Is anybody else reminded of Scrooge saying that if the poor would rather die than go to the workhouses, and prisons then they had better get on and do it? This is a hard hearted philosophy.
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A Philosophy Professor Discusses Ayn Rand in his Ethics Class
- Thread starter Sword of Apollo
- Start date
So far, two examples have been offered for things that would be better in an Objectivist system.
One is that Buckyballs would still be sold. Wow, that's definitely worth turning our whole system upside down to achieve! Fortunately, you don't need to. When I found they were going off the market, I used my free will to buy more of then than I will ever need. In accordance with Objectivist principles, I'm willing to sell a few of those sets privately, for a slight premium. (Bidding can start at 500% of what I paid.) Welcome to Objectivist paradise!
The other is health care.
As it happens, I read an extensive, detailed, and thoroughly researched article about how the current U.S. health care payment system works, just a few weeks ago. I always wondered why my medical insurance payment reports, instead of having two key numbers for each item (how much the provider charged, and how much of that my insurance covers, the difference then being the amount due from me), have three numbers instead: how much the provider charged, how much the insurance company allows them to charge (a much lower amount, usually about 1/8 of the first number), and how much my policy covers.
The difference between the first and second numbers are often in the thousands of dollars, for outpatient medical tests such as ultrasound imaging. That far exceeds the third number. Which means the main benefit I'm getting from my health insurance is not the portion of my bills they actually pay for, but the much larger amounts it protects me from being charged for in the first place.
Here's how that works. Every item a hospital or health care provider provides, from an aspirin tablet to a heart transplant, is listed on two separate price lists. One price list is created by the government program Medicare, and it is based on how much it actually costs the hospital to provide (not just the cost of the aspirin tablet, but a corresponding portion of the hospital's entire overhead as well). A hospital that only ever charged Medicare rates for its services would, in other words, still make a small profit.
The second price list is called the "chargemaster," and it's based on what the hospital feels like charging for that item. It's what they will charge, and attempt to collect, if the patient does not have insurance. That amount, item for item, is about ten times higher than the Medicare price. Sometimes a little less, sometimes a lot more. So an aspirin tablet that cost the hospital $.01 to purchase might have a Medicare price of $1.00 (which is fair, because there's overhead involved in purchasing, stocking, and dispensing that pill), and a chargemaster price of $10 or $19.
For health insurance other than Medicare, the insurance companies negotiate with hospitals what patients carrying their policies will be charged. Usually, that's based on a mark-up of the Medicare price. One recent disturbing trend in areas where hospitals have consolidated under single ownership, giving them more negotiating power, is that they will demand those charges be instead based on discounts off the chargemaster price, which (even taking the respective mark-up and discount rates into account) will be many times higher.
So, that's where those three numbers on my bill come from. One is the chargemaster price (e.g. about $9000.00 for a kidney ultrasound), one is the negotiated price with the insurance company which in my area is still based on a markup of the Medicare rate ($1100 for the same ultrasound), and the final one is how much of that $1100 the insurance actually covers.
So, what we have is two payment systems existing side by side. The Medicare payment system (and insurance policies based on it) might be considered the "Socialism" system. The government sets the amounts based on estimates of the actual costs. By the way, even critics of the system generally acknowledge that those rates are set with reasonable care and precision, neither overpaying nor putting health care providers out of business.
The chargemaster rates instead represent the "Objectivism" system. That's the rate that the hospital will charge you if you're not dealing with them through the government or any intermediary.
Those two systems coexist side by side, so we can see the results! Might it make good business sense for hospitals to have lower chargemaster rates to attract more business and community goodwill, as an Objectivist might argue? Especially because they're in business to help people!
Maybe, but that's not what we see them do. We see them attracting more business by merging with competitors to create regional monopolies (and giving their member doctors shares of revenues the generate from the expensive tests those doctors prescribe), generating community goodwill by intensive and expensive advertising, and soaking anyone who's unfortunate enough to be subject to the chargemaster rates for every penny they can get.
