government interference in our lives to maximize the metrics pushed by the UHC proponents, generally, life expectancy and deaths.
So when Megan gives an example of a lower cost way to achieve the stated metrics and is viciously attacked, there must be hidden metrics (hidden utilities) which have not been openly stated. Based on our priors, we (libertarians) assume the hidden metric is “degree of government control over the economy”.
So, more constructively, after years of hearing UHC is all about maximizing life expectancy and minimizing avoidable deaths and noting the vociferous denounciation of a lower cost suggestion that would do better at both previously stated metrics, I ask the UHC advocates, what exactly are the metrics being applied for which UHC is the maximizing solution and better hygeine is anathema if the metric is not “degree of government control over the economy” as we (libertarians) suspect?
“in a world of scarce resources”
Good Lord, you think this is scarce? And maybe you read those lines on your iPhone?
If you haven’t seen it, please see if this video presentation from the TED conference hooks you. We are rapidly becoming a wealthy world, due to the success of the global market system (even as it varies nation-by-nation over a wide degree of market regulations).
After all, while many single payer schemes might end up costing more than what we have now, some might indeed save money, with the elimination of all the excessive “administrative” activities by private health insurers (trying to avoid paying for care)
I’m not an economist so perhaps someone could explain this one to me. So insurance companies actually pay more in administrative costs to avoid paying for care than the care would cost? Interesting business model. And this is where the savings from single payer insurance will come from? I think I’ll stick to engineering as this makes absolutely no sense to me.
A very entertaining and enlightening thread!
Just goes to show you how few people actually think before they start writing.
It isn’t a false choice she is giving you. She is highlighting for you two ways to save the identical numbers of people, one of which is far more difficult and potentially more costly, while the other appears far more readily achievable, both politically and financially.
Sure, you can attempt to do both, but dilution of effort means you are less likely to accomplish either goal. Here is the real choice: which problem do you attack first? Rationally speaking, you should take the low hanging fruit in this case. Of the commenters attacking both Cowen and McCardle, only one of them is thoughtful and honest enough to admit that he would rather pick the less rational course, and for the reason that it makes him feel best about himself and the society he lives in- and Tyler quite respectfully complimented him for his honesty.
Rationally speaking, you should take the low hanging fruit in this case.
Of course you should, given the implied assumptions that costs are equal and that the benefit of national health care are limited to the lives saved. But these are silly assumptions, so I don’t see how the questionis remotely helpful.
The question McArdle is asking is something like:
We can buy one of two machines to treat heart attack victims. Machine A is cheaper than Machine B, and we can’t afford both. Machine A saves 25% of the patients we use it on and Machine B saves 20%. There are no other effects, or benefits, or differences. Which one should we buy?
This is supposed to help us think about health care reform?
A world in which a never ending Iraq war requires no sacrifice from the funders is not a world with scarce resources. Thus the original thought is not stellar, nor is that of the evaluator.
Something about health care policy makes libertarians go blind dumb. I wish I knew what it was, then you could be helped.
I think McCardle’s statement is good, because what it shows is that if we are concerned about saving life, there are lots of things we could be doing, fighting infection just being one of them. What is the goal of healthcare? Is it about saving life or not? An argument against it could be quality of life, if it can be shown that nationalized care improves quality. I haven’t seen conclusive proof that it can, so I don’t buy it. But it will get you around her statement.
People for nationalized care, help me understand something which I must be missing.
According to data from 2002, the U.S. government (all levels I assume) is currently spending roughly the same amount of money as a percent of GDP on healthcare as other industrialized nations. Why can’t the government provide universal care right now, using the money it currently has? Just open Medicare to everyone right now and impose cost controls. Deregulate the private system. We can have two system’s side by side, just like we have in education.
The question McArdle is asking is something like:
We can buy one of two machines to treat heart attack victims. Machine A is cheaper than Machine B, and we can’t afford both. Machine A saves 25% of the patients we use it on and Machine B saves 20%. There are no other effects, or benefits, or differences. Which one should we buy?
