Bracing for ObamaCare: Shirley Svorny on the Economics of Healthcare Regulation
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- čas přidán 15. 08. 2010
- ObamaCare expands coverage to millions of Americans, but, warns Professor Shirley Svorny, without stronger measures to expand the supply of healthcare providers and contain costs, we can expect a physician shortage and soaring premiums.
The California State University, Northridge economist suggests options for lowering costs and dismantling state-level regulations that restrain competition and innovation.
Approximately five minutes.
Interview by Paul Detrick. Shot by Alex Manning and Detrick. Edited by Austin Bragg.
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You don't know how comforting it is to hear an expert economist hear all of the things I've been telling friends since the bill was proposed. Thank you for this post.
A great presentation of the argument for free market health care; Which the US has not had in a long time.
@DraskyVanderhoff "Licensing is very important because it certificate your capabilities" - Licensing is restricting market entry. Certification is different - it is essentially about providing some sort of objective information (someone's qualifications measured against some set of criteria).
Licensing makes everything more expensive by decreasing supply. Certification provides consumers with information without restricting market entry. Do you see the difference?
@MiranUT not very readily. can you give me some of these example you are thinking of?
@snkatk - Food for thought: Can you think of any situation where competition does not "breed" positive or beneficial results? Or perhaps a situation in which competition is actually detrimental?
I can.
HSA-type insurance (paying out of pocket for most routine things + catastrophic insurance for something truly serious and potentially devastating) is the way to go. I switched about 1 year ago and it has actually led me to discover inexpensive alternatives to clinics and doctors I was used to.
@DraskyVanderhoff "I don't understand very well what is the difference about certification and licensing"
Licensing = You are not allowed to practice your profession without a license. If you do, you go to jail, even if clients come to you voluntarily.
Certification = A paper that says you passed some test, or have certain skills. But you can still practice even if you are not certified, but consumers themselves have the freedom to decide whether they want to use your services.
@theradioschizo - Both examples you used are optional care. I'm not against competition, but I think there are cases were we don't need it. Americans have a skewed biased towards it.
I work at a private school and see the costs that get cut to "be competitive" (and make a profit). I live in a society that values good health for ALL its residents and supplements insurance costs so that it's affordable to all. I choose a doctor not based on the price, but on his or her skills.
@snkatk - I don't think it's as much philosophical underpinnings as much as your reluctance to admit that collaborative work can sometimes bring about more gains than competition. I'm not saying that competition is bad - only that there are sometimes other ways besides that to achieve progress or the greater good. Some fields benefit from different approaches - not forcing the same single "competitive framework" onto every situation (e.g. charter schools).
@MiranUT I think the Insurance Co. haven't caught on cause they have no interest in cutting costs in a free market system.
@XCritonX - That Japan debt figure is overstated. And unlike the US, 95% of Japanese debt is domestically owned. Japanese are not overtaxed, so there's room for tax increases - if needed. Less than 10% of the debt is held by "someone else". No doubt, too much debt is bad, but Japan is also a major creditor nation and has a trade surplus. Japanese also save. Borrowing against equity is quite different than a spending spree with nothing to back it.
@MiranUT The problem with all healthcare is that there are hospitals where sick people go to infect others and get infected. Instead of going to the hospital for care, many of the councils could be done over the internet. It could save enormous time and resources.
The only system I'm used to is the Swedish, which is where I live. Not in the US.
I would argue that many of the health problems in the US are not because of their healthcare, more likely their lifestyles.
@MiranUT Yes i will concede the point. People don't ONLY collaborate for direct personal gain. But i would say in a way they do. Even if you are doing something for fun, knowledge's sake, personal interest, etc, if you are collaborating it is because you expect that it will enhance the experience somehow. That is gain. Even if it is a bit abstract. People seem to gloss over competitions darker side definitely. It brings out both the best and the worst in people.
@MiranUT ah, true. i was guilty of the same blindness i was accusing the politicians of and saw competition as the only option. when usually even when people compete they also collaborate, any team sports is an example of this. Would you say that over all in the market, spaning areas including science, health care, education, technology, food service, etc etc, we could use more or less competition?
@MiranUT yes more competition, or yes less competition?
@DraskyVanderhoff I would be quite happy having a veterinarian take care of most of my health needs. Many nurses are eminently qualified to do 90% of what doctors spend most of their time doing. The way licensing works now has little to do with enforcing quality care, and everything to do with enforcing the perks of an old boy's club.