So, Objectivism, in a side by side race, fails the health care test in such a spectacularly disastrous manner that thousands of Americans every year are impoverished or bankrupted, not by heroic health care measures like transplants or experimental cancer cures, but ordinary diseases and relatively minor injuries.
Thank you for playing.
Respectfully,
Myriad
One is that Buckyballs would still be sold. Wow, that's definitely worth turning our whole system upside down to achieve! Fortunately, you don't need to. When I found they were going off the market, I used my free will to buy more of then than I will ever need. In accordance with Objectivist principles, I'm willing to sell a few of those sets privately, for a slight premium. (Bidding can start at 500% of what I paid.) Welcome to Objectivist paradise!
The other is health care.
As it happens, I read an extensive, detailed, and thoroughly researched article about how the current U.S. health care payment system works, just a few weeks ago. I always wondered why my medical insurance payment reports, instead of having two key numbers for each item (how much the provider charged, and how much of that my insurance covers, the difference then being the amount due from me), have three numbers instead: how much the provider charged, how much the insurance company allows them to charge (a much lower amount, usually about 1/8 of the first number), and how much my policy covers.
The difference between the first and second numbers are often in the thousands of dollars, for outpatient medical tests such as ultrasound imaging. That far exceeds the third number. Which means the main benefit I'm getting from my health insurance is not the portion of my bills they actually pay for, but the much larger amounts it protects me from being charged for in the first place.
Here's how that works. Every item a hospital or health care provider provides, from an aspirin tablet to a heart transplant, is listed on two separate price lists. One price list is created by the government program Medicare, and it is based on how much it actually costs the hospital to provide (not just the cost of the aspirin tablet, but a corresponding portion of the hospital's entire overhead as well). A hospital that only ever charged Medicare rates for its services would, in other words, still make a small profit.
The second price list is called the "chargemaster," and it's based on what the hospital feels like charging for that item. It's what they will charge, and attempt to collect, if the patient does not have insurance. That amount, item for item, is about ten times higher than the Medicare price. Sometimes a little less, sometimes a lot more. So an aspirin tablet that cost the hospital $.01 to purchase might have a Medicare price of $1.00 (which is fair, because there's overhead involved in purchasing, stocking, and dispensing that pill), and a chargemaster price of $10 or $19.
For health insurance other than Medicare, the insurance companies negotiate with hospitals what patients carrying their policies will be charged. Usually, that's based on a mark-up of the Medicare price. One recent disturbing trend in areas where hospitals have consolidated under single ownership, giving them more negotiating power, is that they will demand those charges be instead based on discounts off the chargemaster price, which (even taking the respective mark-up and discount rates into account) will be many times higher.
So, that's where those three numbers on my bill come from. One is the chargemaster price (e.g. about $9000.00 for a kidney ultrasound), one is the negotiated price with the insurance company which in my area is still based on a markup of the Medicare rate ($1100 for the same ultrasound), and the final one is how much of that $1100 the insurance actually covers.
So, what we have is two payment systems existing side by side. The Medicare payment system (and insurance policies based on it) might be considered the "Socialism" system. The government sets the amounts based on estimates of the actual costs. By the way, even critics of the system generally acknowledge that those rates are set with reasonable care and precision, neither overpaying nor putting health care providers out of business.
The chargemaster rates instead represent the "Objectivism" system. That's the rate that the hospital will charge you if you're not dealing with them through the government or any intermediary.
Those two systems coexist side by side, so we can see the results! Might it make good business sense for hospitals to have lower chargemaster rates to attract more business and community goodwill, as an Objectivist might argue? Especially because they're in business to help people!
Maybe, but that's not what we see them do. We see them attracting more business by merging with competitors to create regional monopolies (and giving their member doctors shares of revenues the generate from the expensive tests those doctors prescribe), generating community goodwill by intensive and expensive advertising, and soaking anyone who's unfortunate enough to be subject to the chargemaster rates for every penny they can get.