This is supposed to help us think about health care reform?
Here’s how I would phrase it:
Given that solution A Pareto dominates solution B, why are advocates of solution B spending their time (a scarce commodity) agitating for solution B instead of solution A?
The available answers seem to be:
a) A does not Pareto dominate B because we’re actually using a different set of unidentified utility functions (here I’m using Pareto dominance in the multi-objective problem sense)
b) The proponents were ignorant of solution A
c) The proponents are irrational (in the economic sense of not being utility maximizers)
Rephrasing this in a less abstract manner, why are UHC proponents pushing so hard for UHC when pushing for other solutions would achieve greater benefit at lower cost (benefit as measured by the traditional metrics offered by the UHC proponents – life expectancy and deaths)? Is it because
a) UHC proponents have other unstated utility functions for which UHC would be preferable? If so, what are they?
b) Were UHC proponents previously unaware of other causes which would be of greater net benefit?
c) Are UHC advocacates misguided due to emotion or an inability to properly assess alternative uses of their time?
I think many of you fall into that old trap, thinking that medical-care costs directly buy health. In the case of Staph, one is reminded of the ancient injunction to stay away from doctors: caca bene et irruma medicos.
also econ2econ, what fraction of our food expenses, our exercise options, our “lifestyle choices” etc. are “health care” but not under your “medical care” budget?
Mike Huben said:
“And of course markets have failed for decades to provide universal health coverage.”
Liar liar pants on fire, I caught you red handed you devil. Everyone knows darn well that we do not have a market system for health care in this country.
Am I not understanding McCardle clearly? She is simply asking if everyone is so politically obsessed with nationalized health care because of deaths to the uninsured then why not take the same approach to hospital sanitation, which is evidently killing more people. If everyone wants to stand tall on their morality soapbox and proclaim that they are the MOST moral person in the universe because they are fighting for to nationalize health care then why not apply the same energy towards fighting infection. Unfortunately the pro-government crowd lacks for much of a sense of humor and sucks all of the air out of this thread by taking her hypothetical at face value. I say the joke is on you if you think you have to come up with a choice.
They have universal health coverage in Britain, and they also have infections.
Jody,
I am all for improvements in hospital procedures and other steps which will reduce these sorts of problems. Who isn’t? However, since I am not connected with medicine I am not generally familiar with all the procedures and practices that could be improved. To argue that, before advocating changes in our health care system, I am obligated to investigate everything that goes on in hospitals to look for improvements is to forestall any discussion of systemwide change.
You also overlook a perfectly good reason why reformers might concentrate on systemic reform. There is more resistance to it, and it is a vastly more complex problem. The steps to reduce MSRA are apparently fairly clear, and there is probably little resistance once the problem is called to people’s attention.
megan’s just found another way to illustrate something fairly obvious if you pay any attention to policy debates — people generally don’t choose policies to support based only on how they could most effectively maximize X (here, saving lives), but rather based on other considerations. yes, yes, you can say that X isn’t the only consideration worth considering, isn’t what the debate was about, etc. yes, yes, this is just warmed over lomborg (which is just warmed over etc.).
gotta say, though, i’m amazed by the vitriol. where’s the harm in pointing out yet again that we should think carefully about where we expend our limited resources, how to factor in political impediments, etc.
(Oh yes, if you are a wealthy person with an obscura and non-life threatening ailment, you will get better care in the US than anywhere else.)
Again, our population-wide cancer survival stats are better than anywhere else, so neither the obscure nor the non-life threatening nor the wealth conditions appear to be necessary conditions. See here for data.
Is this one of thise micro-facts? That *only* 18,000 people a year are killed by lack of health insurance?
What was it, *only* 3,500 people killed in 9-11? So that’s all right, then?