@MiranUT Absolutely couldn't agree more.
@MiranUT Yet in America they spare no expense on public education and it is abysmal. In my state each student gets 16k a year allocated towards there schooling. I can send my kid to a private school for half that and get 10 times the bang for my educational dollar. But not when i have to pay almost 10k a year in property taxes. A very substantial portion of those taxes taxes go directly to schools. And don't get me started on people who don't even have kids, having to send yours to school.
@Mastikator - I'd argue that one of the problems in US healthcare is the lack of human connection. In the US, patients are "diseases" or "injuries" - not people. Get 'em in, get 'em out. If you've used another system where this is not true (in my case in Japan - and it's close to "single payer" insurance system), you'd understand.
Another major problem in US care is that it is not holistic.
@snkatk - While competition works well in most sports and many, but not all, business situations, cooperation is perhaps a better framework to use. Examples include: all ecological systems, childrearing, healthcare, education, the sciences, etc.
Sometimes there are better, more fulfilling and value creating ways than just paying someone (the lowest price) for their services. Free markets should be cooperative and creative, not necessarily competitive, IMO.
She makes so much sense. Common sense.
@snkatk - yes.
@averagejoe040 - Or what many Americans do. just don't go to the doctor when you need to even when you have insurance.
This woman made a lot of good points, but there's also a lot she didn't mention - including the core problems in US healthcare in general. Health care used to be much cheaper when there were more public hospitals. One of the few public hospitals left is Cook Co. in Chicago. It proivides excellent care.
I still see people waiting in line at Wallmart "clinics".
@furyofbongos - It can also be done by monopolies. Just to be clear.
Why do politicians never seem to think that competition breeds results when they have a competition to get into office? You know, maybe they are right, because we certainly have a lot of awful politicians despite them having to compete.
@averagejoe040 - Jealous? I've used two systems, which gives me insight into how they work differently, the pros and cons. Can you say the same?
@averagejoe040 - Where did I say Japan was no. 1? But yes, I have found Japan's healthcare to be not only MUCH cheaper (yes, 1/3) than what I paid in the states, but also better overall care. Check yourself on prices of health care. The US is double no. 2, Switzerland. You have not done your homework.
@theradioschizo - I think humans are smart enough to figure out the best way to do something and do it the better way (This information comes from research - not necessarily from competition). Costs/prices sometimes come down from having done something over and over (practice).
Sometimes competition causes people to do the wrong thing (destroy the environment, used chemicals that kill, etc.). Competition is not always the best way. Cooperation is equally important in a healthy free market.
@snkatk - Science is much more about cooperation than competition. Disagreeing has nothing to do with competing. Disagreement can occur in cooperative endeavors (as in science).
How is the voucher system any different from "charter schools" (which CREDO showed to be inferior to traditional education, despite private foundations pouring money into them)? Education's highly personal, so is healthcare.
Americans have a flawed view of competition. Indeed, a true free market is cooperative.
@nicademus1974 -True:Money doesn't gaurantee quality. Charter schools are an example of this. Speaking of which, the popularity of charter shcools makes me wonder how well many parents can choose a school that meets the learning needs of their child.
There are some serious problems not only with US education, but education in most countries. We are using an old model that is not working for the digital age. Check out Ken Robinson on his call for an education reveolution. Quite interesting.
@MiranUT mmm. We obviously have different philosophical under pinning. I don't see a point in arguing this any further. There is a lot more here than what we are arguing about on the surface. >_
@Justwosweet - Indeed. And a good one if you're for some type of public health system. Preventative care and early treatment available b/c of Hawaii's system certainly help. Why haven't insurance co.s caught on to it.
Why do so many libertarians insist on using a "free market" framework for everything under the sun. Certainly it works great in many situations, but it's not perfect (waste is still created sometimes) - particularly in more organic systems like health and education.
@averagejoe040 - check "Public Hospitals Decline Swiftly, "Washington Times, August 16, 2005. The reason for the decline is 50 million uninsured Americans (not illegals) seeking treatment at public hospitals & the US spending all its $ on senseless wars. Very few illegals are gonna risk showing up at a public institution.
You ought to consider the important role that public hospitals, often affiliated with universities, play in education and training medical staff as well providing care.