So, Objectivism, in a side by side race, fails the health care test in such a spectacularly disastrous manner that thousands of Americans every year are impoverished or bankrupted, not by heroic health care measures like transplants or experimental cancer cures, but ordinary diseases and relatively minor injuries.
Thank you for playing.
Respectfully,
Myriad
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I didn't say it would be worth switching over to Objectivism for that. I said that it would be a benefit if we did decide to use an Objectivist system. I consider banning a product because people misuse it--despite clear warnings--to be a bad thing. Thus I consider not banning such products to be a good thing. You may feel differently.
Yes, because our healthcare system so strongly resembles free market healthcare that you could use some aspects of it to determine how healthcare prices would look in an Objectivist market.
Yes, it is. Given that this has been acknowledged by pretty much everyone in the thread pages and pages and pages ago, I'm not sure what your point is.
Yes, because our healthcare system so strongly resembles free market healthcare that you could use some aspects of it to determine how healthcare prices would look in an Objectivist market.
Exactly. The part of the U.S. healthcare system that operates as a laissez-faire capitalist free market -- you walk in to any hospital you choose, the doctors there treat you, you pay the bill, no third parties or government funding involved -- is the part that charges a 900% profit margin. Because legally, they can, and sick patients are in no position to haggle or shop around.
Feel free to explain how making the system even more Objectivist than that will fix everything.
Respectfully,
Myriad
Kevin_Lowe
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A: "But under your proposed system people could beat me to death with a stick. I don't want to be beaten to death with a stick. I like laws that deter people from beating me to death with a stick. I think they are a good thing."
B: "Yes, you might get beaten to death with a stick. Given that this has been acknowledged by pretty much everyone in the thread pages and pages and pages ago, I'm not sure what your point is.
I literally have no idea what your point is. What could your point possibly be? I just don't get it.
You think it's a fatal flaw in a system if people can beat you to death with a stick, I get that. But why do you keep repeating that my system lets people beat you to death with a stick, as if it meant something? There must be some connection between those two propositions but... I dunno... I mean, can you join the dots for me?"
There is no such part of the US healthcare system. There is a part that attempts to operate like a free market, but it most decidedly is not operating within anything remotely resembling a free market. You may as well be looking at a black market for a banned substance to try and determine how that substance would be sold in a legal capitalist market--there are too many compounding factors involved for it to be a meaningful exercise.
Honestly I don't feel like getting into all the complexities of the US healthcare system (I just quit a job in healthcare, which means I don't have to waste brain power on it if I don't wanna
). I realize that may come across as a cop-out, and you're free to take it that way. But seeing as my goal isn't to convince people of anything anyway I'm not going to stress about it too much.
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I'm curious--if someone was complaining about how Evolution is often "mean", and the response was "yes, we know, nobody is trying to say otherwise" would you be responding the same way? The people arguing for Objectivism aren't doing so on the grounds that it's nice, but on the grounds that it's right (that is, on the grounds that it's internally-consistent and consistent with reality). If that's the truth--if Objectivism is correct--then it being mean is completely irrelevant.
Kevin_Lowe
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I guess I might, if we had a superior system to evolution already in place and someone was arguing that we should go back to doing things the old, nasty way.
There are lots of internally consistent moral philosophies, so being internally consistent doesn't win you any prizes. Similarly Objectivism has no special claim to be "consistent with reality" more so than any other non-theistic moral philosophy. The opposite, in fact, because in its original form Objectivism makes spurious claims to knowing the true nature of reality which it can't back up.
The very idea that a moral philosophy could be objectively correct is pretty weird though. Anyone who has that idea really needs to catch up on Hume and the is/ought problem.
Suicide was the other option, but still a pretty crappy choice. Not many people chose suicide - remember I am talking about what has actually happened in many situations, not hypothetical arguments.
