Monday 9 May 2011

Feature, not a bug

Dr Clare Gerada, the chair of the Royal College of GPs on NHS reform:
I would hope that during this pause the government will reflect on what we're all saying and will rewrite the part of the Bill that is actually risking the NHS and risking the NHS being unravelled irreversibly for ever.
She's saying this like it's a bad thing. For me, it's a goal.  So long as the British taxpayer no longer has to pay for the bloated, useless monster, I'd say it's time to get the State out of the health care business (and all other business, for that matter), give the people back their money, encourage private charities, competitive insurance companies and free markets to the utmost, and pop the Champagne.

By the bye, "the chair?"  The College must have fallen on hard times.  When I was last there, they had hundreds of chairs–some of them quite comfy.  Now they have only the one and... Oh, I see.  I think they mean chairlady, but the poor dears are too shy to say it.

9 comments:

Fruitbat44 said...

David - I agree with an awful lot of what you say on this blog; though I am saddened that you don't seem to realise that "Starship Troopers" is the greatest SF novel ever written ;-) (You're right about the film though.)

This is one instance where I somewhat disagree. Yes the NHS is a bloated bureaucracy, and yes it costs a shedload of money, and yes if it wasn't government funded the government couldn't "cut" it.

But . . .

Deep down I rather like the idea of if I turn up at the Doctors the first question asked is "What's wrong with you?" and not "What's your insurance company?"

Ironmistress said...

The problem with health care is that it is something we cannot do without and to which there is no alternatives.

In other words, it is a natural cartel.

The only solution for cartels is monopsony, i.e. a situation where there is a single payer. Only a monopsony can balance a cartel. And vice versa.

NHS may be a bureaucratic, bloated, inefficient monster, but it is still the lesser evil compared to the American way. There are certain situations where Capitalism simply won't work but where it rather produces monopolies and cartels.

It is always Joe and Jane Average who pay it all.

David said...

The problem isn't monopoly (there are many doctors and hospitals, not one). The problem is when a third party is involved in the transaction that removes the supply and demand factor. "Another test? Why not? The government/insurance company is paying for it". Add in the uncompetitive nature of insurance due to regulation and the raft of government mandates and of course it ends up like a cartel.

When that third party is eliminated, market forces prevail and costs come down. We have a perfect example of this in veterinary medicine. There is no national health and very little in the way of insurance for animals, so vets provide most services available to humans at a much lower cost.

Why? Because it is a free market. No, the answer is the market backed by private charities (before the NHS most hospitals were church run and doctors routinely treated half their patients for free)and do away with that bureaucratic nightmare. The government has no business or aptitude for medicine and should stay out of it as it should all other businesses.

Wesley said...

Well said, David.

It appears part of the appeal of socialized medicine - to those who find it appealing - is that it's sold by the statist as a right. And as all good statists know, rights are provided by government. The fact that any service provided by government must derive from taking from the citizens at large and by definition will be poorly managed (because the statist has no "skin in the game", as the US Vice-Statist has said) is conveniently ignored. Thus it ever is when government grows beyond its proper duties (protecting citizens from internal and external threats, providing a common means of exchange). Power invariably corrupts, but unlike a free market, where if you don't like my widget you can buy one from Harry down the street who makes a better one for less, government is a natural monopoly and inefficient to boot, and it never voluntarily cuts its prices or its power (read: control).

And frankly, aren't food, clothing and shelter more immediately necessary to the vast majority of people than health care? The Soviets thought so, and we saw how well their government did with those necessities, didn't we? Or have we forgotten?

Socialism has a perfect record: It fails every time it's tried. And its legacy is a poor, miserable, unmotivated, unproductive, unhealthy populace.

Ironmistress said...

First for the beginners:

Capitalism is not about charity. It is about maximizing the profit.

Capitalism is not about nicety. It is about milking the small guy dry, squeezing him out of resources and throwing him away. New victims will always emerge.

The US health care has failed miserably - it produces poor services at cut-throat prices. Small wonder why patients rather opt to Philippines, Thailand or Mexico when given a choice.

Ironmistress said...

The problem isn't monopoly (there are many doctors and hospitals, not one). The problem is when a third party is involved in the transaction that removes the supply and demand factor.

The problem is that a) we are dealing with human lives, not animal and b) many of the treeatments are well beyond the capability of paying of the patient or would ruin him economically. It is just that most of the treatmens are most sorely needed by those who can least afford them.

With animals you can always opt putting your pet to sleep if the treatment is too costly. You cannot do the same with humies.

Unless we go into Social Darwinism, of course, and use culling on economical basis to weed out the unfit. Aktion T4, anyone?

So the third party enters in anyway.

"Another test? Why not? The government/insurance company is paying for it".

The tests are there to prevent malpractise lawsuits. Doctors are human and prone to error and malpractise occurs. And when it occurs, someone has to pay for it. Malpractise legislature is there to prevent quackery - which would always emerge up should there be no laws criminalizing it. The wasteful tests and over-resourcing are there to save the doctors' and hospitals' butts from greedy lawyers looking for an opportunity to cash on their mistakes. Eliminate that and you get quackery.

The doctors themselves have made very good job on cartellizing their profession and making sure the legislature will cover their butts. It is no socialism, it is about cartels.

And who pays it all? The small guy.

Health care is a natural cartel. The commodity is exactly the same everywhere, you cannot do with out it, there is no reason on competing with price and only licensed practitioneers are allowed to profess it.

When that third party is eliminated, market forces prevail and costs come down.

No, they don't. Health care is no fast food.

