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Author Topic: Free Markets Aren't  (Read 18555 times)
Ihlosi
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« Reply #60 on: March 17, 2009, 03:27:01 EDT »

Prison officers, Prison officiers unions, prison bureaucrats and suppliers to prisons all have the same incentive.

Not the first three. They get paid no matter how full the prison is. In fact, I believe that most prison staff would rather have a prison that's half-empty than one that's filled to 100% capacity or more. Prison suppliers, maybe, but they should have other ways to do business apart from dealing with prisons.

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Besides, do you think that having a high incarceration rate is necessarily a bad thing. 

Each person locked up costs about $25k per year and doesn't pay taxes. And I'm sure that quite a number of these prisoners would stay out of trouble if you just gave them a $300 per week allowance (especially cases like shoplifters that are stuck in prison for freakin' _life_ due to some three strikes law).

/edit: Oops, I think I lowballed the cost of incarceration. It's $88 per prisoner per day, on average, so more like $32k per prisoner per year:

http://en.wikipedia.org/wiki/Prisons_in_the_United_States#Cost_of_incarceration

Talk about a waste of a large fraction of $60,000,000,000 of taxpayer money. With sensible incarceration rates (comparable to other first-world countries - about 0.1% instead of almost 1%), that'd be a savings potential of about $50bn, per year. Even being able to just save half of the $60bn would be a nice chunk of change ... maybe not compared to any bailouts, but those don't happen every year.

What do you mean by "fallen through several layers"?

Well, one layer, actually, which is the short-term unemployment benefits, which come with slightly less strings attached than what I described. They only last for a few months, though, so it's not really something that you can expect to live off for the rest of your life.

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Still, what you're describing isn't very Social Democratic is it?  It's the sort of thing I would advocate.

Well, it's giving people tax money if they can't support themselves. That's not exactly libertarian either. But I'm all for pramatic solutions, not utopias.

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(I wouldn't advocate quite this though. I don't like this interfering business of asking people for evidence they're looking for work, that's just something to keep petty bureaucrats in work.  Better just to make the payment low enough you know everyone is looking for work and save money on intrusive bureaucracy.)

Well, the "normal" payment already requires quite a bit of budgeting. Having that cut by 30% (or more) literally means that you're down to Ramen noodles most of the time.
« Last Edit: March 17, 2009, 05:48:50 EDT by Ihlosi » Logged
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« Reply #61 on: March 17, 2009, 11:26:39 EDT »

Yer still lowballing prison costs, as you are assuming that all prisoners have no economic value were they in the outside economy.

Given that it's the lower classes who ar emost heavily leveraged (and from which we gain most of our prison pop) one could argue that were they've got about 30-40K (at least) of opportunity costs associated with having them doing nothing.

The net loss is probably around 80K a year per inmate, plus knock on costs to families and social structures.  Of course, the true bleeding hearts will say I would be for indoctrainating prisoners for good chunks of each day (which is true).
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« Reply #62 on: March 18, 2009, 12:17:34 EDT »

Government healthcare systems in some countries do spend less money than in the US, though there are measurement problems in the comparison.  Some of them do provide better care, many of them don't.

By "some" you mean "everyone but Switzerland, if you don't count government spending on employee health insurance[1]."
As I said though, there are measurement problems with the comparison.

Firstly, in several systems some of the organization involved receive tax breaks, that distorts the measurement.  Secondly, and more importantly, cross country comparisons in terms of price or GDP percentage don't take into account relative wealth.

In the US incomes are significantly higher than in Europe.  That means wage costs are higher.

If, say, a hospital were transplanted from France to the US then it could not operate for the same cost as it did in France.  It would have to employ locally at a higher cost.

That doesn't mean that the current US costs are the only ones possible, certainly they aren't.

As for relative levels of health care, there are two constant results:

The entire first world is about equal in overall performance, (there is variance with each type of treatment, but it is largely a wash), neglecting issues of access.

The US has the worst health outcomes of the entire first world.
Really.  What report have you found these conclusions in?
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« Reply #63 on: March 18, 2009, 14:23:53 EDT »

Prison officers, Prison officiers unions, prison bureaucrats and suppliers to prisons all have the same incentive.

Not the first three. They get paid no matter how full the prison is. In fact, I believe that most prison staff would rather have a prison that's half-empty than one that's filled to 100% capacity or more.
I'm sure that prison staff would rather have a half empty prison too, as long as they can get paid the same to look after it.  But therein lies the problem.

