Yeah, France, Canada, Holland, Germany, those places don't really exist. Really. So we can't copy their best ideas. And they're foreign. Or something. I'd like some large country to fully take on the libertarian economic system so we can see it in practice. Then we can write it off as soundly as communism as been written off. Until then we'll keep hearing bullshit about mythical fantasy systems and how "real" libertarianism has never been tried. I doubt libertarianism would even last as long as communism did. I can't take it anymore. If everybody is going to pay libertarians so damn much attention I want equal time for communists.

(It's cool when Freddie posts here.)

It is interesting that there are 3 libertarians in a row in the vlog queue.

Megan says that when the government is the only buyer, there's no market. This is a funny thing for a market fundamentalist to say. It only takes three parties to make a market. Two sellers, one buyer.

Bloggingheads young libertarian rule #1: WW>MM

A so-called utilitarian approach to health care, which states that private markets produce the greatest innovation which benefits the most people, is seriously flawed. The poor are not affected either way if innovation slows or doesn't. They can't afford it anyway. They will die significantly sooner than their more affluent counterparts no matter what drugs were available. So you can say 'we're going to take a chance on innovation slowing in favor of providing the basics to the poor, to try to help them live a little longer. The more affluent majority are going to outlive them anyway'. Or you can say 'we want to maintain a system based on the market which provides excellent drugs and more nuanced, subtle choices to the affluent majority, and let the (growing number of) poor continue to die prematurely'. What you are doing by opting for the latter course is to give those with an advantage an even bigger one. This is not true utilitarianism. This is assuming that innovation would slow or disappear, not if the profit motive disappears, which won't happen, but merely if it is diminished somewhat. This is pure

Quoting uncle ebeneezer: Bloggingheads young libertarian rule #1: WW>MM

"The Ebeneezer Inequality."

Not bad, but anyone calling themselves a libertarian who voted for Obama is seriously deluded or not actually a libertarian.

Quoting holyworrier: A so-called utilitarian approach to health care, which states that private markets produce the greatest innovation which benefits the most people, is seriously flawed. The poor are not affected either way if innovation slows or doesn't. They can't afford it anyway. They will die significantly sooner than their more affluent counterparts no matter what drugs were available. So you can say 'we're going to take a chance on innovation slowing in favor of providing the basics to the poor, to try to help them live a little longer. The more affluent majority are going to outlive them anyway'. Or you can say 'we want to maintain a system based on the market which provides excellent drugs and more nuanced, subtle choices to the affluent majority, and let the (growing number of) poor continue to die prematurely'. What you are doing by opting for the latter course is to give those with an advantage an even bigger one. This is not true utilitarianism.

Your premise - that medical innovation doesn't "trickle down" - is wrong. One obvious example, out of many, is new AIDS drugs. Charitable programs immediately start sending them overseas, and even discounting charity

Just one segment of the Ebeneezerian Quality Spectrum: HH>=WW>MM>AA

I disagree with your take on utilitarianism. I used the term in the same sense as did Megan, and the sense in which the term is generally understood. The greatest good for the greatest number, or the least harm for the greatest number. You are right about some select drugs trickling down. If they are sent overseas, that has no bearing on the topic at hand. Completely apart from the debate about health care, the poorer one is, the shorter, statistically, one is likely to live. That is a built-in disadvantage which our market-based system compounds.

Sorry, but if there is something that only affects 1500 people, we shouldn't be spending a nickel on it as long as so many other diseases remain.

yes! that's seriously what we should do from now on. every time some "angels on the head of a pin" apologist comes on we should respond with communist rhetoric. or maybe next time i'll just go with extreme libertarianism to try to one up them either way it doesn't matter cuz ideologues never chenge their mind.

