Ezra Klein points out that we ration healthcare in this country, namely by simply pricing millions out of the market:
The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can’t afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can’t afford your first appointment, you never learn you couldn’t afford the medicine or test that the doctor would have prescribed.
We ration. And if the numbers and the surveys don’t convince you of the point, this is what it looks like when we ration.
Ronald Bailey at Reason replies:
Like most left-leaning folks, Klein clearly doesn’t know the definition of rationing. Take this one from Britannica:
Government allocation of scarce resources and consumer goods, usually adopted during wars, famines, or other national emergencies.
Klein evidently thinks that market outcomes that he dislikes mean that government should step in and impose outcomes that he does like. All right, let’s admit it; the health insurance market and the rest of health care are royally screwed up as a result of decades of government interventions and mandates. Consequently we don’t actually find the usual benefits of falling prices and improving products and services that we experience in normally operating markets where robust competition and choice reign.
It gets worse, but really, what is the point in reading anymore after that blurb?
So to be clear, if you get a box of chocolates for Christmas, and then tell your friend they can only have one because you are rationing them so they last longer, you are a BIG FAT LIAR because you are not the government.
If you work at a non-profit food bank, and you tell people only one five lb bag of flour because donations are down and you are rationing the flour, you are simply an idiot who does not understand what rationing is.
Likewise, when a health insurance company that you and your employer have paid premiums for two decades refuses to treat your ailment because it is an experimental treatment or they found something that might lend them to believe it was a pre-existing condition, they are not rationing, because they are not the government.
And for all the people who can’t afford health care and go without medicine because they can’t afford it, that really isn’t rationing, because it isn’t the government doing it. I’m sure that makes you feel tingly in your naughty places.
Are we due yet for another Reason piece about how libertarians want a serious discussion on health care?
Sirkowski
Thus, Canada is a fascist country…. e_e
4tehlulz
Brittanica puts out a Newspeak dictionary?
lawnorder
So rationing can only be done by the government ?
I doubt Britannica says that.
Sirkowski
fuck, fascism is supposed to be quoted too.
mcc
Also remember, it isn’t “censorship” unless a government does it. This is because the dictionary says so. The dictionary in my mind.
Dr. Squid
Ah yes, Another libertaretard who cherry picks and says, “See, if a non-goernment entity does something that looks like rationing, it’s noit rationing because they’re just being conservative which is good and they’re not the government which is bad. Nyah.”
Also, again with the idea that the government should never be allowed to participate in a free market. Yeesh. Sounds like Mary Landrieu’s type o’ guy.
Maude
Those places aren’t naughty.
James F. Elliott
Or, as my fucking dictionary puts it:
n.
1. A fixed portion, especially an amount of food allotted to persons in military service or to civilians in times of scarcity.
2. rations Food issued or available to members of a group.
tr.v. ra·tioned, ra·tion·ing, ra·tions
1. To supply with rations.
2. To distribute as rations: rationed out flour and sugar. See Synonyms at distribute.
3. To restrict to limited allotments, as during wartime
How many sources did Bailey have to trawl through to find one that mentioned government? The poon.
General Winfield Stuck
Yes, but but but, nobody is without health care, really. When you are near death we will see you at the emergency room and it will cost a bazillion dollars and then you die anyway.
See , just under the wire of moral hazard. Shut yer yappers libtards. Poor people can”t live forever.
arguingwithsignposts
I was just reading Will Wilkerson (thanks a lot, John Cole, for showing me another IGMFU Randbot’s blog to shake my head in astonisment at), when I saw this gem:
Wilkerson’s “partner” is an editor at Reason, so it’s not OT.
djork
Odd, Webster has it as:
1.: to supply with or put on rations
2. a : to distribute as rations —often used with out b : to distribute equitably c : to use sparingly
No mention of gubmint there.
CatStaff
Oh yes, businesses are all about robust competition and falling prices and looking out for the consumer and all. Why, just look at the banking sector and its recent activities if you want proof.
My dog, these people truly live in their own silly worlds, don’t they?
General Winfield Stuck
Dear Gawd. “market outcomes”. So that’s what they’re calling dying due to lack of health care these days.
Maybe we can outsource these shitweeds to bumfuck nowhere and regain our sanity. Imposed outcome indeed.
Sentient Puddle
Wait a second…to determine a definition of a word, he consulted Britannica, an encyclopedia?!
arguingwithsignposts
@General Winfield Stuck:
Don’t they also call paying out claims “medical losses” or some such?
Comrade Darkness
You missed the point entirely. This is all about righteous punishment for the unworthy. That’s why it’s not rationing.
General Winfield Stuck
@arguingwithsignposts:
Could be. Unless you get caught in a “Denial Engine” first.
slag
What I want to know is: Who is rationing Ronald Bailey’s oxygen supply?
South of I-10
No rationing. Right. Tell that to my friend and co-worker with stage IV breast cancer, who has every other PET scan denied by our fantastic insurance company. They can suck it.
MattMinus
Argumentum ad dictionarium is usually favored by the, shall we say, intellectually disadvantaged, but it’s downright hilarious when the dictionary doesn’t say what you want, so you run to the encyclopedia instead.