In a well run bureaucracy the staff must justify their positions by doing some work.  That means they have an interest in making sure a stream of work is available.  Otherwise their jobs can't be justified and they'll be laid off or have their hours cut.

In a poorly run bureaucracy this perhaps isn't true, the prison officers may not wish for more business because their bosses may pay them anyway.  The same may be true of a poorly run bureaucracy buying imprisonment as a service.  The problem of course is that such a lack of oversight has it's own problems.

Prison suppliers, maybe, but they should have other ways to do business apart from dealing with prisons.
Yes.  That doesn't mean though that they won't act as a pressure group for more imprisonment or at least more expensive imprisonment.

Quote
Besides, do you think that having a high incarceration rate is necessarily a bad thing. 

Each person locked up costs about $25k per year and doesn't pay taxes. And I'm sure that quite a number of these prisoners would stay out of trouble if you just gave them a $300 per week allowance (especially cases like shoplifters that are stuck in prison for freakin' _life_ due to some three strikes law).

/edit: Oops, I think I lowballed the cost of incarceration. It's $88 per prisoner per day, on average, so more like $32k per prisoner per year:

http://en.wikipedia.org/wiki/Prisons_in_the_United_States#Cost_of_incarceration

Talk about a waste of a large fraction of $60,000,000,000 of taxpayer money. With sensible incarceration rates (comparable to other first-world countries - about 0.1% instead of almost 1%), that'd be a savings potential of about $50bn, per year. Even being able to just save half of the $60bn would be a nice chunk of change ... maybe not compared to any bailouts, but those don't happen every year.
I agree that the cost of imprisonment is high.  But I don't think that a lower imprisonment rate would necessarily be better.

What the legal system should do is to appropriately punish crimes.  Doing so helps ensure that potential criminals in wider society do not become criminals.  Clearly one particular incarceration rate cannot apply to different countries with different cultures.

The incarceration is the legal system's response to a crime.  The "incarceration rate" doesn't really tell us very much that is useful.  If a population of people are inclined to crime then it would not be surprising if more of them are in prison at any one time.

What is really of interest is how the legal system works.  It is things like the three-strikes laws themselves which are of interest.  The relevant question is: Are people being imprisoned for amounts of time that don't fit the crime?  (It's worth mentioning that most of the sillier 3-strikes laws have been modified or repealed).

What do you mean by "fallen through several layers"?

Well, one layer, actually, which is the short-term unemployment benefits, which come with slightly less strings attached than what I described. They only last for a few months, though, so it's not really something that you can expect to live off for the rest of your life.
I see.  It's that kind of thing though that I think is most destructive in Ireland.  A claimant who has a full set of social security stamps gets the benefits I mention below, jobseekers benefit, 205 euros per week for one year.  The rules for this are a little odd.  If you work for two years (over your who life) then you become eligible in general.  If you pass that criteria and you have worked 39 weeks in the current tax year, or 26 weeks in the current tax year and 26 weeks in the previous tax year then you are eligible for 12 months of jobseekers benefit. 

What this means in practice is that people who work low wage jobs often work for about a year then take about a year off, then work for another year, and so on.  (If they can be sure of getting the work that is, folks I know have stopped doing this, but did it before the recession).

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Still, what you're describing isn't very Social Democratic is it?  It's the sort of thing I would advocate.

Well, it's giving people tax money if they can't support themselves. That's not exactly libertarian either. But I'm all for pramatic solutions, not utopias.
Yes.  I'm not objecting to the idea of providing a minimum income.  What I'm saying is that it shouldn't be too generous.  That hurts everyone and the poorest worst in the long run.

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(I wouldn't advocate quite this though. I don't like this interfering business of asking people for evidence they're looking for work, that's just something to keep petty bureaucrats in work.  Better just to make the payment low enough you know everyone is looking for work and save money on intrusive bureaucracy.)

Well, the "normal" payment already requires quite a bit of budgeting. Having that cut by 30% (or more) literally means that you're down to Ramen noodles most of the time.
In my corner of the world the left are always praising continental europe as having a much more generous benefits system.  Perhaps this has been exaggerated.

I'm interested to know, how much is it in euros?
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Ihlosi
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« Reply #64 on: March 18, 2009, 14:59:27 EDT »

In a well run bureaucracy the staff must justify their positions by doing some work.  That means they have an interest in making sure a stream of work is available.  Otherwise their jobs can't be justified and they'll be laid off or have their hours cut.