Megan, England’s UH is based on rationing.
France’s is based on controlling costs. The VA here in the states does both, and it does it to great effect. Patients fight to get into VA care. The patients are really hurting. But they get both great and inexpensive care. When you go into the VA, your records are electronic, your doctor may change but he can read all your records, the doctors have a limited budget to work with, so they have no incentive to do needless medical tests. Whereas, Medicare sucks because while we limit payments (control costs), it works within the current system, so doctors have ever good reason to do unnecessary shit they can bill for. So here’s my point, before we go trying to push all people satisfied with their healthcare into some universal thing…. why not: 1. Turn the Medicare system into a VA-style system.
2. Use the new VA-style system to cover all the uninsured. This would give us a tremendous first step toward electronic record keeping, we’d have a fixed yearly budget, so the doctors would have stop needless tests / treatments. It’s a BOLD move, it is single payer – and it will house everybody who doesn’t

Megan McArdle's thoughtful analysis of the Obama health care plan has clearly hit a nerve with those who are so emotionally vested in universal health care (and/or Obama) that they will not tolerate rational challenges to the thin plan that Obama and Orszag have laid out. As Megan pointed out, once the government starts to lower the prices paid for pharms, the companies will stop investing in R&D (Mark was unable to provide examples of government controlled industries that deliver consistent innovation). And this argument can be extended to other health care sectors. When doctors' pay is controlled (i.e. lowered) by the government, over time the better students will stop going into medicine and we will have poorer quality doctors. When hospital administrators' salaries are capped, it will become a less desirable field, and ultimately the quality of hospital care will go down. Add to this the rationing of medical procedures and equipment, and it is clear that large incremental number of people will die under this plan. Mark was also not able to give a convincing reason why, if the point of this "reform" is to lower the overall

wow! i guess all of the (made up) "facts" just happen to align with those who are interested is dragging their feet on health care. gee, i guess the rest of the industrialized world must.....not exist? i'm sorry, i'm gonna have to start referring to you guys as "Health Care Truthers."
you should attach this:
http://images.3d4medical.com/_a/stil...M000007589.jpg
to your tin foils hats and it'd be like a cute little antenna or something

Quoting I'm SO awesome!: yes! that's seriously what we should do from now on. every time some "angels on the head of a pin" apologist comes on we should respond with communist rhetoric. or maybe next time i'll just go with extreme libertarianism to try to one up them either way it doesn't matter cuz ideologues never chenge their mind.

Great idea. We should do both simultaneously to maximize the effect. Let's call it Extreme Ironic Commulibertarianism. Here goes: The constitution isn't valid because I never signed it and it's an instrument of capitalist oppression. Property is the bulwark of liberty and is also theft.

Quoting TPGS: Megan McArdle's thoughtful analysis of the Obama health care plan has clearly hit a nerve with those who are so emotionally vested in universal health care (and/or Obama) that they will not tolerate rational challenges to the thin plan that Obama and Orszag have laid out.

As Megan pointed out, once the government starts to lower the prices paid for pharms, the companies will stop investing in R&D (Mark was unable to provide examples of government controlled industries that deliver consistent innovation). And this argument can be extended to other health care sectors. When doctors' pay is controlled (i.e. lowered) by the government, over time the better students will stop going into medicine and we will have poorer quality doctors. When hospital administrators' salaries are capped, it will become a less desirable field, and ultimately the quality of hospital care will go down. Add to this the rationing of medical procedures and equipment, and it is clear that large incremental number of people will die under this plan.

Mark was also not able to give a convincing reason why, if the point of this "reform" is to lower the overall

Everybody agrees that new medical practices, treatments, and technologies are good for society. That requires innovation. So let's try to think clearly about where innovation comes from. Markets don't innovate. Corporations don't innovate. Only people do. Who's the greatest innovator in the history of medicine? I'd say it's Ignaz Semmelweis, the man who figured out that doctors should wash their goddam hands (try commercializing that one). Then there's the guys who developed penicillium. And pretty much every Nobelist. You can play this game all day long and the for-profit capitalists will barely get any points on the board at all. Private sector research is vital and necessary, especially for the grunt work of clinical trials, but on the whole most innovation comes out of the public sector, or at least from guys who will never make on dime on their discoveries. OK, so what are markets good for? They're good for sorting the good ideas from the bad ideas. You throw a bunch of stuff up and see what sticks. It'd be bad to have any kind of system that took final positions on the right treatment for everything and shut out