I guess my economics professors were either stupid or liars when they taught us about the rationing function of price.
Comrade Darkness
@CatStaff: This is the disjoint of all time. It’s the clutch that links lower middle class red ‘merica to the robber barons. Despite years of trying to understand what keeps it alive, I still can’t grasp it.
It’s 100% certain what would happen if you deregulated insurance completely. They would never pay out a single claim again unless by accident or drunkenness on the part of the clerk filing the paperwork. It would cut profit to pay claims, ergo no claims paid. Why would they if no one were forcing them to? It’s the only reason they do so under the current system. So, idiot red stater might say, they’d pay it so, what you wouldn’t switch insurance companies? Okay, that sounds like a healthy market, but you can’t switch insurance companies. Because you made a claim you now have a pre-existing condition and no one will insure you. No one. So, how does that market mechanism work again? Answer, it doesn’t.
Where did this delusion of a benevolent corporate entity come from?? It makes my brain ache. Children clinging to daddy, or what? It must be something infantile, it’s too stupid to be anything else.
lonesomerobot
i’ve had this argument with many of my libertarian (or leaning that way) friends, recently. i used to be a libertarian myself, i say. i also, more recently, used to live in australia – a country with a nationalized health care system.
so you can quote your ideological hoo-ha all day long, but i’ve lived both sides of this coin. quote studies from AEI, the cato institute, whatever. it doesn’t matter. i’m always going to believe my flesh-and-blood reality over your on paper ideology.
kay
I’m going the other way.
I’ve been thinking about what we could do with all the money we’re paying for-profit insurance companies lately, actually.
Can you imagine? That’s a lot of money.
If Medicare Advantage costs 14% more than publicly administered Medicare, and it does, just run that number out to the whole country. Take 15% off the top of what we’re currently paying private insurers, and free it up for myriad other things.
Allowing individual self-employed people or small business to buy into Medicare would be a good test, if we must be wishy-washy, and then we’d have results to look at.
QrazyQat
Why does it seem the main occupation of libertarians is to prove Seth Finkelstein right?
JM
All right, let’s admit it; the health insurance market and the rest of health care are royally screwed up as a result of decades of government interventions and mandates.
Ronald is stupid.
The healthcare insurance market was granted antitrust exemptions, which is why 94% of Americans live under monopolies.
There is no competition. The entire industry runs on fraud.
There are no intelligent arguments against fixing that.
lawnorder
I actually bothered to look at Britannica. It does have rationing (economics) as a government policy used in time of war or national emergency.
Which is not what is being discussed here. We are discussing Health Care policy.
handy
Leaving aside the rationing issue for a bit, how about this part of the quote John cites:
Does anyone have a non-snark answer about what the hell Bailey is alleging here? Just what sort of “government interventions and mandates” does he have in mind that have kept prices from falling? What, the Viagra one? Tort “reform?”
It seems he just throws that out there as is–no backing evidence–simply to prove his point: government is bad bad bad!
Warren Terra
If you Google “rationing”, the Brittanica link comes up eighth – and that’s not counting the dictionary definition link.
In fact, the very first thing you see on the page is:
Not a government in sight.
I guess he chose the Brittanica’s oddball definition because it has more authority than Conservapedia’s?
DougL (frmrly: Conservatively Liberal)
When the fuck has letting business have its way with the public actually led to lower prices?! Any ‘improvements’ in products and service that businesses come up with invariably results in higher ‘costs’ that are passed onto the consumer. Just let businesses run free and everyone will be in nirvana! These RandFucks parrot this shit like a See and Say toy yet what they claim has no basis in reality.
I was taught about supply and demand in school but that is no longer the way our markets work. Over the years, our pols have given the keys to the car to our markets and businesses so that supply and demand have no longer anything to do with the actual pricing and availability of something sold.
Shorter RandRoid: Trust business, not government.
I think Rand did the (so-called) deep thinking so these morans could do the parroting. Heaven knows that they sure as hell can’t think for themselves.
WereBear
I am also baffled by the right’s adoration of huge corporations. Maybe just because their leaders do; the ones with the huge bonuses and golden parachutes for poor performance.
It’s a fantasy on both sides, but only one is living it.
JM
There is no competition here. Capitalism was dismantled by the capitalists, and they bought the political cover they needed, getting around anti-trust laws.
Conservatives can’t grasp this. For them, it’s private, therefore it’s good. The fact that the VA and medicare get higher marks for less money is heresy. It’s impossible.
But it’s true: the public sector does it better for less. The private sector got rid of capitalism. That’s your healthcare system right there.
Corruption, apparently, is no bar to the admiration of profit. Capitalism is to be lauded even where it does not exist. Capitalists are to be lauded even when they act like Victorian monopolists.
… aaaaaaaand we’re back to “are they stupid or are they lying,” because they certainly have no argument.
jenniebee
Shorter Ronald Bailey: I never heard a corpse ask how it got so cold, but live libertarians can complain about the weather non-stop.
