US Health Care: Socialism-Lite

I had largely forgotten about it until I saw a similar comment at Outside the Beltway. A couple of weeks ago, Mithras of the blog Fables of the Reconstruction, in response to my calling the proposals by the various Democratic candidates "full-blown socialism" states in comments that follow the post:

43 million Americans have no health insurance. They do two things as a result: (1) get uncompensated emergency care from hospitals and (2) die sooner. Hospitals are teetering on the edge of insolvency everywhere in America. At the same time, we are spending more per capita than other western countries on health care and doing worse on key health indicators, particularly infant mortality and life expectancy.

Like it or not, these are problems that need to be addressed. The "free market" isn't doing the job.

I must strongly disagree with his characterization of health care in the US as a "free market". Reading the various blogs, especially those outside the US, this is a common perception. And any shortcomings are therefore attributed to the free market. This is a gross mischaracterization. Health care is quite possibly the most regulated industry in the US. Socialized medicine may rule in England and Canada, but it is socialism-lite in the US.

Consider the following questions:

Are individuals fully allowed to make their own health care choices?
How many restrictions are there on the scope of what insurance companies can provide for coverage?
Are there barriers to entry to different schools of medicine?
Can patients and doctors reach mutually agreeable and individualized terms to services?
Can patients exchange risk for limited liability?
Are individuals allowed to engage in mutually agreed upon exchange in their own organs?
What percent of patient management decisions involve an appraisal of the costs involved?
Can patients and doctors use mutually agreed upon private arbitrators to escape the state court system and excessive malpractice awards?
Can patients choose to take any medication they believe will help their well-being? Or is there a white-collar Drug War in effect?
Are there choices for testing for drug safety and efficacy?
How much 3rd-party involvement is there in medical decision making?
How much teaching is there in medical schools on the costs involved with different methods of diagnoses and treatments?

Somehow, the notion has emerged that having corporations, who themselves only exist in their large size due to regulatory burdens and policies, provide healthcare as a third party to workers as a result of tax incentives and the historical legacy of wage controls, is the free market. Somehow, having insurance companies in bed with the US government and a union controlling the supply of physicians, with a state-enforced monopoly overseeing drug and medical device testing is the free market.

Let's not bastardize the meaning of "free market", which is the outcome of voluntary exchanges, with this heavily regulated, subsidized, monopolized, and perverse incentive driven industry we call health care.

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There is an incredible

There is an incredible amount of mirror-imaging between left and right in the misuse of "free market." Both sides falsely refer to the present corporatist economy as a "free market," because it suits their respective power interests. Both sides use, as a matter of course, "free trade" (but without ironic quotation marks) to describe the neoliberal project. Both sides have a strong interest in concealing the extent to which "actually existing capitalism" has been massively statist from its very beginnings.

Corporate apologists of the right (including lite libertarians of the Uncle Milty variety) fear the public becoming aware that David Rockefeller, Bill Gates, and Big Pharma are the biggest welfare whores in human history. Statists of the left fear the public becoming aware that the solution to the evils of corporate power is less government, not more; or that most of its "progressive" intervention in the market was designed mainly to benefit the plutocracy.

So you wind up with intellectual prostitutes like Art Sclesinger referring to Herbert Hoover as a "laissez-faire capitalist," and flacks for Big Pharma describing patent- and FDA-inflated prices as "how our free market system works."

My father and wife are both

My father and wife are both in the health 'care' industry and we almost daily have a 'laugh to stop from crying' discussion about the gross misconceptions by the public and the media.
It is an emotional political football that has almost no cost structure basis left in reality.
Howerver,the baby boom is going to crush the entire monstrosity, its almost a certainty. Here in Kanada, its pure socialism, while in the US you have what the poster called socialism lite and that is appropriate for those who have this bizzare fantasy in their heads that America is a capitalist society. My opinion is that this is the straw that breaks the camels back of western statist goverments,and leads to the hyper inflation of the next decade. There is no politician living who can take on that juggernaut and the only/easy way out for them is to print money. The emergency rooms are overflowing now and we have yet to see the front of the wave.

Remember Rand's statement:

Remember Rand's statement: When opposite basic principles are clearly and openly defined, it works to the advantage of the rational side; when they are not clearly defined, but are hidden or evaded, it works to the advantage of the irrational side.

The enemies of the free market have no interest in giving its clear definition in these debates, and in fact, they have every interest to prevent it from surfacing.

This topic deserves a larger

This topic deserves a larger post, or at least a link to an authoritative article on the subject. As you say, the misconception of the US health care system as "free market" is quite pervasive. Arguing with supporters of single-payer systems (&etc.) is thus quite difficult, as the parties to the debate work from diametrically opposed assumptions that are rarely brought up. It would be helpful in such circumstances to have a well-written all-bases-covered account of the true state of the US health care industry to point to and say, "see, it's like this".

As an aside, statements like...
"we are spending more per capita than other western countries on health care"
...truly confound me. I had a rather lengthy discussion about the health care system with a rather open-minded liberal type a while ago, and these claims that the US is "spending more on healthcare" proved not only difficult to counter, but difficult even to understand. Do you measure in absolute dollars or purchasing-power-adjusted dollars? Do you use one measure or use multiple figures for different demographics? How do you adjust for differences in availability, choice, and quality?

The Fraser Institute in

The Fraser Institute in Canada has released some interesting and minimally biased examinations of the Canadian 'free love' system with the US 'free market' HMO based system, and your libertarian intuitions about both are exactly correct. Anything they(gov't) touch is done poorly at best, or just plain grossly mismanaged with billions in funds misappropriated.

When it comes to the 43

When it comes to the 43 million without health insurance you have to remember that among them there are probably people who are (a) illegal immigrants, (b) self-employed or (c) not much in need of a health insurance (or perhaps rather, feels that they aren't). Cato Institute had a thing on this earlier this winter.

Dear Mr. Wilde: While I

Dear Mr. Wilde:

While I favor a true market system for health care as I would infer that you do from you post, I just don't see how we can get there from here. In your post you give, by implication, some of the obstacles to a free health care market in the U. S. but not the most significant single obstacle. Government, in the form of Medicare, Medicaid, veterans benefits, and subsidized government employee health plans accounts for more than 50% of all health care expenditures. The size of the VA health care system alone is larger than British Public Health.

A simple thought exercise strongly suggests that such a system creates a positive feedback loop. And that's what we've got--runaway costs.

And for anyone who thinks that a single-payer system alone will solve all of our problems please recall that if physician salaries had been limited to the non-health-care rate of inflation since 1965 (rather than the multiple that actually occurred) there would be no health care crisis.

Dear Mr. Wilde: And while

Dear Mr. Wilde:

And while we're on the subject you should add a number of other restrictions on free trade:

- patents (temporary legal monopolies) are restrictions of free trade

- licensing of physicians is a restriction of free trade

- restrictions on telemedicine are restrictions on free trade

So, as you say, rather than bastardize language we should stop talking about free trade in health care (since we can't get there from here) and start talking about what kind of socialized health care system we want (this is desperation speaking--I'm a free trader).