Possibly. I'm fairly sure, though, that the people working in a prison could find other jobs that fit their skill set (cop, accountant, etc ... depending on what their job was at the prison) ... and I don't believe that working at a prison is a dream job for many people.

The company behind a for-profit prison exists solely for imprisoning people, if it doesn't do that, it will go out of business. And the owner(s) don't care how exactly the company makes money, as long as it continues to do so.

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The incarceration is the legal system's response to a crime.  The "incarceration rate" doesn't really tell us very much that is useful.  If a population of people are inclined to crime then it would not be surprising if more of them are in prison at any one time.

I don't think Americans in general are that much more inclined to be criminals than the population of other first world countries. Maybe somewhat (judging from statistics like the per-capita murder rate), but not enough to justify alone an incarceration rate that's more than five times higher.

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In my corner of the world the left are always praising continental europe as having a much more generous benefits system.  Perhaps this has been exaggerated.

Well, that was when the economy was better. Even the social democrats have some sense of fiscal responsibility, and, in fact, they actually want people to have jobs. With the economy in Ireland booming until recently, I can imagine that the Irish government has been more generous than the other European countries, which had less economic growth.

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I'm interested to know, how much is it in euros?

Right now, for an unmarried person without kids, 351 Euros per month (that's for food, clothing, etc). Housing and heating is paid extra, as long as it's "adequate" (which depends very much on where you live, and for a single, unmarried person, something with more than 50 m^2 is not considered adequate and only covered for a few months).

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rwpikul
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« Reply #65 on: March 18, 2009, 21:04:35 EDT »

Government healthcare systems in some countries do spend less money than in the US, though there are measurement problems in the comparison.  Some of them do provide better care, many of them don't.

By "some" you mean "everyone but Switzerland, if you don't count government spending on employee health insurance[1]."
As I said though, there are measurement problems with the comparison.

Firstly, in several systems some of the organization involved receive tax breaks, that distorts the measurement.  Secondly, and more importantly, cross country comparisons in terms of price or GDP percentage don't take into account relative wealth.

Um, that's kind of the point of the point of using GDP percentages:  The higher wages result in a higher GDP which then factors back into the percentage and largely cancels itself out.

Quote from: Current
In the US incomes are significantly higher than in Europe.  That means wage costs are higher.

Not enough to make up for _how much_ higher US costs are.  That objection also does not nullify the fact that the US system is far more expensive than Canada's, (even though wages are similar for most areas of health care).

If you want to get an idea of the scales involved, see page 82 of the 2008 World Health Report .

Quote from: Current
Quote from: rwpikul
As for relative levels of health care, there are two constant results:

The entire first world is about equal in overall performance, (there is variance with each type of treatment, but it is largely a wash), neglecting issues of access.

The US has the worst health outcomes of the entire first world.
Really.  What report have you found these conclusions in?

Pretty much every one that has even been done, including quite a few from the WHO.  This isn't one report I'm talking about, but rather the regular story of yet another report again coming to the exact same result:  The US has higher infant mortality, higher disease rates, and lower life expectancy.
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« Reply #66 on: March 19, 2009, 15:33:34 EDT »

Government healthcare systems in some countries do spend less money than in the US, though there are measurement problems in the comparison.  Some of them do provide better care, many of them don't.

By "some" you mean "everyone but Switzerland, if you don't count government spending on employee health insurance[1]."
As I said though, there are measurement problems with the comparison.

Firstly, in several systems some of the organization involved receive tax breaks, that distorts the measurement.  Secondly, and more importantly, cross country comparisons in terms of price or GDP percentage don't take into account relative wealth.

Um, that's kind of the point of the point of using GDP percentages:  The higher wages result in a higher GDP which then factors back into the percentage and largely cancels itself out.
It isn't that simple.  GDP doesn't just measure wages, it also incorporates interest payments, rent payments, profits, government transfers and rents. (That is one side of the equation the other more often quoted side is investment, consumption, government expenditure and net exports).

The cost of operating a particular enterprise in a particular place depends on the cost of wages in that place and the other costs.  Some of those costs are things like services and land that vary from place to place, other are costs of capital equipment which is traded in a quite globally way.