We did the very same on car inspection in Finland - we privatized it and removed any hindrances on competition. What was the result? The prices quintupled in ten years. No reason to compete, annual inspection is mandatory anyway, you cannot do without, the commodity is the same everywhere, and the cartel-like nature of the business was revealed all too quickly. Too late.

Ironmistress said...

It appears part of the appeal of socialized medicine - to those who find it appealing - is that it's sold by the statist as a right.

And by the very nature of health care as a natural cartel, it works quite well. The most effective health care systems in the world are either public or based on single payer model.

And as all good statists know, rights are provided by government.

It is completely irrelevant whether those rights ar provided by government, insurance company, shareholders, church or security companies, the result is always the same: the small guy gets screwed.

The golden rule on rights is that the one who has the gold dictates the rules. Eliminate the government and you play by the plutocrats' rules. Simple as that.

The fact that any service provided by government must derive from taking from the citizens at large and by definition will be poorly managed (because the statist has no "skin in the game", as the US Vice-Statist has said) is conveniently ignored.

The result is exactly the same with any cartels or monopolies, be they private or public. Cartels are an especially nasty phenomenon on behalf of the small guy. He pays it all. Sometimes a public monopoly is the way of the least nuisance.

Power invariably corrupts, but unlike a free market, where if you don't like my widget you can buy one from Harry down the street who makes a better one for less,

And do you think Capitalist Plutocrats weren't corrupt?

What if Harry provides exactly the same widget with exactly the same price around? Or he provides a worse widget for less? Or they both belong in the same chain of retailers who has the de facto monopoly on the market?

Power is power, be it economical, social, physical, intellectual or whatever. It corrupts and the result is always the same, regardless of the system.

Socialism has a perfect record: It fails every time it's tried. And its legacy is a poor, miserable, unmotivated, unproductive, unhealthy populace.

The Socialists lied about Socialism but told truth about Capitalism. Eiher way the small guy always loses.

Ironmistress said...

For starters:

Capitalism is not about charity. Capitalism is about maximizing profits.

Capitalism is not about being fair. Capitalism is about squeezing the little guy dry, miking out his assets and throwing him away. New victims will always come.

It appears part of the appeal of socialized medicine - to those who find it appealing.

Nope. It is just that practise shows us that single-payer model works better on medicine than capitalism.

And as all good statists know, rights are provided by government.

Better to have government-provided rights than rights whose existence depends on whether you can afford to pay for them or not.

Power invariably corrupts,

What makes you think Plutocrats weren't just as corrupt as anyone with any power?

but unlike a free market, where if you don't like my widget you can buy one from Harry down the street who makes a better one for less,

The free market in practise means you can purchase the exactly same widget from Harry at the exactly same price. Or perhaps a worse widget cheaper or a better widget at higher price. But what if you and Harry belong in the same retail chain? What are my choices then? Pay dearly, through my nose or by my heartblood?

And frankly, aren't food, clothing and shelter more immediately necessary to the vast majority of people than health care?

The problem is that those who most need health care are usually those who least can afford it.

Socialism has a perfect record: It fails every time it's tried. And its legacy is a poor, miserable, unmotivated, unproductive, unhealthy populace

And why do those Americans who have a chance, opt for going to Thailand, Philippines or Mexico for treatment?

If Socialism is such a bugbear, let's try Nazism next time.

The most appalling thing on Nazism is that it never failed. It actually worked really well. It was crushed by its enemies and conquered from outside, unlike Communism, it never collapsed on its own.

Reality check: Health care is a natural cartel. The only solution for a natural cartel is monopsony - one single buyer. It really doesn't matter whether it is provided by socialized medicine, health vouchers or by societal outsourcing, a single payer model will provide better results than markets on natural cartels.

Ironmistress said...

The problem is when a third party is involved in the transaction that removes the supply and demand factor.

This problem arises from the fact that having to go to hospital and getting treated usually is beyond the funds of Joe or Jane Average. Having to go to hospital usually means a personal bankrupt unless you have an insurance. In US some 62% of all personal bankruptcies are due to health care bills.

Those who most need health care are usually those who least can it afford. The solution for a situation where there is a small risk but big consequences is to take insurances. That is why people take health insurances - or why they are provided by the society.

"Another test? Why not? The government/insurance company is paying for it".

That is because of the malpractise legislature. Without it, the medicine would be full of quacks. The wasteful testing is there to cover the doctors' butts, not that of the patient. And yes, there are lawyers who are real vultures - they are specialized on malpractise lawsuits and will tear any doctor who has made a mistake in small pieces and milk compensations. But if we dismantle the malpractise legislature, we are sure to see quacks emerging.

Add in the uncompetitive nature of insurance due to regulation and the raft of government mandates and of course it ends up like a cartel.

The solution for a cartel is monopsony - one single buyer and one single payer which can dictate the price. That will prevent the costs arising skyhigh.

We have a perfect example of this in veterinary medicine. There is no national health and very little in the way of insurance for animals,

The problem is that you can always refuse from threatment with pets, get a quack or put the pet in sleep. You cannot do the same with humies.

There are choices with pets. There are none with people. The choices - refusing from treatment (and opting for death), quackery or an autoeuthanasia are utterly unethical. Unless we want to impose Social Darwinism on culling the sickly and weak. Aktion T-4, anyone?

NHS may be an expensive bloat, but the choices really aren't any more appealing. We may speculate with free markets, but the results in practice will always be the same as with US health care hell.

Socialists lied about Socialism, but told the truth about Capitalism.