@XCritonX - Agreed. A lot of Japan's debt is from WW2 & also from short term (hopefully) revenue loss. Time will tell how quickly they gov can fix it. One of the good things @ the Japanese fed gov is it's rather weak.
I'm American - can't go back to the USA. The value I get for my taxes here is not comparable to what I got in the US. That's what libertarians should be talking about: value - not free market systems as the solution for every problem.
Does policy create value & freedom?
@averagejoe040 - I can imagine why you'd think so, but I'm not AGAINST free/ private markets. I'm very much for limited government. I've seen how a mix of private & public can work well (I'm not talking outsourcing) There are libertarians who like some form of public health. I understand and the benefit of some public funding in certain programs that should not be forced into a "competitive" framework, (e.g education and healthcare). And you? Signing up for medicare in a couple of years?
@XCritonX - That might be true of the US government. Not all governments are so mediocre (that's putting it generously, I know).
@theradioschizo - What evidence do you have that competition works better in healthcare and education? Many other countries are have public systems that work better than the US (Finland & Japan are examples of egalitarian education). The US experimentation with "free choice" charter schools has shown it doesn't work better - in most cases was worse. My point is that there are some things you cannot put a price on, and competition can be counterproductive in some situations.
@averagejoe040 - Of course. Every rich country does. Japan has law similar to Arizonia's. The gov(s) should relax immigration policy (I'm for open borders) rather than restricting it. The US needs >1 million new workers than are available each year (least this was true b4 the meltdown). Japan, more. Do you know any citizens who want to pick lettuce? Iron clothes? Clean toliets?
Who's more to blame: people with the balls to make a better life for themselves? Or employers who are cutting costs?
@MiranUT In your scientists collaboration example you say that they are not collaborating because of competition but to further science in a sense. For the benefit of mankind. paraphrasing but i think that was the jist. They are however not doing it for the good of man or at least not ONLY that. People collaborate to get an advantage over people who don't. To do things in the marketplace they couldn't achieve on their own. They are still competing, they just group up to get an edge.
@nicademus1974 - "brings out both the best and the worst in people". Yup. Again, I'm not against competition, and I very much support a free market approach in many, many situations. IMO some US libertarians are forcing the "competitive" model while ignoring the natural cooperativeness that exists in a free market system.
@averagejoe040 - As I've been saying, the problem with many libertarians is that they try to force the competitive free market model onto everything, when there are alternatives. The gov is there. The only way to limit it is for people to start thinking about the value (or lack of it in the case of many US gov programs - like education - although I don't hear many retirees complaining about medicare) of the services they get. If it's not cost-effective or value-creating, it should be dumped.
@MiranUT Starting a garden is not rocket science. Americans could do them if they knew how and they were shown what to do.
@snkatk - Both. It depends on the situation. Right now the bloated US gov is'nt delivering services effectively. I'm a libertarian, not an anarchist: The gov should provide basic services that are for the common good - and people more often than not have the choice to use in those services. Sometimes the gov can help create competition (not that Obama's plan will help).
Hey, another area competition doesn't work so well is the prison system. Look what's happening w/ privatized US prisons.
@trmentry - Japan privatized their postal system and it got worse.
@averagejoe040 -I've cited my source. Where's yours. You seemed to be the one who doesn't know the system.
I know I paid the same amount in insurance premiums in the US for myself alone as I do for my family in Japan. I know that I couldn't chose my doctor in the US and had to wait 1 or more hours to see one, not so in Japan.
I don't doubt illegals put a strain on hospitals in the US - mostly because of the outrageous prices, but they are NOT the reason for public hospitals going under.
The future of medicine is telemedicine via the internet.
@averagejoe040 Hospitals get shut down because of government interference not because of Illegals. Hospitals shouldn't have to treat anyone without money. Legal or "illegal"
November is coming fast!
@nicademus1974 - Well, there are other goals besides the "benefiting mankind", knowledge for knowledge sake, an interest in the field, etc.
"People collaborate to get an advantage over people who don't" - Do you really think that's the only reason people collaborate? This is what I've been saying: People need to stop trying to fit everything under the sun into one framework of a "competitive free market". Yes, that has a lot of advantages, but it's not the best approach in every situation.
@averagejoe040 They shouldn't have to though. It is like if you sold TV's and the government mandated everyone had to be given TV's weather they could afford one or not. You would blame the people who come here "illegally" to get TV's but not the stupid law that gives out free TV's to everyone?