Consider a labour intensive industry.  That sort of industry has higher wage costs than others and lower capital costs.  Let's say it is located in a world with globalised capital flow and local labour - like the real world - and in a rich country with high wages.  In that case the cost of consuming that industries products will likely represent a higher proportion of GDP than it would in a poorer country.

To be less theoretical about it, the important question is "Are the costs really the same?".  I think the answer is no.

Something that people rarely mention in this discussion is that the price of other products and services are not that similar across the developed world.

Quote from: Current
In the US incomes are significantly higher than in Europe.  That means wage costs are higher.

Not enough to make up for _how much_ higher US costs are.
I think that's hard to say.

That objection also does not nullify the fact that the US system is far more expensive than Canada's, (even though wages are similar for most areas of health care).
As has been said before on this forum Canada's healthcare system is not the most successful.

What I'm not saying here is that the US does everything right.  Certainly it doesn't.  Doctors and the AMA have persuaded the government to make regulations that permit them to overcharge.  The insurance companies, whether through government malice or incompetence, have got themselves into a similar situation.  It is now extremely difficult to start up a rival insurance company.  These things can all be tackled.

I don't think that making a "universal" system will tackle all of these costs.  Also, I don't think though that all of the causes of added costs can be tackled.  Doctors and other staff in the US are unlikely to work for less money.  There are other cost issues, take malpractice insurance.  Malpractice insurance in the US costs tens of thousands of dollars.  As I understand it doctors in NY pay for malpractice insurance an amount similar to the salary of doctors in the UK.

In the UK people frequently decide not to sue the NHS.  Also, the legal system doesn't tend to award damages often.  Could that situation be brought about in the US?  I doubt it.  Are Americans going to become less litigious?  I doubt they will overnight.

Quote from: Current
Quote from: rwpikul
As for relative levels of health care, there are two constant results:

The entire first world is about equal in overall performance, (there is variance with each type of treatment, but it is largely a wash), neglecting issues of access.

The US has the worst health outcomes of the entire first world.
Really.  What report have you found these conclusions in?

Pretty much every one that has even been done, including quite a few from the WHO.  This isn't one report I'm talking about, but rather the regular story of yet another report again coming to the exact same result:  The US has higher infant mortality, higher disease rates, and lower life expectancy.
Well, post a link then.

The US has higher infant mortality, higher disease rates, and lower life expectancy.
Those things don't necessarily reflect only on the healthcare system.  Lower life expectancy could be caused by differences in national habits for example, as could the rates of certain diseases.
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Ihlosi
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« Reply #67 on: March 19, 2009, 16:29:13 EDT »

Doctors and the AMA have persuaded the government to make regulations that permit them to overcharge.

When you're the person who tells someone "You need treatment X withing the next Y hours/days, or you'll be (in pain for the rest of your life/permanently disabled/dead)", being able to overcharge kind of comes with the territory, no evil government regulations necessary. Even if it's not that drastic (say, someone needs a root canal, now. Worst pain ever, though not immediately life-threatening), the doctor has plenty of leverage for overcharging. Or in emergency situations where explicit patient consent to treatment cannot be verified, but implicit consent can be assumed ("Here's the bill for one shot with the defibrillator and a few minutes of CPR, that'll be $BIG_NUMBER. Sir? ... Sir? ... I think we better get out the defibrillator again ...").

Where I live, regulations are in place to keep doctors from overcharging. You can easily find out how much a certain treatment will cost, since there's a big, universal price list that doctors can only deviate slightly from.

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« Reply #68 on: March 19, 2009, 16:55:06 EDT »

In a well run bureaucracy the staff must justify their positions by doing some work.  That means they have an interest in making sure a stream of work is available.  Otherwise their jobs can't be justified and they'll be laid off or have their hours cut.

Possibly. I'm fairly sure, though, that the people working in a prison could find other jobs that fit their skill set (cop, accountant, etc ... depending on what their job was at the prison) ... and I don't believe that working at a prison is a dream job for many people.
I don't imagine that it is.  That said most jobs that people do are not their dream jobs either.

The company behind a for-profit prison exists solely for imprisoning people, if it doesn't do that, it will go out of business. And the owner(s) don't care how exactly the company makes money, as long as it continues to do so.
Not necessarily.  Really the same sort of thing applies to them as applies to prison officers.  The private prisons in the UK are mostly run by general security companies.