Alex
Per Webster’s:
2 : a share especially as determined by supply
lonesomerobot
@DougL (frmrly: Conservatively Liberal):
the problem is that “normally operating markets” never operate “normally” for that long. when profit is the outright motivator, “robust competition and choice” are antithetical to the true goal: dominance of market share. and the insurance industry is the poster child for this malfeasance, having long manipulated local and state governments to create (depending on the region) oligopolies, or outright monopolies.
Brachiator
Sigh. I like this as well. I call it the libertarian fallacy that all social and economic problems are the result of regulation, and perfect happiness will inevitably result from the removal of all governmental intervention and the unimpeded operation of the free market.
handy
@DougL (frmrly: Conservatively Liberal): @JM:
I guess I am giving Bailey way more of a benefit of the doubt than he deserves, but I’m just wondering what specific mechanisms is he referring to that have kept prices from being more competitive from the consumer’s POV?
Waingro
@handy:
It’s religious belief. They’re trying to shoehorn ‘Government Bad’ into an argument where it really doesn’t belong and as a result they sound fucking stupid. It’s just handwaving.
I love the arguments against mandates, ie- making sure your insurance company actually covers things besides sore throat or hangnails.
jenniebee
@handy: He thinks that regulations like “Insurance companies have to fulfill the terms of their contracts with their customers” and “insurance companies can not sell insurance that actually excludes all health care from their coverage in the fine print” are artificially raising prices by forcing insurance companies to pass the costs of doing something other than collecting premiums on to their customers.
In libertarian world, the question isn’t whether a person can get health care, the question is only whether the person has possession of a piece of paper that says “Insurance Policy” at the top.
jenniebee
@lonesomerobot: agreed. Really, anybody who thinks that a lack of regulation = free and open competition needs to read the history of Standard Oil.
Tresy Kilbourne
I’m reading this in my doctors office in rural Canada where I’m waiting to discuss the xrays the hospital took last week. Said hospital took me in immediately upon asking to schedule an appt. Todays appt I scheduled this morning. I never see any paperwork. God this rationed health care is nearly unbearable.
steve s
If “rationing is government allocation of scarce resources”, then medicare is government rationing. Congratulations Bailey, you just blew your foot off.
Who the fuck kept reading Ron Bailey after he published a global warming denial book? That’s like mounting a big flashing “I’m a Tard” sign on your forehead.
handy
@Brachiator:
The thing is, I see libertarians argue along the lines that the market is comprised of rational actors, who in their self interest, will make the choices that benefit themselves the most, thereby “rewarding” quality products and services and conversely “punishing” poor ones.
The problem, especially wrt health care, how can the rational actors in these markets know what’s in their best interest if, for example, the drug they need to take to relieve a physical pain in fact might be a threat to their health? In other words our rational actor would have to have a comprehensive knowledge not only of general medicine but of her particular pre-conditions.
Which is to say that our rational actor is living in a world very far from our own. And so is Bailey, apparently.
WereBear
To me, the deepest irony is that these arguments wouldn’t last longer than a snowball in hell in a free market of ideas; they have to be supported with wingnut welfare.
handy
@jenniebee:
Maybe he’s saying that, maybe he isn’t. That’s the biggest problem I find in his whole argument, which is that it is one set of vague assertions.
SGEW
@steve s:
He did? (googles) Huh, he did. However, he retracted his denial, acknowledged AGW, and then issued an apology for being wrong. But here’s the kicker! Check out this, from his mealy mouthed mea culpa:
(emphasis emphatically added)
So close! And yet so far.
(cf.)
slippytoad
John, I haven’t taken libertarians seriously since Stan Jones arrived on the political scene. He convinced me that Libertarians most likely suffer from some sort of oppositional-defiant disorder because no matter what you tell them, if it means that the government will have anything to do with them, they insist that it’s WRONG WRONG WRONG WRONG. Even if it means literally talking until they’re fucking blue in the face. Or taking colloidal silver even though the FDA says it has no medicinal properties whatsoever.
Shorter slippytoad: Libertarians are FUCKING stupid. I don’t give them any benefit of doubt anymore.
Brachiator
@handy:
Yep. In addition, libertarians assume that anything a business does independent of government control is by definition the free market at work, no matter what the result.
Most libertarians I have ever known or discussed this with always assume that they can perfectly obtain and digest information, and make a perfect decision. Here, they assume a perfect theoretical model of the universe, and can’t be bothered with messy reality.
I decided long ago that libertarianism is not an economic theory or even a coherent philosophy. It is a form of fundamentalist religion.
Brett
Somebody should tell Bailey to take a basic economics course, or at least spend more time using Wikipedia. The very first thing we were taught in Micro-Economics is that the foundation of economics is scarcity (i.e. “Wants are unlimited, resources are not”) and the market system rations resources. Rationing is at the very heart of the market system (rationing by price).
Knowing Bailey, he probably thinks the Free Market is Magic.
Jack Newhouse
Obviously Websters is a vile, liberal poopyhead publication for not mentioning that ONLY the government can ration. The liberal bias of reality strikes again…
J
I suspect much libertarian argument about freedom works in the same way; the only constraints on freedom are, by definition, those imposed by states. In the absence of government power, one is free to do anything one pleases as, for instance, in Somalia, where if one is prevented from doing something one would like, say taking a walk, raising a family in safety, by dire poverty, disease, roving gangs of killers or the like, whatever else it is, it won’t be a constraint on one’s freedom.
jl
If anything good happens, you impute it to the market.