@averagejoe040 - Where I live, illegals do not get free medical care. You show an insurance card and pay a co-payment. If you do not have a card, you pay full price (which is still much cheaper than the USA) - as my mother did when she visited Japan as a tourist - and was amazed at the wonderful, caring service and low price.
Illegals did not put the US public hospitals out of business. Where did you get that info? Anyway, people still have to pay at public hospitals.
Being forced to choose a "Jiffy Lube" of healthcare is a great analogy, but only because it evokes the horror of your doctor bringing out a white dimpled tray with some different liquid in each dimple and saying: "look this is your blood and it is dirty, so for only a few hundred dollars more we can flush your vascular system and treat it with our special cleanser so it looks more like this clean blood sample over here." Do you want more baseless upselling on your personal health choices, just to take more money from you after a "free initial consultation" or "discounted standard service checkup"? No thanks. There is no such thing as a valid free or fair market in life or death choices. Those market players are generally called "extortion rackets" for good reason.
@averagejoe040 - Why not? Japan ranks higher than the US in quality of care (I can certainly qualify that as true) and costs 1/3 that of the US. Wouldn't you like to pay 2/3 less on medical care/insurance? That adds up in my bank account. I'm also not tied to my job like a slave in order to provide health insurance for my family.
Might do Americans good to look at better examples to use to improve their own situation instead of repeating the mantra: USA No. 1.
@theradioschizo - "done nothing to back it up"? I gave the example of charter schools. Above, I cited Cook Co Hospital as an example of excellent public health care - and also education oriented. Science is a creative endeavor that benefits from collaboration. Pick up any academic journal and read it if you don't believe me. Scientists share ideas to make sure they're sound. They don't hide them to make more money than their competitors - although governments do.
@MiranUT I will agree on child rearing. But i disagree for the others. Firstly science is built off of disagreement and competition. one scientists makes a claim, another disagrees and tests the firsts claim. they try to see who is right. if you have been watching any of ReasonTV's videos on the school voucher system, that is an example of education with competition getting real results. I will agree that there are times where competition isn't appropriate. but those are usually personal things.
hawaii is a bad example if your against a public option or government run healthcare.
@residentzombie - Ha! How many people could actually live "on their own" by growing their own food. Very few. Americans need to rethink the myth of "independence". I think it's one of the major causes of dysfunction (including cronie capitalism) there. The Asian countries have a much healthier sense of the true nature of life: interdependence.
I agree with the basic premise but she doesn't provide any routes to this new form of healthcare that she is talking about. She only mentions the end result. I would be interested in how she plans to create these "jiffy lube" health clinics and also how she proposes that we make healthcare costs more transparent to the consumer so they shop around.
@DraskyVanderhoff "there are too much uninformed people... because they don't have enough time to take responsibility for EVERYTHING!! ... the government assures them that any person that is a doctor is reliable" - In other words, people are too busy to research their doctor, just as they would a mobile phone?? Also, do you actually believe that just because gov't licenses doctors, it means all doctors are good?
I suggest that you think your position through a little better.
@oilhammer04 I welcome that day my friend. People need to learn to leave on their own without support of others and this scenario you give is the only way this will happen. Also with noone making income, the beast that is the government will starve to death. Just make sure to learn how to garden and have a dry food supply on hand. Would help to have smokes, booze, and gold/silver to barter with as well. We have to destroy cronie capitalism for folks to understand what the free market is.
That is why Progressives are going to win. Free market capitalism might have been ok when everyone was able to feed, cloth and house themselves. But we live in a country where 47% of the people can't. 1 in 5 American children don't know where their next meal will come from.
Too many people are dependent upon us to keep them alive and healthy for them to be free in the traditional sense.
Everyone will need to sacrifice according to their ability to care for everyone according to their need.
This is utter bullshit. You would prefer the determination as to who get health care to a corporation who's legal obligation is to make more money for their shareholders.
@averagejoe040 - Yes a teacher, and happy to live in a society that values education and respects the profession of teaching.
Arrogance and ignorance? Go look in the mirror, joe. Read your posts again. Why do you need to use such language? Why can't you give sources for your information? Let me guess: Fox News?
@averagejoe040
You do not understand the immigration problem either.
US employers are responsible for illegal immigrants, as mentioned above. You know, you might want to read a bit more. It may help you on some of these facts you are not familiar with. Then you won't need to pull imaginary "facts" out of the air.