The situation is not very different in both cases.  People have skills that can be used in various jobs.  Similarly businesses have assets that can be used for various tasks.  However, these don't command the same price in every role. In the case of a job they don't produce the same wage and satisfaction in every role.  So, people and organizations have an interest in maintaining the state of affairs that suits them best.

I don't know about where you live but the prison officers union in the UK are quite active in making sure prison officers keep their jobs.

Quote
The incarceration is the legal system's response to a crime.  The "incarceration rate" doesn't really tell us very much that is useful.  If a population of people are inclined to crime then it would not be surprising if more of them are in prison at any one time.

I don't think Americans in general are that much more inclined to be criminals than the population of other first world countries. Maybe somewhat (judging from statistics like the per-capita murder rate), but not enough to justify alone an incarceration rate that's more than five times higher.
I'm not sure.  The US is really very different to a European country.

To begin with in the US there are many immigrants from quite lawless countries.  I don't think it's racist to say that they bring some of that lawlessness with them.

I don't think either that legal policies are correct in Europe either.  I don't know if things are the same in Germany, but in Britain and Ireland the left have a strong influence on the legal system.  Criminals who commit heinous crimes are given lenient sentences.

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In my corner of the world the left are always praising continental europe as having a much more generous benefits system.  Perhaps this has been exaggerated.

Well, that was when the economy was better. Even the social democrats have some sense of fiscal responsibility,
I'm not convinced that Social Democrats in general even understand what fiscal responsibility is, though some may.  The Labour Party in the UK continued running budget deficits all the way through the boom.

and, in fact, they actually want people to have jobs.
What they want in votes, like other politicians.  Some of them may have other moral aims like more people having jobs.

Let's say you were organizing strategy for the Labour Party in the UK.  You know that unemployed people will vote labour or not vote at all, they are very unlikely to vote Tory.  So, is it really in your interest to decrease unemployment?  Not necessarily.

With the economy in Ireland booming until recently, I can imagine that the Irish government has been more generous than the other European countries, which had less economic growth.
Yes.

Quote
I'm interested to know, how much is it in euros?

Right now, for an unmarried person without kids, 351 Euros per month (that's for food, clothing, etc). Housing and heating is paid extra, as long as it's "adequate" (which depends very much on where you live, and for a single, unmarried person, something with more than 50 m^2 is not considered adequate and only covered for a few months).
That's about the same as the UK rate, which is ~£50 per week.  Perhaps the left in the UK are exaggerating.  Or perhaps when they say welfare is more generous in Europe they don't mean unemployment benefit.

Doctors and the AMA have persuaded the government to make regulations that permit them to overcharge.

When you're the person who tells someone "You need treatment X withing the next Y hours/days, or you'll be (in pain for the rest of your life/permanently disabled/dead)", being able to overcharge kind of comes with the territory, no evil government regulations necessary. Even if it's not that drastic (say, someone needs a root canal, now. Worst pain ever, though not immediately life-threatening), the doctor has plenty of leverage for overcharging. Or in emergency situations where explicit patient consent to treatment cannot be verified, but implicit consent can be assumed ("Here's the bill for one shot with the defibrillator and a few minutes of CPR, that'll be $BIG_NUMBER. Sir? ... Sir? ... I think we better get out the defibrillator again ...").

Where I live, regulations are in place to keep doctors from overcharging.
I agree that for the sort of things you mention it is reasonable to have regulations on charging.

That though isn't really the big problem in the US, AFAIK.  There are a few problems.  Firstly, the AMA act like a doctors union.  They limit the number of medical schools that can be operated in order to ensure doctors remain in short supply and remain highly paid.

Secondly in many cases the doctor prescribes drugs at his discretion.  The insurance company pick up the bill.  This often means that doctors prescribe more expensive drugs than necessary because they receive a bonus of some sort from the pharmaceutical company.  Sometimes they prescribe more tests than are really necessary too.

You can easily find out how much a certain treatment will cost, since there's a big, universal price list that doctors can only deviate slightly from.
I don't think that sort of price fixing is helpful for non-urgent complaints.
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Ihlosi
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« Reply #69 on: March 19, 2009, 17:22:31 EDT »

I don't know about where you live but the prison officers union in the UK are quite active in making sure prison officers keep their jobs.

Most of the people who work at a prison in Germany are government officials, and hence cannot lose their job unless they quit or retire. The ideal condition for them would probably be the prison being mostly empty.

