There are people that think that we could have much faster medical progress via a basically libertarian approach: decrease or abolish government regulation of drug development. Or permit companies to market new drugs without first proving that they work.
Nutritional and herbal supplements are barely regulated at all: so by this argument there should be all kinds of medical progress stemming from that area. But it hasn’t happened. supplements are mostly useless, yet people buy them anyhow. There’s very little regulation of medical developments in third world countries – why aren’t they a a fount of medical progress? But that’s an unfair comparison: we know why they’re not…
Why did literally thousands of years of low regulation result in almost no progress? The Romam Empire had low marginal tax rates too, and good security of private property most of the time – why so little progress?
* I don’t think he really shows that the market does not weed out bad service or bad medicine, though. He does essentially repeat the argument commonly made, also by some economists, that demand for medicine is too inelastic, i.e. it’s one thing when the alternative of downloading some app is accomplishing a small task more slowly, but it’s another thing when the alternative to getting surgery is certain, painful death. So people will be willing to pay more to get medical service, reducing their bargaining power. But presumably the countervailing dynamics of competition still apply: it’s clearly in the interests of a drug manufacturer to produce drugs with demonstrated efficacy, while a manufacturer that produces ineffective drugs risks destroying his reputation and going out of business.
He wonders why centuries of free market in medicine didn’t achieve much, but can’t we ask the same of just about every other scientific and technological achievement? They all took centuries to develop, and they all or mostly saw the biggest leaps in the early modern period. Economics doesn’t say that the market is magic or achieves modern prosperity overnight. The idea is that no lasting progress can be made without accumulation of capital, which is understood in the broad sense of any goods, including knowledge, that can be used to produce what we want. That is, you need economic growth before you can talk about redistributing wealth.
Greg also notes that the last 50 years haven’t seen as much progress as the earlier 20th century, which kind of undermines his thesis, since those are the years that saw significant increases in regulation and government oversight of medicine. Getting a new drug approved by the FDA is a long and expensive process and you have to ask whether lives potentially saved by keeping unsafe drugs off the market outweigh lives lost because perfectly effective drugs have been kept off for too long. At least we should talk about legalizing the sale of non-approved drugs, as long as patients and doctors understand that the drugs are not yet approved.
* The first rule of Trump — and I love the guy all the same — is that he’s a narcissist. So the idea of replacing “Obamacare” with “Trumpcare” appeals to his ego. He also thinks everyone loves him and he has infinite amounts of political capital to do everything he wants all at once, everyone will see that Trumpcare is far better than Obamacare because it’s Trumpcare, etc.
* I’ll elaborate on “Trump thinks everyone loves him.” He of course knows he has critics, but he thinks they’re just jealous. He’s very similar to most rappers in that respect, as Sailer often mentioned during the early days of the campaign.
This is why whenever Obama, or Hillary, or the New York Times demonstrates even the barest minimum expected level of cordiality or fairness,[1] he goes out of his way to lavish them with praise and announces all has been forgiven and they’ll be working together from now on. And then he seems genuinely surprised and hurt when they immediately go right back to attacking him.
It’s also why in the early campaign he was constantly insisting that he’d win all 50 states and the black, Hispanic and Muslim vote, the NYT would endorse him, most Muslims supported his Muslim ban, etc. That he thinks everyone’s on his side explains his occasional odd uses of the royal we, and even odder uses of the third person.[2]
Again, this is not to attack the guy, but to the extent that we in the alt-centrist-sphere have influence (I bet Bannon and/or Miller are at least occasional Sailer readers), it helps to understand what makes the PEOTUS tick.
[1] Such as: Hillary calls to concede, Obama invites him to the White House, NYT says the Buzzfeed dossier is uncorroborated.
[2] “The Muslim ban is something that in some form has morphed into the ‘extreme vetting.’”
* The more I think about healthcare, the less sure I am. I’m not sure there’s a good system, only that there are always hard tradeoffs, and that there’s no system which is better than the other in all respects.
It’s difficult even to tell if a particular system is doing worse or better than the previous one. The US for example tends to pay more for its drugs than other countries, but in part that’s because it pays for research and development costs which other countries with centralized bargaining power avoid. However, it’s obvious that the US couldn’t simply replicate those better bargains, because in the absence of higher US prices there would be no R&D.
All I can tell is that the Swiss system is based on private insurers, is truly universal, very expensive, and at the highest level still not providing US quality technology (and for economy of scale problems often German or French clinics are better), and it’s difficult to tell if it could be scaled up to the size of the US. I’m not sure a Medicare for all system would work better than for example Obamacare, but it’s also a question of “for whom?” Maybe it’d work better for Latinos and even poor whites, but worse for the white middle class, or only worse for the upper middle class, or there would be more cheating as the upper middle class would just try to opt out of the system, or it’d slow down progress…
I don’t know much about it, and my feeling is the people in charge don’t know any more.
It definitely wouldn’t be the thing to start a presidency with, because the chances of failure are just that much higher.
* I think it’s quite true that, with a free insurance market, those with any kind of pre-existing condition would be shut out of the market, or at least face much higher premiums. The only way it could work is with some kind of group insurance, through a job or some kind of charitable society (the way it worked way back at the start of the 20th century). It was interesting for me to read about some of those lodges and friendly society of the pre-WWI, though; a worker through his society could buy a year’s worth of care with a day’s wage.