Great edition. Some interesting insights from Megan, whom I know many are irritated by (more on that later).
The part about people living longer is true I think. People died earlier decades ago, and that saves expenses. As treatments get better and people live longer, I do not see how the net cost of health care can go lower all things being equal. Now maybe this can be offset with some hidden efficiency, that is the hope, but living longer, and more advanced treatments must make the cost of surviving more expensive. Also found the point about the R&D budgets for drug companies interesting and telling. Call me an optimist, but I DO think there can be a better system that preserves the profit motive but dampens cost. I will not let the fact that I am too dull to divine it lessen the possibility of its existence or our resolve to craft it. But the last comment will be to highlight my take on why so many are irritated by Megan. You know who you are. I think it is because she is a bubble burster. Sometimes it's pretty hilarious, this liberal or non liberal alike goes on

Quoting JonIrenicus: She often finds the bare thread on that perfectly clean suit and yanks at it, exposing the faults. And some of you cannot stand that! I suspect some do not like the assaults to their views, to see them picked at and viewed through the eyes of a different colored lens, usually a less flattering lens.

I couldn't decide if she sounded more like Eyeore or the comic book guy on The Simpsons. No, you got it backwards. Megan (at least in this one) is a one-way function. It only takes her a second to spout nonsense, but it takes poor Mark Schmitt minutes to spell out why she's wrong. Hell of a debating tactic.

Quoting claymisher: I couldn't decide if she sounded more like Eyeore or the comic book guy on The Simpsons.

No, you got it backwards. Megan (at least in this one) is a one-way function. It only takes her a second to spout nonsense, but it takes poor Mark Schmitt minutes to spell out why she's wrong. Hell of a debating tactic.

nonsense, yes, an interesting word http://www.veoh.com/browse/videos/ca...316436GQ6CawaR

I haven't listened to the whole thing, but even though I'm a right-wing extremist who agrees with a lot of what she says Megan is really pissing me off. This is probably the worst I've heard from her. Why is she acting like such a hack and reducing everything to those bad liberals vs righties in need of defense against dishonest attacks? Mark wasn't bringing in an axe to grind, did she need to turn it into a partisan fight?

Quoting holyworrier: I disagree with your take on utilitarianism. I used the term in the same sense as did Megan, and the sense in which the term is generally understood. The greatest good for the greatest number, or the least harm for the greatest number.

You are right about some select drugs trickling down. If they are sent overseas, that has no bearing on the topic at hand. Completely apart from the debate about health care, the poorer one is, the shorter, statistically, one is likely to live. That is a built-in disadvantage which our market-based system compounds.

That isn't the sense it's generally understood, though. Wherever that summary came from it's pretty misleading. Utilitarianism is choosing whatever action produces the most utility, meaning (happiness/pleasure per person benefited * number of people benefited) - (harm per person hurt * number of people hurt). That doesn't involve simply maximizing the number of people, as well it shouldn't: that reasoning leads to even worse '51% enslaving 49%' outcomes than utilitarianism normally gets accused of. I'm not sure I understand your complaint here. If it's a question of the poor getting medicine, then international consequences are much more important than domestic ones. Being poor in America is still a

Quoting JonIrenicus: There is probably more to the irritation, but I think that is definitely part of it. For my part, I think she's great.

I like Mcardle too. I think it's because I like hearing people get worked up and she always sounds a little excited or anxious when she interrupts someone to disagree. She reminds me of the main character of the Phoenix Wright games

Quoting claymisher: Anyway, the point is that we're better off without the ritual incantation of "markets" and "innovation" and that we should instead think clearly about the specific contexts and mechanisms that get us good outcomes. It's not at all clear the more capitalism is always going to be the answer. But if we're smart we can create institutional and regulatory frameworks to enable scrappy startups get a crack at making things better. BTW, I have an idea for a MRSA cleaning company.Your hospital hires us and we'll make sure your doctors wash their fucking hands ...

