ColbyCosh.com

Colby, I never thought I'd see you arguing for the socialization of the entire economy.

Hey, maybe it's my rural background. I mean, what if everybody forgot to plant crops one year and we were all suddenly at the mercy of a bunch of charlatans with sacks of mouldy wheat and half-chewed tofu burgers? Where's your free-market messiah now, am I right?

Where's your free-market messiah now, am I right?

I hear "long pig" is delicious, particularly the kind that are deficient at economic reasoning...

On the one hand, I can understand Ezra's argument. And, while food/clothing/shelter isn't scarce in the U.S., health care is. Does socializing it make sense? In the short term, perhaps. In the long term, socializing health care will, I believe, stifle potential advancements as surely as creating a monopoly will raise prices.

Today I ran across a link to a study which claims over a half million Scots have died in the past thirty years due to poor NHS service...

http://www.dailyrecord.co.uk/news/news/tm_headline=462-000-deaths-caused-by-nhs—&method=full&objectid=19241847&siteid=66633-name_page.html

I cannot think of a government-provided service, save military defense, that is of better quality than would be provided by the private sector. I see no reason medicine would be different. Remember what a smart blogger once said - the standard is not perfection. The standard is the alternative.

That wasn't a blogger. That was Frédéric Bastiat.

That makes sense. I think I first heard it/read it on Den Beste.

I cannot think of a government-provided service, save military defense, that is of better quality than would be provided by the private sector.

Firefighting.

I would disagree strongly with this view, actually, up to a point. I think the "public sector" provides many universal services extremely well when it is free to privately subcontract appropriate elements of those services. I am thinking of something like road construction... I think that governments do this quite well, at a high level of quality, especially where they can contract out the parts that are suited to being contracted out. Other kinds of infrastructure, too. In fact, I'd say that infrastructure in general is something governments are pretty good at - maybe because governments can take the long view?

Indeed, the public sector is an awesome vehicle for paying for things. I don't necessarily think that's a good argument for public sector services :) but it's something.

In both cases I talked about above, road construction and firefighting, the public sector took over private-sector services that were absolutely lousy (even by the standards of the time) and developed a service of immeasurably higher quality...

The critical difference between ambulance rides and the other widgets is precisely the fact that you can't plan for them. In the case of all the other widgets, you are told the price at the time of purchase, and if you think you can't afford the price asked, you can at least choose to not buy it and hope for another one to come along at a better price. That's not possible with ambulance rides. You don't get the bill untl well afterwards--in part because, under the screwed up insurance system we now live under, the hospital can't give you an honest bill until well afterwards [I'd like know what rational system of billing can produce a bill of over $13k of which the patient and his insurance is expected to actually pay only $900--as happened to me last month]. In part it's because the patient is not the one to choose--it's the ambulance driver who chooses for him. The element of informed choice present in the others is missing here.
The best "plan" you can make is decide which hospital you want to be taken to, then buy a house and find a job in close proximity--and hope the hospital stays the way it is now.

There is also another difference between ER visits and the other widgets you mention: the other widgets only become life or death because of circumstances; Visits to the ER are by their very nature matter of life and death (or at least, matters of serious health issues). 99 percent of the time you don't have to worry about shoes preserving your life in blizzards. That's never true of ER visits.

In fact, I'd say that infrastructure in general is something governments are pretty good at

You don't live in Calgary (Land of 1,000 Bizarre Interchange Concepts), do you?

Oh, and I actually question whether military services (especially in the age of superweapons) are best provided publicly and not privately. Having a standing army to do what Canada asks of them, instead of hiring private forces, seems horribly, horribly inefficient to me.

It's certainly good quality, and maybe that's your only point, but it is (funnily enough, since we're talking about the military) like paying $5,000 for a kitchen knife. There are huge differences in quality of knives, but I seriously doubt it's five grand worth.

Doogie, I live in Ontario, and lived in NS and Quebec before that. I mean, everyone complains about potholes, but you should have seen what roads were like in the 18th century.

Tybalt, here in Florida, it's often hard to see how anyone could do worse with infrastructure than the government does.

That may well be. Florida, though, has grown like topsy (or kudzu) over the last five decades, so infrastructure planners have my sympathy. I don't have any evidence for my suspicion except for an historical understanding of pre-govt infrastructure days, though.

It also may be that FL infrastructure sucks because your govt is cheap and underfunded. I dunno... FL has that rep but I'm suspicious of such rumors.

The critical difference between ambulance rides and the other widgets is precisely the fact that you can't plan for them. In the case of all the other widgets, you are told the price at the time of purchase, and if you think you can't afford the price asked, you can at least choose to not buy it and hope for another one to come along at a better price. That's not possible with ambulance rides. You don't get the bill untl well afterwards--in part because, under the screwed up insurance system we now live under, the hospital can't give you an honest bill until well afterwards [I'd like know what rational system of billing can produce a bill of over $13k of which the patient and his insurance is expected to actually pay only $900--as happened to me last month]. In part it's because the patient is not the one to choose--it's the ambulance driver who chooses for him. The element of informed choice present in the others is missing here.
The best "plan" you can make is decide which hospital you want to be taken to, then buy a house and find a job in close proximity--and hope the hospital stays the way it is now.

You can't plan for ambulance rides? Why not?