If anything bad happens, you impute it to the government.
Therefore, government is always bad.
QED.
And, that my friends, is libertarian logic.
Ed Drone
Okay, if the government does it, it’s “rationing,” but if an insurance company does it, what should it be called?
My suggestion: THEFT. FRAUD. Highway robbery. After all, they take money for services not rendered. Since they are not the government, we can’t call it rationing, so let’s call it what it is!
Any other suggested terms?
Ed
Mark S.
I sort of wish libertarians could be given one year to enact all of their stupid ideas so we could rocket them into the sun in good conscience.
PeakVT
This is more or less the textbook definition of economics:
Economics is the study of how people make choices under conditions of scarcity.
Apparently the entire economy is a method of rationing. Who knew?
…. f*cking-A, McAddled is on Marketplace again. What the hell is wrong with the people on that show?
Ailuridae
Interesting that he went and found that Britannica piece and managed to miss this one:
http://www.britannica.com/blogs/2009/06/health-care-rationing-get-over-it/
Arguing about rationing is conceding the argument. I like Ezra but his point shouldn’t be to argue rationing already exists in our mixed model health care system; instead he ought to have attacked the right’s use of rationing and pointed out that it was hollow and meaningless. We all remember actual rationing in WW2 and nothing like that kind of rationing exists in either Canadian Medicare or the NHS. Instead, when Krauthammer et al talk about rationing they are doing little more than arguing that the terms of distributing health care to those who have it – Krauthammer is in favor of a set of rules that is swallowing the GDP of this country year by year and is incredibly unjust to all but the wealthiest, retirees and veteran. In contrast reasonable people want to control long-term costs, provide economic security to small business and the self-employed and stop widespread personal bankruptcies from health care.
arguingwithsignposts
@SGEW:
The “perhaps” is the punchline. Comedy gold.
The Crafty Trilobite
So, Negro slavery would be okay with libertarians, then, as long as it remained free-market ? Glad we cleared that up.
Ailuridae
@steve s:
To be fair, I would imagine Bailey thinks Medicare is tyrannical. I’m not being glib (no pun intended); Bailey isn’t an elected official so he can make all sorts of absurd, empircally-incorrect claims that Republican politicans (many of whom I suspect believe that Medicare and Social Security are also tyrannical) also believe but can’t admit to and ever be re-elected.
arguingwithsignposts
@Brachiator:
Is that yours? I’m stealing it.
Mark S.
@slippytoad:
Wow, that Jones guy sounds like fun:
But at least he would never allow the government to ration it.
Ailuridae
@Brachiator:
Its very easy to posit solutions to problems for libertarians if they set up a structure where none of their hypotheses are falsifiable and this, of course, is the logical extension of any sort of ‘hard’ libertarianism. It makes them all Austrian school nutbags – until there is no regulation nothing will improve so pointing out that lessened regulation (the last 30 years in finance) was an unparalleled doesn’t give them pause at all
burnspbesq
@MattMinus:
“I guess my economics professors were either stupid or liars when they taught us about the rationing function of price.”
Probably neither, but they were most likely liberals.
rs
What a convincing argument.
I think we need to start letting the market operate normally with police and fire and EMS, road plowing, parks, libraries, air traffic control, the military, navigable waterways and harbors, bridges and tunnels, public health departments, the NIH (because we don’t have enough drugs for erectile dysfunction).
Every one of us would have to be wealthy to get through a single day using all of the services we take for granted. I’m right with the libertarians when it comes to being left alone to smoke or snort what I want while I screw and maybe then marry who I want, but their faith in the market is on a par with creationists and their belief in a 4000 year old Earth where Jesus rode a dinosaur to temple.
Brachiator
@arguingwithsignposts:
RE: I decided long ago that libertarianism is not an economic theory or even a coherent philosophy. It is a form of fundamentalist religion.
As far as I know, it is original with me. Use it with my pleasure.
Sentient Puddle
@Ailuridae: So not only did he cherry pick the definition that was most favorable to his position (from a non-dictionary source, nonetheless), a writer for the source in question already demolished that line of argument.
Truthiness in action here, folks.
jenniebee
Just read Klein, and I have to say, wtf? Canadians are waiting 4 months for elective procedures and this compares to… nothing in the American system. Private insurers – at least all the private insurers I’ve ever had contact with – do not cover elective procedures. In the US, you can get your elective procedures right away, but only if you start counting from the day you’ve put the cash together to pay for the procedure. You may be able to get in for liposuction or breast implants or a nose job or non-covered life-saving treatment the day you call, but that’s comparing apples and oranges; your real wait time didn’t start when you called, it started when you decided you wanted or needed it and started saving up the cash to pay for it. A more accurate measure would be to compare the wait time for Canadians to the amount of time Americans spend saving up for a procedure plus the time they wait for it to happen.
Ailuridae
@jenniebee:
I am not sure its elective as much as it is non-emergency. Thing of fair skinned people and suspect mole removal. In America with good health insurance thats probably a 4 week wait. In Canada it averages out to a four month wait.
sven
Your economics professor should be beaten with a Polish Salami. The GOOD part of markets under a capitalist system is that in right circumstances they are a much more efficient method of rationing than other systems.