Quote
That though isn't really the big problem in the US, AFAIK.  There are a few problems.  Firstly, the AMA act like a doctors union.  They limit the number of medical schools that can be operated in order to ensure doctors remain in short supply and remain highly paid.

That would indeed be an odd situation. Is there any information out there on the capacity of medical schools in the US (to find out whether they are at 100% capacity, or whether there are just not enough students)?

In Germany, licensing of physicians is done by the government, and medical schools (as part of universities) are also mostly government-run. This has lead to kind of the opposite problem (according to nationmaster, Germany has 50% more physicians per capita than the US).

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Secondly in many cases the doctor prescribes drugs at his discretion.  The insurance company pick up the bill.  This often means that doctors prescribe more expensive drugs than necessary because they receive a bonus of some sort from the pharmaceutical company.

That's fairly common. Here, part of the problem has been tackled by allowing doctors only to prescribe a certain drug, but not a certain brand of the drug. So, if cheap generics are available for the drug in question, the patient can chose them. Of course, this doesn't do anything for drugs that are still manufactured exclusively by one company.

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Sometimes they prescribe more tests than are really necessary too.

That is a fairly common problem. However, who other than another doctor could tell which tests are really unnecessary (except for rather blatant cases)? Also, litigiousness factors in here. Most doctors do not want to be dragged to court for not doing a certain test and missing something.

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I don't think that sort of price fixing is helpful for non-urgent complaints.

Doing it any other way would leave a lot of wiggle room. Also, it eliminates the practice of your insurance company telling you which doctors and hospitals you may see - since there are no huge differences in how much they may charge, the patient can see whichever doctor he feels most comfortable with (which can also have an impact on possible outcomes).
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« Reply #70 on: March 19, 2009, 20:40:29 EDT »

That objection also does not nullify the fact that the US system is far more expensive than Canada's, (even though wages are similar for most areas of health care).
As has been said before on this forum Canada's healthcare system is not the most successful.

Nice attempt at a sidestep, but that wasn't the question. The question was "Does the US healthcare system give the worst bang for buck, in the first world?" Given that infant mortality, life expectancy and infection rates are higher in the US than anywhere else in the first world, it's the worst. Given that other systems that are better cost much less per capita to run, it's got less bang for buck than other healthcare systems.

This, then, implies that the answer is "Yes, the US healthcare system does give the worst bang for buck in the first world." I say implies because you can always, as you're trying to, claim local differences make direct comparison inaccurate. But the evidence is pretty much in; the system that is closest to free market economics failed. It costs everyone more than a single-payer system and gives everyone worse outcomes.

I don't think that making a "universal" system will tackle all of these costs.  Also, I don't think though that all of the causes of added costs can be tackled.  Doctors and other staff in the US are unlikely to work for less money.  There are other cost issues, take malpractice insurance.  Malpractice insurance in the US costs tens of thousands of dollars.  As I understand it doctors in NY pay for malpractice insurance an amount similar to the salary of doctors in the UK.

In the UK people frequently decide not to sue the NHS.  Also, the legal system doesn't tend to award damages often.  Could that situation be brought about in the US?  I doubt it.  Are Americans going to become less litigious?  I doubt they will overnight.

There are legislators looking into tort reform. Unfortunately, such reform is hard to sell, and hard to get through parliament. Having a single payer system, though, could mean forming a court in much the same way as the vaccine injury court, where part of being licensed to [practice medicine|make vaccines] means paying a small tax into a collective fund. When someone is injured, that fund is sued, not the [doctor|manufacturer] directly. This would mean expansion of the FDA, though.

Quote from: Current
Quote from: rwpikul
As for relative levels of health care, there are two constant results:

The entire first world is about equal in overall performance, (there is variance with each type of treatment, but it is largely a wash), neglecting issues of access.

The US has the worst health outcomes of the entire first world.
Really.  What report have you found these conclusions in?

Pretty much every one that has even been done, including quite a few from the WHO.  This isn't one report I'm talking about, but rather the regular story of yet another report again coming to the exact same result:  The US has higher infant mortality, higher disease rates, and lower life expectancy.
Well, post a link then.

Google is your friend: Business perspective or, WHO health report 2000.

This is five minutes worth of searching. In that time I turned up two links that claimed that US healthcare was the best. Both of them posited a conspiracy on behalf of WHO.

The US has higher infant mortality, higher disease rates, and lower life expectancy.
Those things don't necessarily reflect only on the healthcare system.  Lower life expectancy could be caused by differences in national habits for example, as could the rates of certain diseases.

