Stossel Solves the Health Crisis with Capitalism

[Lonewulf]

You've got a pretty loose definition of coercion. When I talk of coercion I'm talking about the threat of violence. Not patronizing a particular business because I don't like the way they operate doesn't seem coercive to me.

Boycotts are pretty coercive, yes. They're about not giving someone your business, which, when done enough times over enough people, puts the person you're boycotting out of business. So it's threatening to drive them out of business if they don't do what you want.

 

[Darat]

I never said that a single physician was an island. I never said that cooperating and pooling of resources was bad. Exceptional individuals working with other exceptional individuals has improved our world dramatically. I don't see why organisations of cooperative individuals would cease to exist just because coercion goes away. Anybody whose taken a leadership course has learned that the least productive teams are the ones that are being coerced.

But we aren't talking about some utopia, what this thread is about is whether the USA, as the world currently is, would be better adopting a universal health care system or not or just trying to tweak its current non-universal system so that it will become a universal health care system in all but name.

 

[Lonewulf]

But we aren't talking about some utopia, what this thread is about is whether the USA[...]

Isn't it amusing that, no matter how what system or proposal you're talking about, in the Utopia, it always comes out just right, and just as the proposer imagines?

 

[Rolfe]

And in Utopia, I wouldn't have been close to the end of typing a long and closely-reasoned post, only to lose it all, and my lunch hour, because our office computer system suddenly went down without warning.

Guess what? Real life isn't Utopia.

Maybe in Utopia, Tim and Dan and ServiceSoon and the other posters making the exact same points would all come along together so we only had to reply once. But this isn't Utopia, so even though we have fully answered all these points, certanly to the stage where Dan went away declaring he would think again, we now have to start again.

And again.

Rolfe.

 

[Rolfe]

The top cardiothoracic surgeon in the country is a scarce resource however. There is only one of him. In a freemarket the surgeon who possesses the skills and faculties to perform the surgery decides who to operate on based on his values... whether it be money or altruism... his motivation is his motivation a bureaucrat can't change his motivation.

This is a slightly different slant on a point we already did to death with Dan.

There is only one "top man". It is actually physically impossible for him to treat everyone personally. Not to mention the other cardiothoracic surgeons who are now unemployed because everybody is getting only "the best" (assuming this guy has some sort of time machine).

However, only a small number of patients will actually benefit from seeing the "top man", rather than one of the others. The majority of patients are routine cases of routine complaints requiring the routine skills possessed by the bulk of the ordinary, decent, competent surgeons. The people who will really benefit from seeing the top man are the complicated, unusual, high-risk patients.

So, you seem to be advocating a system where this surgeon has two possible courses of action. He can auction his skills off to the highest bidder, and spend his life doing routine donkeywork surgery on the very very rich, and retire a very rich man himself. Or he can choose his patients according to clinical need and surgical challenge, and really make a difference, but in that case, as most of these people are not going to be very rich, he won't make much money.

Or, as you also point out, he can mix the two. He can charge the routine wealthy patients large amounts of money, and use that money to fund care for the high-risk complicated but indigent patients. Er, am I the only one who thinks we're getting uncomfortably close to the dreaded coercion here? The forced application of philanthropy? If you want to have your routine surgery done by Top Man, you have to pay for the little orphan's heart surgery as well?

Pretty hit and miss, too.

Of course the way this works in a universal healthcare system is that the Top Man is recognised as such, and secures the most prestigious and highly-paid teaching hospital post. The healthcare system then sends him all the high-risk, complicated cases to stretch his skills and utilise them to their fullest advantage. These patients get the high-level care they need, irrespective of their means, and the Top Man gets the Top Salary.

Obviously, I'm missing something....

Oh yes, what I'm missing is that the Top Man is still free to spend whatever hours he has left after fulfilling his contractural agreement with the universal healthcare system, operating on private patients. Thus if Daddy Warbucks really, really wants Top Man to do his routine angioplasty, he can have that. Top Man is able to enhance his income a bit more, Daddy Warbucks gets to spend his money on what he wants to spend it on, but at the same time Top Man has a fulfilling and demanding day job utilising his skills to the fullest, and the patients who really do need his skills on clinical grounds, get them.