No rationing under private insurance? Cool, I’m going to get an MRI tomorrow just because I have never had one before.
A post titled, “Elementary Economics: The Price as Rationing Mechanism,” from the libertarian-leaning blog Outside the Beltway can be found at this address.
http://www.outsidethebeltway.com/archives/elementary_economics_the_price_as_a_rationing_mechanism/
kay
The real dilemma for me is this: I do not mind paying higher income taxes so everyone is insured. What I will mind, however, is paying that subsidy to private insurers. I simply will not pay taxes to subsidize shareholder profits and lavish executive pay.
It’s as if you told me the social security payroll deduction was first going to investment brokers, to take some of the top, and to sort of launder my mandatory contribution through the cleansing fires of capitalism. It’s just nonsense. It’s a scam. It doesn’t benefit me at all.
I’m not subsidizing a for-profit entity, and I’ll have to do that with a mandate coupled with a purely private market.
I am currently subsidizing a private market that has captured 20% of Medicare, since 2003. I don’t want to hand them another windfall. They’ve done an astoundingly poor job with just 20% of Medicare.
Seriously, are we suckers, or what?
Tom
I noticed that dude at reason didn’t link to Britannica.
I stumbled across this from their blog:
http://www.britannica.com/blogs/2009/06/health-care-rationing-get-over-it/
Sloth
Yes, this is very true. That said, there are going to be market structures where intervention is necessary, as that blog says.
When you find a market where the good is regarded as a societal necessity and where the pricing process causing the good to be unavailable to a large proportion of the population, you have a problem. The libertarian POV of view is that the government just needs to deregulate and the invisible hand of the market will magically solve all of these problems.
The flipside of that argument is that the market may well be of a structure that will result in limited competition, the resulting rents (i.e. profits) will not be acceptable to society as a whole, and price regulation will be required.
Available evidence, i.e., the entire rest of the civilized world, suggest that something between socializing the entire medical system and dropping strict price regulation will result in a system that has much lower costs than what we have now and generates goods of a comparable (if not better) quality.
Now, we could choose to go it alone and just deregulate the whole kit and kaboodle. A grand experiment. Maybe it will work better. More likely it will be an utter disaster (every single segment of the health care market exhibits strong economies of scale suggesting that we’ll see a series of oligopolies.)
Or we could take the path that has been tried all over the world and manifestly works: socialized medicine, single payer, a public option or very, very strict price controls. Something on that spectrum.
Ailuridae
@kay:
But you already do pay to subsidize those corporations. Business that provide healthcare and employees that receive it do not pay any tax on the part the employer chips in. Additionally self-employed folks (like myself) get a straight tax deduction to buy their insurance. Unfortunately the only way for any of us- the self-employed, the employee or the firm to buy insurance is through private insurance the overwhelming majority of whom are indeed fattening at the public trough. If there has ever been a clearer case of tax breaks as corporate welfare I can’t think of what it would be (actually I can but don’t think IRAs are relevant to the larger point).
You’re right about Medicare Part D – its a disaster. But I wonder if the percentage of money that ultimately lands on the head of the taxpayer through missed tax revenue is higher or lower in normal insurance than the share in Part D. By the way, I am assuming that the Dems have every intent of reigning in Part D as a separate measure after larger scale HCR is passed because its a huge driver in the long term deficit.
kth
Bailey is sort of right: strictly speaking, rationing doesn’t just mean that a provider doesn’t pay for it, but that you are forbidden to buy it from anyone else. It’s a lot fuzzier to call something rationing just because a third party won’t pay for it.
Of course it’s the anti-reform side that introduced “rationing” in the bogus sense of the government not paying for something. Even with the British NHS, widely considered the most intrusive and restrictive health care system, no one is prohibited from buying health care services outside the system.
b-psycho
@JM:
I wonder what the justification for that was…
No, seriously, I can’t think of a rational one. Anyone?
BDeevDad
@kay: You are also already paying for the uninsured via the private market at approximately $1000 per family policy or $380 via individual policy.
jenniebee
@Ailuridae: And in the US, you’re taking your chances that the insurance company won’t decide to write their software so that all mole removal in its loading procedures defaults to the code for a cosmetic procedure and you have to fight them to get it covered.
steve s
Wouldn’t have any rockets left. Or the free time, cause we’d be too busy hiding from armed rape gangs.
worn
Comrade Dread
Rationing is the distribution of scarce resources. Klein is quite correct in an economic sense.
In a free market system (or even in a limited free market like we have), prices are used to distribute scarce resources to the public.
Because everyone can’t have all of the gasoline they might want, prices are used to balance supply and demand resulting in efficiency. Everyone who is able or willing to pay the fixed price of gasoline can buy as much as they care to, and everyone who is unable or unwilling does without.
The higher the demand, the higher the price, and in most normal markets, this would result in more people being tempted into becoming a supplier of the scarce good.
