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Tags health care issues , health care reform , uhc

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Old 14th December 2011, 02:03 PM   #161
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Still ignoring that we provide comparable standards of healthcare for half the cost, eh Malcolm?
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Old 14th December 2011, 02:20 PM   #162
Malcolm Kirkpatrick
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Originally Posted by Architect View Post
Still ignoring that we provide comparable standards of healthcare for half the cost, eh Malcolm?
Considerably less than you all ignore the questionable assessment of "comparable" and "cost". I have repeatedly said that "care" includes:...
  1. Access to diagnostic services
  2. Use of diagnostic services
  3. Effectiveness of diagnostic services
  4. Access to post-diagnostic treatment
  5. Use of post-diagnostic treatment
  6. Effectiveness of post-diagnostic treatment.
There's considerable variation across countries in these dimensions. By some measures the US fares well (e.g., post-treatment cancer survival rates for the elderly).
"Cost" has problems. If a Brit travels to a private imaging clinic in Spain, on which country's account does that medical bill appear?
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Old 14th December 2011, 03:39 PM   #163
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And no matter how often you trot this out, you still don't manage to refute the point. Feel free to post some statistical evidence.
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Old 14th December 2011, 07:45 PM   #164
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Originally Posted by Architect View Post
And no matter how often you trot this out, you still don't manage to refute the point. Feel free to post some statistical evidence.
I'll go back to an earlier thread and find the link which Drachasor provided that supported this. I quoted it at length and some moderator deleted the quoted material.
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Old 15th December 2011, 01:04 AM   #165
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No he didn't, Malcolm, he attempted and was unsuccessful. Now it's time for you to back up your arguments with some hard evidence.
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Old 15th December 2011, 02:39 AM   #166
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The biggest economic case for some degree of universal health insurance cover is that it is an insurance market with assymetric information (favouring the insuree) which means that if buying cover is voluntary, it is likely to be priced too high and/or be no good. So while the information "advantage" favours the insuree, the outcome doesn't.

Other economic pros/cons are beyond the scope of my post.

There is also a moral case for various forms of cross-subsidised social insurance.
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Old 15th December 2011, 09:35 AM   #167
Malcolm Kirkpatrick
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Originally Posted by Architect View Post
No he didn't, Malcolm, he attempted and was unsuccessful. Now it's time for you to back up your arguments with some hard evidence.
I'm glad to see that you think Drachasor was unsuccessful, since he's a supporter of state-sponsored health care.
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Old 15th December 2011, 09:50 AM   #168
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Originally Posted by Francesca R View Post
The biggest economic case for some degree of universal health insurance cover is that it is an insurance market with assymetric information (favouring the insuree) which means that if buying cover is voluntary, it is likely to be priced too high and/or be no good. So while the information "advantage" favours the insuree, the outcome doesn't. Other economic pros/cons are beyond the scope of my post. There is also a moral case for various forms of cross-subsidised social insurance.
I see two problems with the above:
1. Sellers and buyers always have different information, in almost all markets.
Competition between providers will create incentives for one provider to supply information that other suppliers hide. Deny this and Francesca makes an argument for State-run everything.
2. The government of a locality is the largest dealer in interpersonal violence in that locality. Government is not God. Government employment does not spiritually transform people into omniscient, omnipotent altruists. They're just a bunch of guys with guns. The "charity" argument for State provision of public goods contains a flaw: institutional oversight is a public good, and the State itself is an institution. Therefore, State assumption of responsibility for the provision of the "public good" of charity (in education, health care, disaster relief, etc.) transforms the "free rider" problem at the root of public goods analysis but foes not eliminate it.
Thanks for the link. I'll read your link later.
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Old 15th December 2011, 11:31 AM   #169
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Originally Posted by Malcolm Kirkpatrick View Post
I see two problems with the above
Only two? It might not be so bad then.
Quote:
1. Sellers and buyers always have different information, in almost all markets.
Competition between providers will create incentives for one provider to supply information that other suppliers hide. Deny this and Francesca makes an argument for State-run everything.
As I said, it is the hidden information known to the insurees (buyer in your lexicon) that is of import. It doesn't really matter how many insurance sellers there are in respect of this issue.
Quote:
2. [ . . . ]The "charity" argument for State provision of public goods contains a flaw: institutional oversight is a public good, and the State itself is an institution. Therefore, State assumption of responsibility for the provision of the "public good" of charity (in education, health care, disaster relief, etc.) transforms the "free rider" problem at the root of public goods analysis but foes not eliminate it.
Charity (voluntary transfers) is not a public good. Public goods are those which are economically efficient but undersupplied by voluntary actions. Do you believe that charity is undersupplied (over and above "because the government took my money already at gunpoint")?