I'm sure there's some horrendous ethical or ideological reason why this isn't accceptable, but hey, you know what? It actually works.

Rolfe.

 

[Darat]

Plus of course how does the Top Man (and "man" Rolfe - I'm ashamed of you going along with that! ) become the Top Man? Certainly not by only doing the routine operations on the "routinely" sick, it will be someone that has gained their skills by tackling the more difficult cases. And it should be clear that means operating on people assessed by clinical need rather than ability to pay.

 

[Francesca R]

But this isn't Utopia, so [ . . . ] we now have to start again.

And again.

That's odd, I almost read this as indicating that Rolfe did not totally luvvit really.

ETA--Not sure if you need to be sick to shop at Top Man . . . perhaps you need some help though.

 

[Rolfe]

I don't disagree that people should not have to die, and I would certainly donate time and resources to help cure disease. I think our ethical disagreement stems from our understanding of rights. I believe that everyman has the right to autonomy... to be left alone. Your advocation of a positive right like healthcare requires the belief that coercion is okay in some cases. I think coercion is unethical and in fact is counterproductive if the desired result is a healthier society.

Another point we already discussed. You want the right to choose to donate your resources freely, or withhold them if you want to. Is this really a good way to deliver healthcare to those who cannot afford it for themselves?

On the other side of that coin, hear the rant from the exploited philanthropist. Why should it be left to me and others like me to bear the whole burden of feeding the poor/providing healthcare to the indigent/building the new town hall? Joe Bloggs has just as much money as me, but the tight-fisted miser won't part with a penny he doesn't have to. It's not fair!

Too damn right it's not fair. Voluntary charitable contributions from the wealthy could perhaps support the system even up to 100 years ago, when social pressures (noblesse oblige, and all that) could usually be counted on to see that most of the wealthy did their bit. Not now, I fear. Too easy to be a Joe Bloggs, and just hang on to the stuff. While you, or at least your family and employees, take advantage of the philanthropy of others.

Hence this peculiar, commie notion of taxes. Because it's fair. Sure, you lose that lovely philanthropic glow you get when you donate money (or goods or time) on a voluntary basis, and instead you get a mean-spirited resentment of the compulsion. Or at least you do if you haven't thought it through. But it's fair, and it works.

It also works as regards equity of distribution. You know which is the richest charity in Britain? Guide Dogs for the Blind. They have more money than God. Why? Because the combination of needy people who can be viewed as brave and strong and who don't have any embarrassing anti-social habits, and the whole animal-charity thing, is irresistible. Very popular fundraising "good cause". While mental health services, particularly geriatric mental health services, struggle.

When donors have the choice which good cause to donate to, this sort of inequity is inevitable. A universal healthcare system on the other hand can look at the less sexy needs and allocate resources on a more equitable basis. As I said, it works.

Get over it.

Rolfe.

 

[Francesca R]

Voluntary charitable contributions from the wealthy could perhaps support the system even up to 100 years ago, when social pressures (noblesse oblige, and all that) could usually be counted on to see that most of the wealthy did their bit.

From whence does the evidence come that charitable benefactors ever "supported the system" in a way remotely comparable with UHC? The population doesn't die out because a fifth of it has no healthcare. The system can stay alive just fine. It's just a ****** system.

 

[Rolfe]

Fair enough. I was just trying to give the idea some credence. Of course, there was no such thing as a cardiothoracic surgeon then anyway.

Rolfe.

 

[Darat]

Of course there was - he'd even throw in a short back and sides!

 

[Rolfe]

Francesca, what I wasn't totally lovin was losing a long and closely-argued post to a computer crash. I'll try again, though I'm not sure I can recapture it and I'm now short of time.

My problem with UHC is primarily ethical and results from my lack of belief in positive rights (the notion that I must be coerced to provide some service or resource to someone else):

1) Money should not be extorted from one individual and given to another.
2) Physicians, or anyone who provides any service really, should not be compelled to work against their will, or charge prices against their will. Coercion is unethical and counterproductive in the long run.