However, medicine is very specialized and requires years of preparation, and insurance and Medicare do skew pricing, as does regulation. (Note: This is not a bad thing as I would prefer my doctor’s to have some oversight.)
steve s
@Ailuridae:
Oh, he probably does. I was just referring to him saying “Like most left-leaning folks, Klein clearly doesn’t know the definition of rationing.” Bailey claims that Klein was wrong, rationing does not currently exist. And then Bailey went on to use a definition under which Klein is right, rationing does currently exist.
kay
@BDeevDad:
I think we’re going to end up with a mandate. I think there is wide recognition that a mandate is necessary, because the system is unsustainable. Republicans know it, but they’re congenital liars. President Bush has already imposed a mandate on anyone who pays child support. In my state, if you pay child support, you pay 5% of gross towards “medical support”, unless you are under 150% of the poverty level. That’s the 2007 Bush mandate. Imposed by fiat.
I think I’m being sold a mandate without a non-profit option.
I just bailed out these creeps on Wall Street. Now I’m going to subsidize the creeps who run for-profit health insurance?
I’d rather buy into Medicare.
kay
@Ailuridae:
I actually learned about Part D here, following helpful links, so thanks for the clarification.
My stomach hurts when I think about 15% of gross mandated to private insurance coffers, for lower middle class, who are not making it anyway. That’s unconscionable. It’s a huge pay cut.
I know the US has to throw health care cost somewhere. Why do I just know my clients are going to get screwed when the dust settles?
I would happily pay towards the uninsured buying into Medicare.
As far as I’m concerned, Medicare Advantage shows us that the “private option” is a huge rip-off.
kth
The comments to that post are a cesspool, btw; someone calls Ezra Klein, probably the most decent and temperate blogger in the whole ‘sphere, a “twat”.
Brian J
I always thought that the government should step in only when there is a market failure, such as we see with the right pricing for carbon pollution and so on. Then again, perhaps people not having health insurance and health care just isn’t a problem for these guys, no matter what the outcomes. I suppose that the folks at Reason feel those who don’t have enough to eat should simply go without food, whether or not that means they will starve to death. After all, it’s only natural that they are priced out of the market for food, and the government stepping in to correct that with some simple policies like food stamps and the like just isn’t right because some won’t like it.
Sure, he can hide behind a technical definition, but a simple Google search reveals that people use the term in a variety of contexts. Basically, where there is scarcity, there is rationing, whether it’s determined by natural forces or something else, and anybody who uses the term in an allegedly colloquial fashion isn’t expressing some insanely bizarre concept. It’s pretty ridiculous that this is the best he can do.
Now, as for his contention that the government has screwed up health care, perhaps he’s right in some sense. There are some who claim a lot of inflation in that area is due to government intervention, and while I doubt that’s the majority of the cause, it’s definitely plausible. But unless his next claim that prices would be falling so dramatically if government were to remove itself from the vast majority, if not all, of its involvement in health care, he still doesn’t have much of a point. Unless there is an unlimited supply of services or products–in other words, no scarcity–there will still be people priced out of the market. What’s his solution there? Or does he simply not care? It’s probably the latter.
Sloth
This is where I part ways with a lot of libertarian thinking. “Assuming a normal market”. It seems to me that a competitive market is actually fairly rare, and in the case of healthcare, probably mythical. Not only are there the barriers to entry that you note, but the economies of scale are going to favor a few large players in health insurance, maybe hospitals, and certainly pharma. So we’re probably going to have to do some regulation just to keep those markets honest, even if we totally lift all other regulation. If we want to do that.
Tonal Crow
Or, to quote the Red Queen:
“Conversatives” dived through the looking glass en masse sometime before W’s advent. They have since become more postmodern than most postmodern theorists. At least the theorists don’t usually act as if language has no meaning.
Tonal Crow
@Tonal Crow: Rats. How could I misspell the Enemy’s name? That should be “conservatives”. John, I can haz edit button? Mrrrow?
Tonal Crow
On the gliberarian’s main argument, it’s but an argument for corporatocracy. Individuals don’t have nearly the market power, information, or — critically, when important health issues are at stake — the time or energy to stand up to health insurers, doctors, and other market participants. The market cannot work efficiently or humanely without very strong regulation. There’s a reason we have regulated utilities, like retail electric service. The same reasons apply to healthcare, glibertarian rants notwithstanding.
jibeaux
Whoa, guys, you’re missing the broader implications here. If the government just got out of *everything*, we would have tons of shit.
Reason, is, like, blowing my mind.
Seriously, what a fucking stupid argument. I think they should take it to Rwanda and explain how since there is no functional government, their food couldn’t possibly be rationed.
grumpy realist
The most amazing brain-fart that I consistently see from Libertarians is their axiomatic assumption that if government does something, it is BAD, whereas the very same activity, if done by the private sector, is GOOD.
They also never seem to catch on to the fact that the reason the government is “more inefficient” than the private sector is that the government is mandated to cover *everyone* when it offers a service; the private sector can decide at what point it’s just not cost-effective any more.
Example: if the US Postal Service could tell all those people living out in the middle of nowhere that no, it wouldn’t deliver mail to anyone that was further out than 20 miles from the center of any town unless they paid $50/letter, then YES, the USPTO could cut costs quite a lot….
