“What he hasn’t done is lie in a corridor all night at the Royal Free [Hospital] watching his severed toe disintegrate in a plastic cup of melted ice. I have.”
— James Christopher, writing about Michael Moore’s film, “Sicko”
Paul Krugman writes:
“We have always known that heedless self-interest was bad morals; we know now that it is bad economics.” So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn’t one of those cases where we face painful tradeoffs — here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.
So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can’t overcome those forces here, there’s not much hope for America’s future.
I just have a few points:
1.) Self-interest is not bad economics. By contrast, I would actually consider most of FDR’s economic policies to be bad economics.
2.) How would universal health care save lives? Krugman makes the claim, but provides no evidence.
3.) It is government regulation and tax incentives that have ruined our health insurance system. Employer-based coverage leads to over-consumption. What’s more, individuals are not only less sensitive to the price of care, in some cases, they are not aware of the prices whatsoever. The single payer system is not the panacea that Krugman claims it to be.
4.) Krugman claims that, ” the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens.” He further mentions that health care is about morality. That may be, but health insurance is different than health care. Individuals do not have a right to health insurance on moral or economic grounds. A poor, uninsured man who arrives at the hospital having a heart attack will be treated. Perhaps the hospital will write-off the cost of the treatment or perhaps they will attempt to get the man to pay from his own pocket, but he will be treated.
His discussion of scare tactics is ironic given the fact that the single-payer crowd loves to appeal to pity. They often reject economic arguments and argue about the moral superiority of the issue (“This goes beyond economics…”). However, at its very core, the issue requires the application of economic concepts, not moral suasion. The theme may be different, but horror stories are just as common under single-payer and nationalized systems as under our private system. Ironically, our system’s horror stories are often confined to those who are unable to get insurance, while those with socialized medicine are unable to get quality care.
You state that if a person doesn’t have insurance that the hospital will still treat them. A woman just died in a Hospital emergency room because she didn’t have insurance, while her husband was on the phone with 911 to get her to another hospital who would treat her. And, if a hospital treats a person and does not get paid for their services, they might write off the charges, but then cost shift those expenses on to the backs of all other beneficiaries of healthcare, in the form of higher charges, which the insurance companies pay to the hospitals, and in turn jacks up our premiums or raises our deductibles and co-insurance. So it is an economic fact that we could have equal or better care, for less money, and less waste and less promotion of the use of the care (pharma commercials telling us to “ask our doctor”) and avoid the need for hospitals and other providers to cost shift the expense on to all of us. We pay for it one way or the other, we might as well pay for it through a “tax” or “fee” for those who have an aversion to any TAX, and eliminate the huge profit of the Insurance Industry which brings no added value to their service. That is Economics, in a nutshell.
Lani, you’re talking about two different things. Since you aren’t providing specifics about the anecdote, I can only speak generally in return. What really happened was that the husband wasn’t trying to find a hospital that would treat her, but a hospital that would treat her *faster*. The hospital no doubt *was* going to treat the woman, but only eventually, because at least one of these two things were true:
1. Other patients were assessed more critical. This is the more probable.
2. Without insurance, you must go through an admissions process that can take a long time. If you don’t have insurance and have others waiting ahead of you, and you’re not deemed in immediate need of care, it can take a while for nurses and doctors to get to you.
What is actually economic fact is that health care is a finite resource like any other, and it is high demand for a limited supply that causes the price of health care to be high. Furthermore, demand increases as the price goes down. An emergency room is required by law to treat everyone, regardless of insurance and ability to pay, so it has become a “free” health care resource for a not unsubstantial percentage of the population. Because the price is therefore kept artificially low (zero) for those who otherwise couldn’t pay, it creates not only a scarcity of the resource, but a *shortage*. The difference is that a scarcity means there isn’t a relative lot of the resource, and a shortage is that there isn’t enough of the resource to satisfy all the buyers at the current price. That’s the true economics behind emergency rooms.
It’s tragic that the woman died, but it’s not other people’s legal responsibility to pay for the care of others. It is not a legitimate power of government to coerce property from some people and use it to pay for the benefit of others, even if it is to save lives. You may have a moral duty to help your fellow man, but not a legal one, and legitimate government has no power to coerce you into performing moral duties. There’s the moral argument.
The practical argument is that you advocate paying six instead of a half-dozen. Instead of having a government-charged “tax” or “fee,” why not just have people pay for their own health care? As Josh and I have pointed out for a long time, the problem is ironically that so many people are insured, and since they aren’t paying out of pocket, they aren’t careful about how much health care they consume. The solution is to make people pay for the health care they use, not just for emergency rooms, but particularly emergency rooms.