Again, points we've been over with other posters, especially the first one.

1. This appears to be a position far wider than simply a healthcare argument, opposing all taxation to create a "common good" fund, where some may benefit disproportionately to their contribution. This covers rather a lot of ordinary life here. Including education, firefighting, libraries, museums, highways, rubbish collection, policing, the criminal justice system, parks, sporting facilities, even defence and international diplomacy.

I agree that there may be an argument as to whether or not healthcare should be covered by this common good fund or not. I would also maintain that in that context healthcare has to be considered alongside everything else that is already funded in this way. What are the arguments for funding e.g. firefighting, or libraries, or the police from the common fund, which do not apply to healthcare?

However, that blanket statement sounds very much like a rejection of the entire principle of taxation for the "common good", where benefit from this fund may be disproportionate to payments made. I'm rather curious to know how this Utopia of yours is going to function.

2. Tell me, are physicians in Canada "compelled to work against their will, or charge prices against their will." I think we covered a lot of this in the discussion of the "Top Man". Certainly in our universal healthcare system, doctors simply have jobs, just like the rest of us. Jobs gained by competitive interview and CV inspection. And the better you are, and the more experience you have, the better a job you'll be able to secure, and the better your salary will be. Nobody is "compelled to work against their will" any more than any of the rest of us who have to get out of bed every morning and go to work in our chosen fields because we find money does come in quite handy for all those annoying little bills.

And within the universal healthcare system, nobody "charges prices". As I said, they receive agreed, negotiated salaries, commensurate with their skill, experience and responsibility. In fact, the doctors' negotiating body (the BMA) turned out to be spectactuarly better at negotiating than the government bods, and so secured a very sweet deal indeed. I simply don't recognise your "coercion" in this situation.

Rolfe.

 

[Francesca R]

Well since I can, since you're also covering stuff that came up before/elsewhere . . .

1--The aversion to any compulsory taxation is the stuff of the libertarian / anarcho-capitalism thread on this forum

2--As far as An-Caps are concerned, coercion happens when the alternative if you don't submit to it is "harm" which you cannot avoid other than by doing as the coercer wants. In this case: if a doctor doesn't want to do work for the state buyer, they're disallowed to work as a doctor. If they go and set up as a doctor anyway they will be enforced against in court and criminally convicted. It is unreasonable to an ancap that you cannot exercise the option to work as a doctor--but not for the state buyer--without this harm being done to you.

 

[Rolfe]

Well since I can, since you're also covering stuff that came up before/elsewhere . . .

1--The aversion to any compulsory taxation is the stuff of the libertarian / anarcho-capitalism thread on this forum

2--As far as An-Caps are concerned, coercion happens when the alternative if you don't submit to it is "harm" which you cannot avoid other than by doing as the coercer wants. In this case: if a doctor doesn't want to do work for the state buyer, they're disallowed to work as a doctor. If they go and set up as a doctor anyway they will be enforced against in court and criminally convicted. It is unreasonable to an ancap that you cannot exercise the option to work as a doctor--but not for the state buyer--without this harm being done to you.

I've just been catching up on the AnCap thread. Which planet are these people on? I note that Tim entered that thread about 48 hours ago, coming explicitly from the AnCap position. It will be interesting to see if he does any better than Kevin (who I see has admitted to being 26, just a woefully uneducated and immature 26 from his posts). Anyway, if he's that far out on that particular limb, I don't imagine he has anything especially insightful to contribute.

But to address the end of your post. Of course doctors are not disallowed from working independently, outwith the universal system. (Seems to me that a lot of Canada's problems stem from their attempts to outlaw private practice.) They're completely free. They face only two difficulties. The ordinary guys face the problem that patients don't come to them, because the universal system supplies patients' needs just as well as Independent Ordinary Doctor could, and costs them nothing. The Top Man faces the problem that his patients look to his eminent position within the universal system to gauge just how good he really is. It's no coincidence that the chief consultant in maxillofacial surgery at the most prestigious teaching hospital in London is also the most sought-after and highly-priced facelift man on Harley Street. And he stays that way because the smart buyer of facelifts knows what question to ask when she's deciding whom to trust with her eternal youth and beauty.