All your points are valid. And your example of the cancer patient illustrates how the meaningless rhetoric of "choice" and "innovation" clouds the whole issue in the US by making people believe that their health care will be inferior if medical providers are subject to cost controls---as in France and the rest of Europe. By the way, European pharmaceutical companies also innovate! Alas, your common sense and the common sense of health care professionals everywhere but in the US, is subject to a constant barrage of nonsense spread by such ideologues as Megan McCardle, who, as

Wow -- what made Megan such an asshole? Constant interruptions in a nasty hectoring tone and wild accusations of "sounding like a SOCIALIST!" More Obama derangement syndrome (Brink Lindsey is the other example, but he wasn't rude to Josh.) Take a valium next time Megan -- or maybe read some kind of etiquette manual.
Good thing Mark is able to absorb her nastiness without giving it back.

Quoting Freddie:
So the question that we must insist on asking Megan, et al, is what she and they would have these sick people do. What should they do, if they can't get a job that provides health benefits? What should they do?

They should die so that the wealthy here and the poor of other countries that do control drug prices will have more and better drugs -- more people will live longer and have longer sexual lives in the rest of the world as a result of their deaths. Perhaps people in the rest of the world will put up plaques thanking the American poor for their unselfish sacrifice. Some libertarians are natural rights theorists of a particularly absolutist bent (Ayn Rand, Robert Nozick). Others (like Megan) appear to be people who believe that Economics provides you with a complete moral system: One part crass utilitarianism ("seek the greatest overall good, no matter how that's distributed") and one part modified Alexander Popism ("Whatever is is right" -- so long as the market is doing it, not Government). Will Wilkinson apparently accepts Rawls's focus on the worst off and has

Quoting holyworrier: I disagree with your take on utilitarianism. I used the term in the same sense as did Megan, and the sense in which the term is generally understood. The greatest good for the greatest number, or the least harm for the greatest number.

You are quoting the slogan, not the doctrine itself. Classical Utilitarianism tells you to maximize the aggregate happiness, counting every person's happiness equally. Effectively, it comes up with a sum, and sums do not say anything about what they are sums OF. I can get to 50 by adding 5 tens or I can add 1 + 1+1+1+46. pampl's criticism cannot be blocked at the get-go. It is not a knock-down argument as it stands though. The standard utilitarian response is that (because of diminishing marginal utility), it's more likely that a more even distribution of resources will tend to produce the greatest sum of happiness: give a dollar to a millionaire and he won't even notice -- give the same dollar to a poor person and he can get something to stave off starvation.

You are right about some select drugs trickling down. If they are sent overseas, that has no bearing on the topic

Quoting pampl: That isn't the sense it's generally understood, though. Wherever that summary came from it's pretty misleading. Utilitarianism is choosing whatever action produces the most utility, meaning (happiness/pleasure per person benefited * number of people benefited) - (harm per person hurt * number of people hurt). That doesn't involve simply maximizing the number of people, as well it shouldn't: that reasoning leads to even worse '51% enslaving 49%' outcomes than utilitarianism normally gets accused of.

The Classical Utilitarians, Jeremy Bentham and John Stuart Mill, identified the good with pleasure, so, like Epicurus, were hedonists about value. They also held that we ought to maximize the good, that is, bring about ‘the greatest amount of good for the greatest number’. http://plato.stanford.edu/entries/ut...anism-history/ Take a fucking poll.

Quoting pampl: I'm not sure I understand your complaint here. If it's a question of the poor getting medicine, then international consequences are much more important than domestic ones. Being poor in America is still a relatively high standard of life. If it's just about being able to compete in the market, then I have to point out that most of those added years of lifespan aren't spent competing, they're spent in retirement

Whether the poor in foreign countries get cheap medicine or

Quoting TPGS: Megan McArdle's thoughtful analysis of the Obama health care plan has clearly hit a nerve with those who are so emotionally vested in universal health care (and/or Obama) that they will not tolerate rational challenges to the thin plan that Obama and Orszag have laid out.

As Megan pointed out, once the government starts to lower the prices paid for pharms, the companies will stop investing in R&D (Mark was unable to provide examples of government controlled industries that deliver consistent innovation). And this argument can be extended to other health care sectors. When doctors' pay is controlled (i.e. lowered) by the government, over time the better students will stop going into medicine and we will have poorer quality doctors. When hospital administrators' salaries are capped, it will become a less desirable field, and ultimately the quality of hospital care will go down. Add to this the rationing of medical procedures and equipment, and it is clear that large incremental number of people will die under this plan.