The rates of any diseases would fall under "quality of healthcare". Lifestyle is, admittedly, only partially under control of the healthcare system. But this is more of the ball going into the plate than a clean hit.
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But that's what I'll do
-- "Seven Nation Army", The White Stripes

So what you're telling me is that LTV's fudge factor means more than it's independent variable?
Yes...
Medivh
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« Reply #71 on: March 19, 2009, 20:52:04 EDT »

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Secondly in many cases the doctor prescribes drugs at his discretion.  The insurance company pick up the bill.  This often means that doctors prescribe more expensive drugs than necessary because they receive a bonus of some sort from the pharmaceutical company.

That's fairly common. Here, part of the problem has been tackled by allowing doctors only to prescribe a certain drug, but not a certain brand of the drug. So, if cheap generics are available for the drug in question, the patient can chose them. Of course, this doesn't do anything for drugs that are still manufactured exclusively by one company.

Apologies for the double post, but I read this after I'd posted.

Here, it's the pharmacists who can sub generics in for brand names. I'd be surprised if they weren't allowed to do so in the US (or Ireland, for that matter), owing to the fact that a pharmacist is basically trained in how to dispense drugs effectively, with an eye to drug interactions. Primary care physicians don't have the knowledge of drug interactions by default; they'd have to have trained as a pharmacist first. And a pharmacist can overrule a PCP's prescription if necessary.

An example I've heard is that a PCP in Sydney was telling his patients that generic drugs are a third the strength and cut with gelatine to make them seem bigger. The law expressly prohibits this, and any pharmacist would have shut the fool down immediately. Unfortunately, some people have been fooled by this PCP and have refused generics when they haven't really been able to afford refusing them.
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And if i catch you comin' back my way
I'm gonna serve it to you
And that ain't what you want to hear
But that's what I'll do
-- "Seven Nation Army", The White Stripes

So what you're telling me is that LTV's fudge factor means more than it's independent variable?
Yes...
rwpikul
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« Reply #72 on: March 20, 2009, 00:31:46 EDT »

Government healthcare systems in some countries do spend less money than in the US, though there are measurement problems in the comparison.  Some of them do provide better care, many of them don't.

By "some" you mean "everyone but Switzerland, if you don't count government spending on employee health insurance[1]."
As I said though, there are measurement problems with the comparison.

Firstly, in several systems some of the organization involved receive tax breaks, that distorts the measurement.  Secondly, and more importantly, cross country comparisons in terms of price or GDP percentage don't take into account relative wealth.

Um, that's kind of the point of the point of using GDP percentages:  The higher wages result in a higher GDP which then factors back into the percentage and largely cancels itself out.
It isn't that simple.  GDP doesn't just measure wages, it also incorporates interest payments, rent payments, profits, government transfers and rents. (That is one side of the equation the other more often quoted side is investment, consumption, government expenditure and net exports).

Did you see the word exactly there?

You also should know that most other variable costs will be reflected in the GDP.

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Quote from: rwpikul
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In the US incomes are significantly higher than in Europe.  That means wage costs are higher.

Not enough to make up for _how much_ higher US costs are.
I think that's hard to say.

Then you have never actually bothered to look.

Your deletion of a reference to this magnitude is noted is noted.

Quote from: Current
Quote from: rwpikul
That objection also does not nullify the fact that the US system is far more expensive than Canada's, (even though wages are similar for most areas of health care).
As has been said before on this forum Canada's healthcare system is not the most successful.

Yet it does a much better job than the American system for far less money.

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Quote from: rwpikul
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Quote from: rwpikul
As for relative levels of health care, there are two constant results:

The entire first world is about equal in overall performance, (there is variance with each type of treatment, but it is largely a wash), neglecting issues of access.

The US has the worst health outcomes of the entire first world.
Really.  What report have you found these conclusions in?

Pretty much every one that has even been done, including quite a few from the WHO.  This isn't one report I'm talking about, but rather the regular story of yet another report again coming to the exact same result:  The US has higher infant mortality, higher disease rates, and lower life expectancy.
Well, post a link then.

The WHO provides on-line statistics.