I think Tim wants to see top-down coercion where in fact simple market forces are the main deciding factors.

Rolfe.

 

[Francesca R]

Assuming you're right on that issue, then an an-cap has no business objecting to it. Leaving them with "taxation is violence" only.

 

[Rolfe]

Have a look at this guy's CV. Didn't take me too long to find out who my hypothetical "Top Man" in facelifts actually is.

Mr Niall Kirkpatrick, BDS MB BS MD FRCS(Eng) FRCS(Plast) is a previous President of the Plastic Surgery Section of the Royal Society of Medicine. He is a Consultant Craniofacial Plastic Surgeon, having qualified in both Medicine and Dentistry. He is head of the Craniofacial & Orbito-Palpebral Surgery Unit at Chelsea and Westminster Hospital, London, and also a member of the multidisciplinary Head and Neck cancer team at the Charing Cross Hospital, London.

Mr Kirkpatrick’s special interests, in his NHS practice, are Craniofacial and Reconstructive Facial surgery. In private practice he undertakes all aspects of Cosmetic and Aesthetic surgery, as well as Reconstructive and Craniofacial surgery. He has published extensively in the medical literature and lectures both nationally and internationally. He has active research and teaching programs at the Chelsea and Westminster and Charing Cross Hospitals. Mr Kirkpatrick is medical director, and one of the team of surgeons who work for the charity ‘Facing the World’.

Educated, trained and employed in the NHS. Actually, probably delivered, vaccinated and treated for his childhood sprained ankles by the NHS as well!

And he's yours if you need craniofacial reconstruction and you live in Britain, for the price of free. Or he's yours if you want to look 20 years younger, for the price of a great deal of money. Or he's yours if you're a needy third world child with a facial deformity, again for the price of free. The former "free" being funded by our taxes, because we like having a civilised society, and the latter "free" being funded by our charitable donations, because we recognise that not every country's citizens have our advantages

Please explain to me just where this guy is being "compelled to work against his will, or to charge prices against his will".

Rolfe.

PS. Having looked at that charity's web site in more detail, I think it was actually this guy here I was originally thinking about. There was a TV programme about the charity I saw once, and he appeared to be top dog both there, and in the NHS, and in Harley Street.

Mr. Norman Waterhouse, (Co-founder) MD, FRCS, FRCS(Plast) is a past president of the British Association of Aesthetic Plastic surgery and previous head of the Craniofacial Unit at The Chelsea & Westminster Hospital. Noman teaches and lectures both nationality and internationality. His experiences volunteering internationally were part of the inspiration behind the charity.

Same thing. Product of the NHS from antenatal care to senior consultancy. Where's he being coerced?

 

[Professor Yaffle]

I think I watched the same programme.

 

[ponderingturtle]

Fair enough. I was just trying to give the idea some credence. Of course, there was no such thing as a cardiothoracic surgeon then anyway.

Rolfe.

Remember the idea of charity for many was to buy street children a nice christmass dinner. They didn't really care about the rest of the winter though.

 

[Rolfe]

OK, OK, I capitulate. It didn't work then either.

It just didn't seem quite so inadequate when nobody at all was getting chemotherapy, or quadruple bypasses, or insulin, or brain surgery, or whatever.

Nowadays, though, it's a lot harder even to pretend that voluntary charitable donations could in any way substitute for universal entitlement.

Rolfe.

 

[DaN K. StAnLeY]

Fair enough, this forum is a resource. However, I think you'll find it works best when you don't put unreasonable restrictions on the scope of the answers you want to get.

I don't think it is unreasonable to ask for alternatives to switching completely to a UHC system. The point of the thread was to brainstorm ideas that could lower the cost of the US health care without switching to a soc-type system. The Stossel video had some ideas that I hadn't thought of before and I'm hoping others might be able to contribute similar ideas.