Mark was also not able to give a convincing reason why, if the point of this "reform" is to lower the overall

If there's a profit to be made there will be pharma research. AemJeff

But there won't be a profit to be made. The big, evil pharma companies shouldn't earn a profit, that will be "cost savings" (or, more likely, spent to buy votes via union concessions, etc...). In your fairytale land, the scientists and researchers will show up everyday and work for free?

Quoting TPGS: But there won't be a profit to be made. The big, evil pharma companies shouldn't earn a profit, that will be "cost savings" (or, more likely, spent to buy votes via union concessions, etc...). In your fairytale land, the scientists and researchers will show up everyday and work for free?

In my fairyland demand still drives research. Hard to imagine such a thing? Yours seems to be a somewhat binary world.

One of Megan's best performances. Usually I find she comments on things she doesn't have much knowlege on. "If there's a profit to be made there will be pharma research, (most of which will find its way into the sewer of finding a new blockbuster, a chemical similar enough to somebody else's blockbuster to allow it to marketed as competitor) there will be R&D." This makes no sense. What is a drug company going to do: spend billions on a new drug that could cure cancer or spend a few million slightly improving their current drugs (ie making a 4 hour drug into a 24 hour drug) and make significantly more profits? It's not a matter of IF they can make a profit. It's a question of how much profit they can make with their limited investment resources.

Quoting holyworrier: The Classical Utilitarians, Jeremy Bentham and John Stuart Mill, identified the good with pleasure, so, like Epicurus, were hedonists about value. They also held that we ought to maximize the good, that is, bring about ‘the greatest amount of good for the greatest number’.

http://plato.stanford.edu/entries/ut...anism-history/

Take a fucking poll.

Try actually reading the article you linked to. You're simply wrong.

Whether the poor in foreign countries get cheap medicine or not is not relevant to this discussion of the American health care system. The relative poverty of Americans is not relevant to this discussion of the American health care system. Whether or not a person can compete in the market after retirement not relevant to this discussion of the American health care system. Neither are any of your points relevant to the point I made, which is that maintaining our current profit-oriented system, which produces innovations accessible to only the affluent, compounds the advantages the affluent already have over the poor, which, contrary to Megan's little riff on utilitarianism, does not ensure the greatest good for the greatest number. Rather, it disproportionately increases the good already enjoyed by the greatest number, rather than decrease the disparity, which

Quoting gwlaw99: One of Megan's best performances. Usually I find she comments on things she doesn't have much knowlege on.

"If there's a profit to be made there will be pharma research, (most of which will find its way into the sewer of finding a new blockbuster, a chemical similar enough to somebody else's blockbuster to allow it to marketed as competitor) there will be R&D."

This makes no sense. What is a drug company going to do: spend billions on a new drug that could cure cancer or spend a few million slightly improving their current drugs (ie making a 4 hour drug into a 24 hour drug) and make significantly more profits? It's not a matter of IF they can make a profit. It's a question of how much profit they can make with their limited investment resources.

I don't think I follow your pont, quite. I think the way the market is currently structured makes for a lot of bad incentives - comapared to the actual needs. Drug companies waste a lot of resources on reinventing Vioxx, or creating a new Statin, or whatever - or worse yet, finding a tiny tweak in a molecule so

nice i'll try to think up so good ones for next time.

Quoting claymisher: Megan (at least in this one) is a one-way function. It only takes her a second to spout nonsense, but it takes poor Mark Schmitt minutes to spell out why she's wrong. Hell of a debating tactic.

Over on the Prospect's blog TAPPED Mark Schmitt it explains it better:

You may be familiar with a wonderful short book by the economist/philosopher Albert O. Hirschman called The Rhetoric of Reaction. Hirschman (better known for his essay "Exit, Voice and Loyalty") simply catalogs the three great arguments that conservatives use against virtually any progressive idea: Perversity (It will do the opposite of what you intend). Futility (It'll never work). And Jeopardy (It'll cost too much).