Mike P
@General Winfield Stuck:
What’s dumb here is that Ezra isn’t advocating for a government determined outcome; rather, he’s simply arguing for something these nitwits claim they like, and that is merely competition. If these private companies are so good, then they’ll be able to keep people from joining the public option. It’s not that hard to understand.
Why do conservatives and libertarians hate the free market? The Obama administration has already said they would put restrictions in place that would prevent the government from deeply undercutting the private firms, so I don’t know what else these douchebags want. Oh wait. I do. They want to claim they care about budgets after they cheered and supported the W tax cuts and the prescription drug benefits and two wars. They want to act like the big kids by striking a pose of seriousness after they let all of the personal liberties they profess to care so deeply about die under the most expansive government intrusion into those personal liberties that any of us have ever seen. So now they find their footing by saying that we should be ok with the idea of guns at political rallies.
Whatever.
Libertini
@slag: If the position is open, I can start right away.
J. A. Baker
@Dr. Squid:
I prefer the term “glibertarian.”
arie
canada has 30 million people. we can easily find a set of 30 million americans getting the same or better healthcare and life expectancy, etc.
it is stupid to keep comparing countries when the countries with more explicitly public options are much, much smaller, younger and population-centralised.
as well, all the ‘better’ healthcare these other countries have doesn’t appear to have gained anyone eternal life, or even guaranteed 100 year lifespans. at best, a few extra years, most of which is attributable to lifestyles very different than american ones, not so much that they could get prescription cold medicine at the doctor’s instead of non-prescription at the walgreen’s.
genetics (your personal family tree) is a better benefit than being able to visit the doctor ten times a year instead of two.
maybe i live in a mysterious parallel america, but doctor visits in cash are 30-60$, and free if you have no money, prescriptions are free with visit or comped some percentage out of the doctor’s pocket, and even surgery can be negotiated on price before you show up. or you pay a small sum (40-100/month) and you can bring yourself and your kids in as often as you like, no ‘copays’ or ‘deductibles’.
this kind of stuff already exists to provide cheap, accessible care to people. why not actually expand such private options that are in fact tailored to serve the poor and working class? we already have private doctors working directly with patients to give them cheap preventive care without even needing government or private insurance. we COULD support that with government grants if one wishes to give away freshly printed money. then you get all the benefits of helping people out directly without giving free jobs to social work majors.
Wile E. Quixote
This is one of the primary reasons why I no longer consider myself a capital “L” Libertarian. Back in the late ’80s and early ’90s when I was spending way too much time on various newsgroups arguing about libertarian principles it struck me just how many capital “L” Libertarians there were who were OK with horrible abuses of power by private corporations. Whether it was running company towns to keep workers in debt, hiring goon squads to break strikes and bust heads or polluting tthere was always a significant contingent of Libertarians who would argue that in reality this sort of thing was actually the government’s fault and that if we had a truly free market that respected everyone’s property rights that this sort of thing wouldn’t happen.
I don’t know what was wrong with me (by Libertarian standards anyways) because I looked at these situations and couldn’t see how being savagely beaten by a bunch of jackbooted thugs working for Pinkerton (or Blackwater/Xe) would be any different or any better than being savagely beaten by a bunch of jackbooted thugs working for my local police department or the DEA, FBI, ATF, etc. Try as I might I just couldn’t perform the mental contortions necessary to believe that there were any meaningful differences between being fucked over by a private corporation and being fucked over by the government* From my reading of history when private corporations were fucking people over it was government intervention that made them stop doing so, not market competition from companies that weren’t evil.
It was around this time that I realized how much the capital “L” Libertarians were like the communists I used to encounter around the UW campus. Point out to any of these communists that every time a communist political system has been put in place that it has turned out to be at the very least miserable and more often than not insanely murderous and they’d basically say “Ur doin it rong” and then talk about how things would have been different if Trotsky had taken over instead of Stalin after Lenin died, or how true communism had never been put into practice because none of the nations that called themselves communist had evolved according to the dictates of Marxism and hadn’t reached a sufficiently advanced mode of production to become truly Marxist, etc, etc, etc, etc.
Arguing with these people and pointing out that the reason why Trotsky had to leave the Soviet Union wasn’t because he wasn’t a ruthless murdering bastard but instead was because he wasn’t as much of a ruthless murdering bastard as Stalin or that no advanced capitalist country had become communist or was about to become communist and they just ignored you or called you a fascist or told you that you were an idiot for believing the “lies” that capitalists had spread about communism. Similarly if you pointed out failures of the market to Libertarians, or historical examples of brutal abuses of power by private individuals, or flaws in any of their reasoning, arguments or logic and you were either ignored by them, called a statist (or a fascist, or a communist, etc) and you’d get an earful about horrible abuses of government power throughout history.
*I also had the same problem with Jeanne Kirkpatrick’s essay Dictatorships and Double Standards” (aka “Dictatorships and Doublethink”). I just couldn’t see, regardless of how many times I read the essay, how it made any difference as to whether or not the government that was hooking electrodes to your testicles was totalitarian, as defined by Kirkpatrick, or merely authoritarian.
Will
Fuck Ronald Bailey. Fuck him.