If we were obliged to pay for ambulance services in advance through insurance--i.e., plan for them--it wouldn't be all that complicated, wouldn't it? It's not oversimplifying much to say that ambulances are taxicabs with a trained guy and a fancy payload in the back (and if anyone is allowed to oversimplify about this, it's me)*. For the most part ambulance services don't have the characteristics that make hospitalization insurance relatively difficult to price; given suitable waivers from traffic regulation and accident-liability pseudo-regulation, the cost of a trip needn't have the sort of frightening log-normal cost distribution that hospital stays do. In an open market the uninsured would still have the chance to benefit from the prices set by the insured (under the current US system of health "insurance" this process is subverted completely by the need to force the insured to cover the costs of treating the uninsured), and aside from the fact that a public hospital system would never tolerate it for reasons** related to ER rationing, there is no reason in principle that an insuree couldn't specify his preferred emergency room. Your arguments against ambu rides being "widgets" apply equally well to taxicabs, on rare occasions.

Anyway, for most ambulance companies, I think you'd find that the majority of their revenues do now come from explicitly "planned" semi-elective trips.

*Former ambulance cadet, son of volunteer ambulance driver
**"Reasons" here means "excessive delicacy about finding methods of discouraging attention-seeking visits from the insane and elderly."

"And, while food/clothing/shelter isn't scarce in the U.S., health care is." HalfCanadian, I hope your other half isn't American. There's nothing particularly scarce about health care in the US, even for the indigent...particularly for "unplanned" emergencies. Sure, you might have to put off dental work longer than ideal (though for the professional poor, the gov't picks up the tab). And health care is scarcer than it needs to be, because of state-approved entrance barriers (sort of like, er, zoning and rent control). Fact is, anything for which there is a market is scarce, otherwise nobody would pay for it. Any degree to which health care is "more scarce" than anything else is not a justification for communizing it.

One wonders what Klein's understanding of the phrase "a horse a horse my kingdom for a horse" is like.

I mean, everyone complains about potholes, but you should have seen what roads were like in the 18th century.

Not really what I was talking about, if you look at what I said. Everyone has potholes, of course. How many people have that ridiculous Memorial-Deerfoot-Barlow nightmare to contend with? Or see millions of taxpayer dollars go towards an "interchange" that actually adds more lights to an intersection, when the whole concept is to get rid of them and improve traffic flow? Calgary seems to like to try every new and novel idea in traffic control (the old joke is, the city planner rides a bike to work), and there are times when the older, simpler ideas really are better. Thankfully, they seem to be learning their lesson, as the McKnight-36 St/Metis Tr interchange looks about as normal as this city's ever seen.

I'd argue that governments don't even do a great job in terms of infrastructure, firefighting, or defense. The argument in favor of the effectiveness of public management of infrastructure and firefighting is that there appears to be a lot of supply there. However, how much of that infrastructure was built in the last 20 years? We're living off a glut of roads that were built in the 1960s, and the government has done a poor job of maintaining, replacing, and upgrading what we've got. Part of the problem is that the public sector has been very poor at considering total life cycle costs - how much is it going to cost to support this stuff after it's built, and does it really make sense economically? A fine example would be the extensive road paving projects in rural areas of Alberta and Saskatchewan, which are underutilized and consequently decaying badly. The public would've been better served by keeping the original gravel roads. Gravel's not as good as a well-maintained paved road, but a lot better than a deteriorating stretch of asphalt.

Jeffrey Quick,

I live in the U.S., am a U.S. citizen, and stand by the claim that health care is 'scarce', but agree that this can be misleading. I used the term 'scarce' in the sense that varying degrees of health care are harder to come by than other goods (like rice, bread, carrots, etc.). Food is plentiful in the U.S. Poor people are fat for goodness sakes. Housing is more scarce than food, but really anyone who wants a home can get one (though that government housing is pretty crummy). Same with clothing (maybe even less scarce than food).

With medical care, the cost of it is a measure of the scarcity. The amount that my employer pays for my insurance, in addition to my on out-of-pocket expenses (deductable, copays, etc.) add up to more per month than I spend for food for a family of 6. It's about the same for my mortgage (NOT gov. housing). So I could argue that health care is more scarce than food and about as scarce as housing, but that's not what I was getting at. Anyone can get meds for their kid's ear infection or for setting a broken arm. If nothing else, ERs will do that and the rest of us will eat the costs. But for more serious afflictions (which are invariably brought up) such as Mr. Klein's example of cancer, the cost, and thus the scarcity, goes up. Not everyone can afford it, and that's because there isn't enough for everyone. In Canada, that scarcity is controlled through government rationing. In the U.S., that scarcity is controlled by price. Either way, someone loses out, but in the U.S., I hold some level of control over my situation.

And before someone brings up the example of me losing my job, and thus my insurance, etc., that's a risk in any situation, except in Canada, it's a risk if the country goes into recession. If the money isn't there (which could happen with Canada in recession) the money for the cure will be lacking. So, in the U.S., it is incumbent upon me to remain competative so that people will want to give me money for my services. If I'm able to do that, I'll do well. But in Canada, if I worked hard, but the country goes to pot, even if my employer prospers, I can't spend my own money on a treatment in Canada even if the country is unable to pay for it.

anyone who wants a home can get one

Anyone? You are suggesting that there are no homeless people in the United States? Lower the dose, man!

In a small town in Iowa last summer, my parents visited a relative who's neighbours house was up for sale. 2 floor, 5 bedroom, 2 bath, finished basement, and a large landscaped yard.

$28,000. Been on the market 2 months without a hit.

Comfree's mortgage calculator reports you can get that for $82 every two weeks. If that disagrees with you, offer $25,000 and pay less than $150/month. Wait 3 years, and that will be Alberta's healthcare premiums.

The only problem is that the private system (the alternative) doesn't seem to do a very efficient job of providing health care either. For instance, the US spends over 13% of GDP on health care compared to other industrialized countries spending about 8 - 9%. The US health care system overall is not better (in fact places poorly) in indicators of population health.

The reason for this may have nothing to do with private vs. public, but at the very least it suggests that a switch to private health care is no panacea.