From: bright@nazgul.UUCP (Walter Bright)
Newsgroups: pnw.general
Subject: Re: Trust Me - I'm from the Government to help you
Date: 10 Jan 93 07:48:16 GMT
Reply-To: bright@nazgul.UUCP (Walter Bright)
Organization: Zortech, Seattle

In article <1993Jan9.181008.11099@fylz.wa.com> fyl@fylz.wa.com (Phil Hughes) writes:
/Walter Bright (bright@nazgul.UUCP) wrote:
/And right now private insurance companies pay the bills.  I would
/rather not think of them as "responsible" for health care.  They are
/responsible to their stock holders and their mission is to maximize
/corporate profits.  There is no way that can be in the best interest
/of someone who needs health care.

The idea of a free market system is that by attempting to maximize profits,
the "invisible hand" causes one to service the needs of your customers.
If you do not operate to please your customers, then you either go out of
business or you get a law to prevent your customers from leaving.

/Ok, as I asked before, offer a better alternative.  I see no way that
/adding another level of overhead in paying health care providers can
/keep costs down.  Right now the insurance providers in the US only
/have an incentive to maximize their profit.  Yes, there can be
/competition but as long as their part is only overhead (they don't
/provide service) you are not going to have any real competition.

I don't understand. You propose to have only one insurance company,
in order to eliminate competition, but then say that the existing system
has no competition (at least that is my impression of what you're saying).

/I offer Seattle City Light vs. Puget Power as a local answer to this
/question.  Seattle City Light is owned by the ratepayers, Puget Power
/by the stockholders.  You could consider both a monopoly.  Compare the
/rates.  Seattle City Light, even thought it is government, provides
/better service at lower rates.

Not really a good example, because they both are legal monopolies, so we
don't really have a basis for comparison with a free market power company.
A better example might be to compare US Post Office next day service
with Federal Express. I know I always choose FedEx.

/: /doctors get paid less than U.S. doctors.
/: I imagine that this can cause a "brain drain" of the better doctors
/: emigrating to the US. Of course, one can resort to putting a wall
/: around Canada to keep them in...
/This question was asked at the talk I attended.  First, there are more
/doctors graduating from med schools in Canada than they need.  Second,
/doctors get paid more in the US than anywhere else.  Thus, if the US
/established fees similar to Canada doctors would have no where to run
/to.

One reason I advocate reducing the AMA's monopoly powers is that they
actively restrict the flow of new doctors, in order to keep doctor rates
high. You don't need a law about doctor fees, you need to remove the law
that prevents an adequate supply of doctors.

/: /Now, does this confilct with free enterprise?  No.  Canadian doctors
/: Yes. Legal monopolies are not free enterprise.
/You ignored the point.  First, I was talking about health care
/providers.  Doctors still work for themselves.  There is no monopoly
/in the health care provider industry.

You advocate a monopoly in the insurance business.

/Second, the government does not have a monopoly on providing health
/care.  Private insurance companies can, if the so choose, operate in
/Canada.  The catch is that everyone gets basic health care and it is
/paid for with "everyone's money".  But, if the Canadian "insurnace"
/wasn't covering what is needed people are free to buy additional
/insurance.  The fact that they don't supports the argument that
/apparently the system provides what is needed.

This sounds similar to the private school problem we have in America. A
customer who wishes to attend a private school basically has to pay double,
once for the public school and then again for the private school. This gives
a tremendous financial incentive to attend public school.

/I didn't say anything about lines.  I used the word _queue_ only to
/indicate that you may not be able to, for example, see a specialist
/about something immediately.  Emergencies are treated as such but
/there may (and probably will) be a wait for a procedure that is not
/dealing with a life-threatening problem.

Of course, what is a life-threatening problem is not decided by the customer,
but by the government. What happens if you disagree, or you die waiting
for treatment?

/: The vast experience in socialist countries is that if you artificially set
/: the price low, then the customers pay anyway in a combination of:
/: o	Inferior service
/: o	Long lines
/: o	Heavy infusion of taxpayer dollars
/Do you keep offering Soviet anecdotes because you see some connection
/with Canadian Health Care and Communism?  Study the Canadian model.

Yup. I see government monopolies in a futile search for "efficiency"
and "social justice" as the wrong approach.

/: o	Change the mission of the FDA from:
/: 	"Treatment shall be safe and effective"
/: 	to:
/: 	"If the treatment is not recognized by the FDA as safe and
/: 	effective then the patient must be so informed and must
/: 	specifically authorize its use"
/Basically I agree with this but don't really see how this is going
/to make a cost saving.

Because I know a number of people who work in the biotech industry researching
new treatments for disease. A *major* cost and impediment to success is the
FDA. An arbitrary and capricious ruling by unelected bureaucrats on the FDA
can ruin a company's investment. The more you impede and add expense to
new treatment development, the more the end user pays.

I don't remember the source, but I read that since the adoption of the FDA
the rate of new treatments coming to market has slowed substantially, but
the percentage of bad treatments reaching the customer has remained about the
same. In other words, the FDA has only succeeded in raising costs and causing
needless suffering (through delaying needed treatments).

The high cost of FDA approval has also stymied research into obscure diseases,
because the profit isn't there anymore. Medical research is pretty much
forced to concentrate only on developing cures for common problems.

/: o	Remove the monopoly power of the AMA to restrict the number
/: 	of physicians.
/I would expect that having more doctors would increase, rather than
/decrease, average medical costs.  Not that I am a fan of the AMA but I
/expect that doctors would "discover" all sorts of additional things
/that people "should" have done.

Huh? Basic economics is that as supply goes up, prices come down.

/: o	Make health insurance and medical expenses fully tax deductible.
/Sounds like Socialism to me.  And, again, it doesn't reduce the cost
/of anything, it just changes who pays the cost.

I didn't complete the thought. Right now, if a business provides health
insurance it comes out of pre-tax funds. If an individual buys health
insurance, it comes out of after-tax funds. Thus, it costs 20-30% less
to buy health care through your job. This greatly decreases competition
for insurance, as you are usually financially stuck with what your
employer provides, and other problems are caused like you can't change
jobs because you would have to change insurance providers, etc. Making
health insurance fully deductible to individuals would level the playing
field and make for more competition, thus lower prices.