As I’m sure you know, European healthcare systems are not without costs or deficiencies. I think when it comes to healthcare, psychological security plays a big part, and Europeans are no doubt reassured by the idea of being financially covered. Actually getting care, on the other hand, is not guaranteed, going by what I’ve read of timeliness of care in most European countries, waiting lists and so on. This survey did a good job summarizing the pros and cons of 12 different countries:
https://object.cato.org/sites/cato.org/files/pubs/pdf/pa-613.pdf
* The requirement to enroll was the lynchpin, because otherwise the young healthy people who tend not to buy, and actually rarely need, health insurance wouldn’t be there to finance the scheme.
Supposedly we are talking about an 11 million person gap. I would think via an expansion of Medicaid and Medicare, and removing the atrocious employer linkage we could get everybody covered. Oh, and scrap the tort system. You can afford a casualty compensation system or you can afford a casualty tort system but you can’t afford both. Of course, that’s the last vestige of States as sovereign entities but that’s been in the works for 150 years.
“Health” is inherently uninsurable, but we’ll kick that can down the road like all the others.
* As long as the bills are paid they really don’t care how much anything costs, as long as the co-pay (which comes out of their own pocket at the time the service is performed) is small. If you ask them what some procedure costs they will tell you what the co-pay was, not what the hospital or physician has billed.
I have seen over the years that since our system of “insurance” covers a whole range of things that do not fall under the catastrophic umbrella, such as running to the doctor every two months to have blood glucose levels taken if you are considered “pre-diabetic”(can be done at basically no cost by yourself at home) and taking children to the doctor if they have a cold (all my colleagues at work did this repeatedly) that a great deal of what we term “health care” does not really improve people’s health. A doctor’s office is a seat of infection that should be avoided at all costs, as are hospitals. Look up how many people lose their lives annually due to mistakes made by the medical profession – it is horrendous.
* Trump is tackling the ACA because its held together with farts and chewing gum in the form of dictats from HHS Secretary and executive orders announcing how the government will view certain statutes, no matter what the original wording is.
Trump is smart enough to know that the minute he starts adding to the garbage fire that is the ACA, the Democrats and their media wing will go “Aha! You OWN it now!” Fixing it now and getting it out of the way requires a legislative fight.
Those of you who wore the zipper mask through the election can’t wait to break them out at every opportunity, I know. However, 95% of what Trump will do with immigration can be reversed by HIM, Day 1. Live by the pen, die by the pen. The ACA is going to be the fight in Congress, and he has to focus the firepower there first because he wants nothing to do with it down the road.
* Trump mentioned yesterday that the drug companies were “getting away with murder.” This hints that he might let Medicare finally negotiate prices. It’s a start on bending that cost curve in the direction Obama had promised.
The mandate needs to go. But if it can’t go, then instead of mandating private insurance premiums, and subsidizing their inflationary cost, the mandate could be shifted to Medicare. Think about it. Young people can buy into Medicare for less than ACA costs, and it shores up Medicare by bringing in new payers. They could adjust a premium for them to reflect that they’re still paying into the system with payroll deductions. I think it should be a option.
The Left that got excluded from Obama’s famous Table with its Conversations on ACA wanted a Medicare alternative to enforced purchase of private insurance. Given the relatively small number of workers, mostly self-employed, being ‘served’ by ACA, they could be moved to Medicare (or Medicaid) and shut down the ACA disaster.
BTW, I am on it. I am a beneficiary of it, and I support its repeal. As an example of the waste of money it represents, I cannot use the federal website. All of my business with them is done over the phone, which is expensive for the government and painful for me. Why? Who knows. Somehow, somewhere, someone entered some information into my account and now it is permanently unavailable to me to use. No one can fix that little glitch for me. Oh, and thanks for the subsidy. I’d tell you how much but it would ruin your day.
* Recently had the misfortune of having to speak to a psychologist regarding some cardiac health issues. They wouldn’t discharge me from hospital without an assessment of my emotional status. In the course of the interview he asked me with what gender did I self identify. The look on my face must have prompted him to add, “I have to ask that question.” Scary to think that he’s a mental health professional. I would prefer being crazy. How can someone buy into that nonsense without laughing at the absurdity of it? Confirms the wisdom of bailing on statist education when I was 15. Am so glad I never attended university.
* I’m sure it’s purely a coincidence that Stabby McGomez wanted to be know as “they” and Mother Teresa didn’t – it could have just as likely been the other way, right? Just like it’s a coincidence that all the black guys that the police shoot are “aspiring rappers” and none of them are brain surgeons like the black guys on TV. I’m sure Julia would say that the cops would shoot these guys EVEN IF they were brain surgeons, but by some odd coincidence, they never are. As soon as Julia finds the genderqueer Mother Teresa, let us know.
* I recently had to fill out a form from the state government. It had a question, “With which gender do you identify?” followed by, “Which gender were you assigned at birth?”
I was with a group of other middle-aged people and there was a lot of guffaws over this. The Hispanic bureaucrat running the meeting laughed and told us, sorry, but that’s the way it is these days. It occurred to me that he better not reveal that he finds it amusing if he wants to keep his job, because that’s the way it is these days too.
