Monday, May 04, 2009

Real Medical Care v. Healthcare

The United States has a decent medical system.

Our medical system has top notch technology and well trained medical professionals.

I believe the system is weak in providing direct personal care. It appears that medical specialization, bureaucracy and liability fears are driving a wedge between doctor and patient.

Early this year, Tom Daschle pointed out that our system could use a stronger focus on wellness.

The shrill discontent we have with our medical system is the result of the political and financial systems wrapped around healthcare.

When engaging in debates about healthcare, it is important to make the distinction between real live medical services (the things that actually improve our lives), and the artificial political constructs devised to ration health care.

When we fail to make the distinction, we end up with shrill public discourse that often devolves into the absurd argument: "The system we designed to ration health care is preventing us from getting the care we desire; therefore we must expend more resources on the failed rationing system."

Bureaucracies work by focusing resources on whatever makes the loudest noise.

The challenge in debating healthcare is that the form of the debate often influences the outcome. A shrill debate leads to a system that brushes aside the health concerns of the individuals needing health care and concentrates resources on the power brokers that feed of the health care system.

To make inroads in the healthcare, classical liberals would do well to expend effort drawing the important distinction between real medical care, and the the political system that delivers it.

Conversely, progressives have been able to dominate discourse simply muddying and using the term healthcare for the bureaucracy. Progressives have manipulated the terms "healthcare" so that it refers to the bureaucracy and not the actual care received by patients. The clever little trick has created a paradigm where arguments for better real medical care end up twisted into arguments for expanding the power and scope of the bureaucracy.

Winning the debate for the side of liberty is primarily a matter of driving the argument that the free market allows for the most dynamic and direct relation between the caregiver and patient.

Classical liberals tend to lose the debate when they are drawn into macro discussions about the free market being the best mechanism for distributing scarce resources. Even though the argument is both sound and humane, it is always possible for collectivists to manipulate the argument and make it sound Darwinian.

The argument of the classical liberal is that freedom of the micro level tends to the optimal solution at both the micro and macro level. Unfortunately, classical liberals tend to be drawn into detailed discussions of macro economics, when, if they really followed the logic of their arguments, they would realize that they need to focus on how things work at the macro level.


Scott Hinrichs said...

As you have pointed out many times, those that control the terminology control the debate and the outcome.

y-intercept said...

My personal beliefs are more along the line that we must recognize the definition of terms as a dimension of discourse.

The first reason that people should check their definitions is to check for any unwarranted assumptions that may lurk in the definitions.

One needs to be at tentative to the fact that others are likely to hold different definitions and may misunderstand your arguments.

Unfortunately, the modern world has adopted all sorts of nasty techniques for manipulating debates with definitions.

The healthcare debate is manipulated in ways to promote a given outcome; Therefore one must be more attentive to definitions.

In the ideal world, people would seek a vocabulary that allows different parties to clearly express their ideas. This happens quite often in Classical Science (less so in Modern Science).

When people seek to engage in a higher level debate, they can.

Unfortunately, that is not what we have at the moment.

Progressivism seeks to establish a socialist state through subliminal manipulation of discourse. The people opposed to this system must learn to fight back.

That means shining light on the epistemological distortions that the left has injected in discourse.

Dr. Joe Jarvis said...

I beg to differ with y-intercept. Health care is not a commodity efficiently distributed by market forces. None of the pre-requisites of market economics described by economists from Adam Smith on applies to health care. Consumers of health services (particularly the intensive, expensive variety that account for 80% of care cost)are patients, not shoppers. Sellers of health services are professionals with ethical obligations to consider the needs of patients to the exclusion of their own interests. Positive externalities prevail in health care, contrary to markets. What market is based upon $1.5 trillion in tax money? 60% of this year's health spending ($2.5 trillion) will come from taxes. How is that a market? Commidities in general are in greater demand as their price decreases (the concept behind 'putting something on sale'). Yet, no one buys an appendectomy because it is on sale this week. The inverse price-demand function does not hold for health care, how is that a market? In fact, we in the US are in the dilemma of poorest quality care in the first world at the highest price paid for health care in the world precisely because we continue to pretend that markets will somehow solve our health system problems. A pretend market fails because people are forced into transactions without countervailing forces (invisible hands) to drive improved quality at a lower price. Contrary to market commodities, high quality in health care costs less, not more. We have a pretend health care market rife with perverse incentives, meaning that our hospitals are induced to provide inefficient, mediocre care in order to maximize their revenues. Doctors in the US are paid to harm their patients. If you want to learn more, join my blog for ongoing discussion of our health system problems and their solutions.

y-intercept said...

Dr. Jarvis,

Thank you for your response. I will place links to your web sites.

I should point out, however, that I did not say health care was a commodity to be distributed by the market.

I guess I should also point out that in your rejection of Adam Smith you referenced price curves and other mathematical models that Adam Smith did not use.

It is possible that you have fallen into the habit of reading things into other people's words.

This is something of which I am often guilty. I process what I read in the context of my own thoughts.

My posts on health care have actually been saying something radically different from the response you gave.

They say our discontentment is the result of our efforts to fund health care through an insurance mechanisms.

Insurance is inherently antimarket in that it exists to overcome perceived flaws in the free market.

This is especially true in the case of third party payment systems like employer based insurance.

A true free market system would be radically different from this bizarre third party payment system we have.