Will
@lawnorder:
That’s why moron says “Take this one”. Because Brittanica offered a series of possible uses of “rationing”, and moron cherrypicked the one best suited for his “response”. The others mentioned nothing about “government”, because rationing is obviously not exclusive to “government”.
Fuckers.
Chuck
@Wile E. Quixote:
The rationalizations you faced can be summed up in three words: “No True Scotsman”.
No TRUE communist regime would be oppressive…
No TRUE libertarian system would be feudal…
No TRUE christian would promote hate…
etc.
Sly
Ignorant slop. And I thought the Weekly Standard was bad.
Competitive markets are supposed to do three things, based on the assumption that competing firms will try to reach the point where what they produce equals the demand in the marketplace.
1) Keep prices low. Competitive markets take price controls away from producers and put them in the hands of consumers. People won’t buy something from a business if they can get an identical product or service, or a reasonable facsimile, from another business at a cheaper price.
2) Create allocative efficiency. The opposite of rationing, in essence. Firms are supposed to be responsive to what the market is demanding, and produce goods and services that people will want. This is why you won’t find, in a given market, a hundred different businesses making umbrella stands and only one making food.
3) Make competitive firms financially successful.
When all three of these criteria are not met, it is consider an example of market failure. These criteria usually are not met when the incentive structure for doing business in a particular market has been fucked up royally by collusion or political largess on the part of the firms themselves.
There is a specific scenario where you find rising prices, allocative inefficiency, and profitable firms. It’s called monopolism.
For libertarians, or anyone who has treated Milton Friedman as a holy prophet, monopolies are only created by governments or through collusion. Unrestrained competition negates the possibility of a handful of firms gaining complete dominance over a particular market. What they usually fail to understand is that the business of insurance does not abide by the same rules as other competitive markets, largely because insurance firms are required to create allocative inefficiency (through risk selection) and hide costs through anti-selection to become competitive.
Grumpy Code Monkey
In one sense, Bailey is right; what we do now cannot be called “rationing”, since one of the goals of rationing is making sure that everyone gets a share, no matter how small. That’s not what’s happening now.
Someone smarter than me (Nate? Ezra?) pointed out that the market’s solution to the problem “not everyone can afford adequate health care” is “not everyone gets adequate health care.” According to Libertarians and Randroids (most of whom have access to adequate health care), this is right and proper and the natural order of things; there is no problem to fix. For normal human beings, however, it’s an intolerable situation.
“But anyone can go to an emergency room.” Yes, and emergency rooms are overburdened with non-emergency cases, and in the end someone has to pay for indigent care, and those costs aren’t being controlled.
LarryB
@Waingro: Every time you try to talk to a libertarian about some sort of capitalist bad behavior they come back with “government “interference in the marketplace created it”. After years of scratching my head over this, I’ve come to your conclusion: it’s a religeous thing.
Otto Schmidlap
Rationing as defined from the horses mouth:
“I believe we’re getting the pushback because we are standing up for what we believe in,” said Cheryl Tidwell, 45, Humana’s director of commercial sales training. “We believe there’s a better way to control costs by controlling utilization and getting people involved in their health care.”
http://www.nytimes.com/2009/08/28/health/policy/28insurer.html?_r=1
(see also David Sirota post at Openleft)
Pug
I guess my economics professors were either stupid or liars when they taught us about the rationing function of price.
I wonder if we had the same misguided economics professor because I learned that markets…yes, markets… ration goods through price. That is exactly what they do.
Rationing is the heart of capitalism. Everything traded in markets is rationed. The mechanism to accomplish rationing in the free market libertarians claim to love so much is price.
Is there some other place where libertarians learn basic economics?
different church-lady
Actually, Baily is right: this isn’t rationing of health care. Rationing is when you don’t have enough of something, so you try to share it equitably, in a measured way.
What we have now is actually much worse: the commoditization of health care, where something is made artificially scarce and sold to the highest bidder.
skippy
bet bailey had to look thru 18 dictionaries before he found a definition w/the word “government” in it. why not websters? why not funk & wagnalls?
dictionary.com sez rationing is:
nowhere does the word “government” appear. the closest thing is “military.”
Robert Waldmann
The point (made upthread I’m sure) is that people who claim that health care reform will lead to rationing can’t have it both ways. If telling people you can have that, but you have to pay for it out of pocket is rationing, then we are have health care rationing now. If it isn’t rationing, then we won’t have rationing even if health care reform is enacted. No one is proposing a ban on buying non covered care out of pocket (except for morphine and cocaine and such like pharmaceuticals which physicians already can’t presribe to anyone who asks ).
Their position must be that any limits on public payments for health care to people over 65 are rationing and unacceptable, while any public payments for health care to non poor people under 65 are socialism and unacceptable. Basically they have an interest group — the elderly — who they can convince might lose if health care is reformed. They are appealing to selfishness (in fact, according to the bills on the floor of the house and senate the only change for the elderly is that the prescription benefits doughnut hole will be closed so the elderly gain unless they are real rich).
There is no possible philosophical basis for the claim that we must pay for everything for people over 65 (not that we do now) but may leave people under 65 without health care. Hence the incoherence.