Tuesday, January 2, 2007

Random Thoughts in the Midst of Other Random Thoughts

i'm in the midst of wrapping up the global warming post, but i'm also finishing grad school applications this week. so, part 2 will have to wait. unfortunately other random ideas keep popping into my head, and i find it more useful just to write about them then to let them linger and distract me from the applications.

in particular, i've been thinking about the idea of price; price as a mechanism within marketplaces. in specific, i've been thinking about how price works in the healthcare and education marketplace. i've always been in favor or market reforms to healthcare and school choice and vouchers as a means of reforming our public school system. however, these views were mostly just reflections of my general bent towards free market policies.

a few weeks ago i read an article in the ny times (i would link to it, but it's been placed in that wonderful "lockbox" called times select) about how some colleges raised their prices and subsequently raised the number of applicants. around the same time i learned something new from a doctor friend of mine: most medical fees are based on what medicaid pays. i realized that i knew nothing about the price of healthcare. i know what a bottle of aspirin costs in the drug store and i know roughly what a night in a new york hotel costs, but as for an aspirin administered in a hospital or a night's stay in that same hospital... i haven't a clue, nor do i know where to begin to look for such information.

in both the case of healthcare and education, there seems to be something fundamentally wrong with the pricing mechanism. i'm not sure how that affects my views. that part is a work in progress.

in the meantime here is post i wrote on slate.com's reader forum in response to this and this (both articles in favor of socialized medicine):

krugman, wells and noah seem to imply that national healthcare is the obvious answer to a question that's only being obfuscated by special interests and libertarian ideologues:

"In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues."

in regards to the latter argument, perhaps healthcare is not a system that translates exactly to the market for cars, lawn care, widgets or whatever other goods or services people need. but that is a long way from "wholly inappropriate", which implies that the marketplace has nothing whatsoever to contribute to the debate. this sort of hubris and blind faith in government bureaucracy is as dangerous as blind-faith in free markets.

and that danger can be seen in the former argument, a claim that really perplexes me. how does switching to single payer system make these industry lobbyists go away? are the nurses and hospital workers unions just going to accept what government technocrats decide to pay them? will medical associations acquiesce to the diminished salary and standing physicians might play in this new healthcare system? and what about healthcare and drug companies? with socialized medicine they essentially become government contractors. well, that's good news because we know government contracts are only given out in the most fair and efficient manner and the process almost never involves wasting money…

look at the role that teacher's unions play in deciding education policy or haliburton in defense spending. i just don't see how congressman beseeched by special interests or government bureaucrats insulated from voters are automatically better suited than market forces to decide how healthcare resources get allocated.

critics of the iraq war most often blame bush for failing to either envisage or admit to the unintended costs, in lives, money and america's diplomatic standing, of invading iraq. yet, here timothy noah makes the same sort of argument for steaming full steam ahead into socialized medicine.

just because something works in another country, doesn't necessarily mean that it's going to be successful here. it's very easy to see that doctors in taiwan, a culture where perhaps there is a greater willingness to do what's best for the group at your own expense, might accept less money and prestige, while their American counterparts will balk. and for the english, forming a proper queue is almost a source of national pride. that doesn't mean that we'll stand for it here.

here's an idea: how about we move the burden to the states. let each state decide how it's going to deal with rising healthcare costs. some may adopt single payer systems and others may opt for a consumer-driven model. they won't all work or be viable in the long-run, but at least we'll have as many as fifty different approaches being tried. and once certain models prove to be more effective then those states with failing models can switch.

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