The US has higher infant mortality, higher disease rates, and lower life expectancy.
Those things don't necessarily reflect only on the healthcare system.  Lower life expectancy could be caused by differences in national habits for example, as could the rates of certain diseases.[/quote]

No, health outcomes are not a perfect indicator of health care system quality, although little else has an impact on infant mortality.
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« Reply #73 on: March 20, 2009, 10:59:30 EDT »

I don't know about where you live but the prison officers union in the UK are quite active in making sure prison officers keep their jobs.

Most of the people who work at a prison in Germany are government officials, and hence cannot lose their job unless they quit or retire. The ideal condition for them would probably be the prison being mostly empty.
Well, that's the other side of the coin, a bureaucracy that doesn't really control the workforce.  I don't think it's much better.
If prison officers can't be fired then why should they do a good job?

In the UK many other government services are still like this.

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That though isn't really the big problem in the US, AFAIK.  There are a few problems.  Firstly, the AMA act like a doctors union.  They limit the number of medical schools that can be operated in order to ensure doctors remain in short supply and remain highly paid.

That would indeed be an odd situation. Is there any information out there on the capacity of medical schools in the US (to find out whether they are at 100% capacity, or whether there are just not enough students)?
Here's a post by M.J.Perry on the subject.  As I understand the situation it's fairly accurate.

The BMA in the UK also try to limit the number of doctors.  They aren't as blatant about it or as successful though.

In Germany, licensing of physicians is done by the government, and medical schools (as part of universities) are also mostly government-run. This has lead to kind of the opposite problem (according to nationmaster, Germany has 50% more physicians per capita than the US).
I wouldn't trust the government with the job either really.  They don't have an interest in restricting supply, but they have other axes to grind.  Look what happened when they took charge of university admissions.

Quote
Secondly in many cases the doctor prescribes drugs at his discretion.  The insurance company pick up the bill.  This often means that doctors prescribe more expensive drugs than necessary because they receive a bonus of some sort from the pharmaceutical company.

That's fairly common. Here, part of the problem has been tackled by allowing doctors only to prescribe a certain drug, but not a certain brand of the drug. So, if cheap generics are available for the drug in question, the patient can chose them. Of course, this doesn't do anything for drugs that are still manufactured exclusively by one company.
Yes.  I happened to me a few years ago when I was ill while visiting Germany once.  My employers medical insurance company paid, but was not happy about it.  This is a problem in other countries too.

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Sometimes they prescribe more tests than are really necessary too.

That is a fairly common problem. However, who other than another doctor could tell which tests are really unnecessary (except for rather blatant cases)? Also, litigiousness factors in here. Most doctors do not want to be dragged to court for not doing a certain test and missing something.
The problem in the US is a bit different.  This is how I understand it from reading about it - I'm open to correction.  A Doctor charges his time to the insurance company.  The doctor is a resident of a hospital.  The hospital ask the doctor "we're a bit short of cash, can you make sure you always order lots of tests".  The hospital provide the tests and charge the insurance company for them.  The resident gets favours from the hospital for doing this.  The only parties that lose are insurance companies and those who buy insurance.

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I don't think that sort of price fixing is helpful for non-urgent complaints.

Doing it any other way would leave a lot of wiggle room. Also, it eliminates the practice of your insurance company telling you which doctors and hospitals you may see - since there are no huge differences in how much they may charge, the patient can see whichever doctor he feels most comfortable with (which can also have an impact on possible outcomes).
It will do that.  But the issue remains of who is to set the price, by what criteria and for what interest.

What happens if a technology is invented to make a certain operation cheaper?  What happens if a technology is invented that makes an operation more expensive but more successful?
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Ihlosi
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« Reply #74 on: March 20, 2009, 11:16:21 EDT »

If prison officers can't be fired then why should they do a good job?

There are other ways of providing adequate motivation, like being "overlooked" repeatedly for a promotion, or assignment to a boring job.

The idea behind not being able to fire most government officials is that a new government can't replace all of them with their cronies as soon as they take over, which is a fairly sensible idea.

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I wouldn't trust the government with the job either really.

You'll have to trust someone with it, or go back free-for-all quackery (we've already been there, and it's not pretty). Which body would you find trustworthy for the job?

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What happens if a technology is invented to make a certain operation cheaper?  What happens if a technology is invented that makes an operation more expensive but more successful?

The price list does get updated once in a while to reflect this. As a temporary measure, new treatments can be "mapped" to older items on the list until the update happens. The list also contains items the reflect usual "optional" parts of treatments (like different materials for tooth fillings, etc).
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