So I am not sure what your objection is.
Quote:
Thanks for the link. I'll read your link later.
If/when you do, you should be able to see where your objection (1) missed its target.

PS--One can make a case for state-run everything. Just not a very optimal one in most cases IMO, which is why I don't. One can make a case for voluntary everything too, but likewise, not optimal. I wouldn't do that either.

Last edited by Francesca R; 15th December 2011 at 11:39 AM.
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Old 15th December 2011, 12:20 PM   #170
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Originally Posted by Francesca R View Post
Only two? It might not be so bad then.
We have agreement, at least in style.
Originally Posted by Francesca R View Post
As I said, it is the hidden information known to the insurees (buyer in your lexicon) that is of import. It doesn't really matter how many insurance sellers there are in respect of this issue1.
Charity (voluntary transfers) is not a public good. Public goods are those which are economically efficient but undersupplied by voluntary actions. Do you believe that charity is undersupplied (over and above "because the government took my money already at gunpoint")?

So I am not sure what your objection is.2

PS--One can make a case for state-run everything. Just not a very optimal one in most cases IMO, which is why I don't. One can make a case for voluntary everything too, but likewise, not optimal. I wouldn't do that either3.
1. Insurers have an incentive to uncover information on other insurers.
2. A public good is a good that is non-exclusive in production and non-rival in consumption. The archetypal example is a lighthouse. Outdoor fireworks displays and (unencrypted) broadcast radio qualify as public goods, in that producers cannot exclude people from using the service without paying and one person's consumption does not reduce the amount available to other people. Charity qualifies as a public good: if I feed a beggar, other altruistic people, who would want to see that beggar fed, benefit.
3. Two questions:
a) From State (government, generally) subsidization or operation of what industries does society as a whole benefit? You may imagine either a dichotomous classification: A={x:x is an unlikely candidate for State subsidy (or operation} and B={x:x is a likely candidate for State subsidy or operation}...or a continuum
(highly unlikely) -1______.______+1 (highly likely).
b) What characteristics determine an industry's classification or position on the continuum?
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Old 15th December 2011, 12:36 PM   #171
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Originally Posted by Malcolm Kirkpatrick View Post
1. Insurers have an incentive to uncover information on other insurers.
Same mistake again. Please refer to some of the stuff in the link which is a straight google (scholar) search of "adverse selection in health insurance", because then you may no longer need to fire back objections which are not, in fact, objections.

Quote:
2. A public good is a good that is non-exclusive in production and non-rival in consumption.
That is a good definition as well. Probably more encompassing than mine

Quote:
Charity qualifies as a public good: if I feed a beggar, other altruistic people, who would want to see that beggar fed, benefit.
Pointing out that this kind of warm glow is not excludable doesn't really make charity a public good though. Do you think charity is under-supplied relative to the economically optimal amount? If so why is the optimal amount of charity higher than the equilibrium amount provided?