(Oh yeah – and one of the reasons to insure *everybody* is to insure that infections are not spread simply because people cannot afford simple prevntion).
Ironic to read single-payer advocates accusing anyone else of setting up a false choice. That has been the essence of their argument for quite sometime: single payer or status quo.
I am in a bad mood today, thanks to a recent decline in my status. There I was smugly contemplating how my ideas would help other people, but as it turns out it was just a mirage.
Re: the comment on private property, society, the state and so on by Mike Huben.
I couldn’t ask for a better example to illustrate the philosophical differences between classical liberals and modern day liberals with respect to the state, people, and the source of power (or private property or individual rights).
Liberals used to think the state derived its power from the consent of the people.
Now liberals think people derive their power from the consent of the state.
(Normally I would insert a parenthetical next to the second liberals to point out that Mike is not representative of many liberals, but I liked the line too much to spoil the flow.)
Jody seems to be displaying those strange mutant powers of libertarians who can read their own paranoid fantasies of enemies into anything they disagree with.
“Now liberals think people derive their power from the consent of the state.” I’d love to see how she gets such drivel from what I actually wrote here.
If [we do have the best health care], why are people not living as long in the US?
Culture and genetics.
On culture:
we’re the fattest nation in the world.
We’re the most violent in the western world.
On genetics, different groups of people are just predispositioned to longer life.
For example Japan (basically racially homogenous) has the longest living people in the world. That is, except for the Japanese living in America. See here.
Blacks also tend to die younger all else being equal due to greater susceptibility to heart disease and diabetes. Though that’s typical of the tradeoff that comes with maturing sooner.
So all else being equal (i.e., ignoring that we’re fat and violent), one would expect the US to have a shorter lifespan than Japan as the US has relatively less Japanese and relatively more blacks.
One could argue that the black/Japanese divergence is cultural or cultural and genetic, but that’s not relevant to this part of my point. What is relevant, is the mixtures of people that make up a nation impacts life expectnacy.
If you dig down a little bit into the life expectancy statistics, something pretty interesting pops up. First, because we’re fat and violent, we have a pretty low probability of reaching age 65, basically last in the First World. (Israel is 1st at 85.1%, we’re 32nd at 77.4%)
But once we reach 65, we’re middle of the road in life expectancy in the Western world. (13th)
However, if we only look at Europeans living in the US (i.e., whites), we actually do pretty well. See here where US whites average about 18.5 years (2002) while blacks average around 15.5 years (2002). In context of that last table, US whites as a nation would trail only Japan, Italy, Hong Kong, Costa Rica, Canada, and Australia (making us 7th instead of 13th). (Note, removing blacks only adds about 0.5 years for the expectancy after 65 stats, and the relative movement is indicative of how tightly packed national life expectancy stats at 65 are)
So even though we’re probably still the world’s fattest at 65 (though presumably less than 30% of those over 65 are obese) we’re doing rather well in terms of life expectancy at the point health care becomes an expected part of life.
[FYI for those who don't want to follow through on the links, the US obesity "lead" is huge - US (1st) is 30.6%, Mexico (2nd) is 24.2%. Also obesity for those six countries ahead of the US in life expectancy at 65 are as follows Japan (3.2%), Italy (8.5%), Hong Kong (no data), Costa Rica (no data), Canada (14.3%) and Australia (21.7%)]
T-Cow’s just jumped the shark on health care “commentary.” But I’ll keep reading for the fun insights on other issues.
Today i was reading a few articles and ran across what i thought the best two sentences i read for the day were. “With Beckett being Beckett in the postseason and Manny being Manny, the Red Sox sent the ALCS back to Boston with a 7-1 win in Cleveland. Step one of a Sox comeback? We’ll see on Saturday.” Yes, this is three sentences but who can deny that the Red Sox have their backs against the wall and last night everything was clicking to perfection. Makes for a great game 6 saturday in Boston.
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