The tenants couldn't be evicted for periods for which they had paid their rent. However, my recollection was that the landlord often raised the rents to an unreasonable amount at the next rental review period when the hope was that the tenant would have to leave - not being able to afford the rent. Not against anything objectivist principles.
Cain
Straussian
It's curious anyone would claim "Objectivism" is consistent with biology. David Friedman has a take down here: http://www.daviddfriedman.com/Libertarian/My_Posts/Ought_From_Is.html
Kevin_Lowe
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This.
This is why Objectivists aren't people you can productively engage in a philosophical discussion with.
Anyone who reads that tortured nonsense and says "Yup, that seems like a totally watertight logical argument to me, no room for skepticism or disagreement after that!" is someone who isn't capable of logic as we know it.
Evolution used to be the long-term (and only) solution to infectious disease. Over a few dozen generations, as more vulnerable individuals died more frequently of the disease, and as more infectious strains of the disease killed more of their victims and so limited their own spread, the surviving population would evolve to become more resistant as the disease evolved to became less virulent. (A population resistant to an endemic pathogen could even end up using the disease as a weapon against other populations not previously exposed. Though usually unwittingly.)
Now we have vaccinations, antibiotics, therapeutic treatments (such as ORT), and sanitation instead. The old way, evolution, is mean but it's right and natural, so we should go back to it. Yes?
Respectfully,
Myriad
Mister Agenda
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Ah, ok. I was counting any form of death as the same option.
Not to the point where the practice would be illegal, no, but this definitely skirts around the "rational self-interest" concept for people on both sides of the equation (the landlord for engaging in practices that obviously make him a bad person to rent from, meaning anyone following Objectivist principles won't work with him, and the tenant for accepting an agreement where he can basically get legally kicked out of his home).
Thanks for that. I'll be interested in seeing how the Objectivists respond (I don't think I've seen that line of criticism, so I don't know if they have a response to it).
Mister Agenda
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If you're an O'ist, it would be because your fundamental moral principle is to refrain from inititiating force or fraud against others. If you're a non-O'ist and a sociopath, I can't think of a reason that would persuade you to give up power under those circumstances. How is this a problem for O'ism?
It's a problem because, as has been repeatedly pointed out, it puts any practical public implementation of Objectivist principles into the fatally flawed "requires immediate total cooperation from everybody at once" category.
Respectfully,
Myriad
Or, you know, a police system.
Edit: missed that this was in response to the comment about a sociopathic dictator, not merely about the violation of rights in general. For the violation of rights in general you don't need everyone to cooperate so long as the ones who don't are arrested, same as now. For the dictator situation it really doesn't matter what philosophy anyone follows because you're at the whim of a dictator.
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remirol
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You (and many other Objectivists) still seem to be having some real trouble with the problems inherent in assuming that everyone is both rational and omniscient.
First: How does a given prospective tenant know the landlord is a bad person to rent from? You really can't handwave over this, because slumlords thrived for a long time even though everyone knew about them. Some still exist today, but fortunately the legal and regulatory climate is no longer quite so friendly for them (when the State can pursue prosecution on behalf of the afflicted, resources to hire an attorney, perform an investigation, etc. are no longer a problem).
Second: How does a given tenant necessarily have any plausible options that can be taken? When you don't have a place to sleep and it's going to get below freezing that night, it's not such a cut and dry decision as to say "Well, your agreement isn't fair, so I won't rent from you". This even touches on the 'assuming everyone is rational' problem; many people get themselves into such situations by saying "I'll stay there just long enough to find somewhere else", and then never actually do so for ($IRRATIONAL_REASON), until they finally get screwed.
I swear, it's like some of you have never bothered to crack a history book and discover that humans can actually be some real pig****ers if they don't make the effort to watch over themselves. Not to mention all those pesky literary classics out there that might give some insight despite being fiction.