(This is tangential to my mind, because state-funded economic activity, requiring state-compelled income transfers, does not come under any heading of charity that I know)

Quote:
3. Two questions:
a) From State (government, generally) subsidization or operation of what industries does society as a whole benefit? You may imagine either a dichotomous classification: A={x:x is an unlikely candidate for State subsidy (or operation} and B={x:x is a likely candidate for State subsidy or operation}...or a continuum
(highly unlikely) -1______.______+1 (highly likely).
b) What characteristics determine an industry's classification or position on the continuum?
I don't think this is relevant really. Not to my economic argument for universal (read: compulsory) health insurance. The economic argument is that the market in health insurance suffers from adverse selection due to the asymmetry of information known to the insuree and insurer. The theoretical result from attempting voluntary health insurance in that regard is that it would be priced too high (relative to compulsion) and/or a "pig in a poke", in the general sense of the user discovering that cover they thought was there has a habit of vanishing inexplicably when called on.

The US health insurance market suffers from these two aspects in spades. (Though adverse selection is not the entire explanation for the high-cost/inadequate cover snafu that is a facet of the US system)
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Old 15th December 2011, 07:25 PM   #172
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Originally Posted by Francesca R View Post
Pointing out that this kind of warm glow is not excludable doesn't really make charity a public good though. Do you think charity is under-supplied relative to the economically optimal amount? If so why is the optimal amount of charity higher than the equilibrium amount provided?
Milton Friedman constructed an argument for a negative income tax on "public goods" along the lines I suggested for charity as a public good. Although some economists seem to suppose otherwise, neither "undersupplied" in the absence of subsidy nor "optimal amount higher than equilibrium" follow from the definition (non-exclusive in production and non-rival in production). For example, a beautiful girl walking down the street, radiating beauty, qualifies as a public good (she brings a twinkle to the eye of this old man, anyway). Subsidies are not needed, as women have sufficient incentive to produce this good without subsidy. Broadcast radio is non-exclusive in production and non-rival in consumption, but government-operated broadcast news media would be a public bad, not a good (are, in totalitarian countries). Propaganda, anyone?
Originally Posted by Francesca R View Post
The US health insurance market suffers from these two aspects in spades. (Though adverse selection is not the entire explanation for the high-cost/inadequate cover snafu that is a facet of the US system)
Why would not State-operated systems suffer from defects at least as large (e.g., moral hazard, regulatory capture)?
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Old 16th December 2011, 02:14 AM   #173
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Originally Posted by Malcolm Kirkpatrick View Post
Why would not State-operated systems suffer from defects at least as large (e.g., moral hazard, regulatory capture)?
They could do. The experiment pretty much needs to be run in real-time on various alternative methods/doctrines to evaluate the results. That does not negate the argument I gave for compulsory health insurance. Right now the US system would appear to have the worst of all (well, most) worlds in respect of perverse incentives.

As before, the rest of your response is somewhat tangential. Compulsory health insurance is not being advocated (by me) due to it being an under-supplied public good, but because of market failure due to adverse selection.

Originally Posted by Malcolm Kirkpatrick View Post
Although some economists seem to suppose otherwise, neither "undersupplied" in the absence of subsidy nor "optimal amount higher than equilibrium" follow from the definition (non-exclusive in production and non-rival in production).
Correct, that definition is more encompassing than mine. So there is no need for any organised authority to intervene with compulsion or selective incentives (EG subsidies) when the individual gain from providing such goods exceeds the individual cost regardless of free-riders. There are many public goods (according to your--more correct--definition) that are not under-supplied. We don't need to be concerned with those.

But that is not always the case and there can be a case for organised policy (compulsion or selective incentives) when it is not. Friedman's advocation of negative income tax shows Friedman's agreement with the concept; of course he only advocated that sparingly.

Originally Posted by Malcolm Kirkpatrick View Post
Broadcast radio is non-exclusive in production and non-rival in consumption, but government-operated broadcast news media would be a public bad, not a good (are, in totalitarian countries). Propaganda, anyone?
Well in the UK, BBC radio is cross-subsidised by a mandatory government levy on TVs (although it is operated independent of the government of the day via charter). Listening figures indicate high popularity. There are various voices calling for it to be abolished but I do not recall any major political parties running for election in its 70+ year history campaigning on a manifesto to do that and it is hard to prove that it exists against the will of the electorate. It has been expanded and (more recently) scaled down via the political process, however.

Last edited by Francesca R; 16th December 2011 at 02:25 AM.
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