The book is only 167 pages long, but if you were hoping for a movie version, may I recommend bloggingheads today, where Megan McArdle of The Atlantic and I started off talking about the budget deficit, and quickly moved on to health reform, which I think is key to solving the long-term budget problem, and Megan, well, Megan thinks it will never work, will do the opposite of what's intended ("it will kill thousands of people"), and will cost too much. You can decide for yourself.

Heheheh.

Quoting AemJeff: Drug companies waste a lot of resources on reinventing Vioxx, or creating a new Statin, or whatever - or worse yet, finding a tiny tweak in a molecule so they can market an extremely similar variant on an older drug under a a new patent, extending their monopoly for another seventeen years..

Speaking as someone who had to try four variants of same type of drug to get one to actually work (some actually made my medical condition worse), I believe that things like "creating a new statin" are very beneficial and not just marketing. Also remember that statins were once completely new drugs that required billions in research to develop. With price controls, they may not have been profitable enough to develop in the first place.

Speaking as somebody who is deeply deeply dependent on pharmaceuticals - of me twelve daily prescriptions, two are not generic, and one of the non-generics is insulin, which isn't available in generic form. Where is all the innovation, when out of all those drugs, only one is actually recent enough to covered by a patent?..

I don't really get what you are complaining about. 10/12 of your

I agree with you about Megan.

Quoting pampl: Your premise - that medical innovation doesn't "trickle down" - is wrong. One obvious example, out of many, is new AIDS drugs.

The problem is that care isn't about innovation. If you want to argue that the government shouldn't tax pharmaceutical companies at all to spur innovation, you might make some headway. But you can't lump pharma and health care providers together as if their financial incentives are at all the same. It's like saying that we'll get better TV programming if we tax Samsung at a lower rate. Health care access is a delivery system and drug research is content. We don't have a content problem in the US, we have an access problem. So every moment we sit here talking about innovation is one in which we are not discussing our actual problems.

Quoting pampl: Try actually reading the article you linked to. You're simply wrong.

MM prefaced her remarks on the market and innovation in terms of utilitarian argument. The market, according to her, creates greater good for a greater number. Am I wrong about her meaning? Three hundred million people in the US who will die of diseases we have no cure for, I think she said, and this number is far more than the number who will die for lack of health care. Therefore innovating for those many millions is more important than providing health basics for the fewer millions. Am I on the mark so far? Do you consider that her remarks properly reflect your interpretation of a utilitarian argument? Or do they reflect what I call the 'common understanding' of the nature of utilitarian theory? I interpreted them as the latter. All I'm trying to do is take the sense of her usage of 'utilitarian' and show that her argument is flawed. I sensed I might get called on the complexities of all the variants of the philosophy, of which I am aware. I've read several papers on dense utilitarian problems. I don't care about that here. I'm taking MM's statement and dealing

I think I caught McArdle doing the great libertarian cop-out: the people in poor countries are worse off than America's poor, so let's help neither. Will Wilkinson plays that one all the time.

Quoting holyworrier: MM prefaced her remarks on the market and innovation in terms of utilitarian argument. The market, according to her, creates greater good for a greater number. Am I wrong about her meaning? Three hundred million people in the US who will die of diseases we have no cure for, I think she said, and this number is far more than the number who will die for lack of health care. Therefore innovating for those many millions is more important than providing health basics for the fewer millions. Am I on the mark so far? Do you consider that her remarks properly reflect your interpretation of a utilitarian argument? Or do they reflect what I call the 'common understanding' of the nature of utilitarian theory? I interpreted them as the latter.

All I'm trying to do is take the sense of her usage of 'utilitarian' and show that her argument is flawed. I sensed I might get called on the complexities of all the variants of the philosophy, of which I am aware. I've read several papers on dense utilitarian problems. I don't care about that here. I'm taking MM's statement and dealing with it in the sense that it was made.

I made

From today's headlines:

June 12 (Bloomberg) -- Eli Lilly & Co. urged doctors to prescribe Zyprexa for elderly patients with dementia, an unapproved use for the antipsychotic, even though the drugmaker had evidence the medicine didn’t work for such patients, according to unsealed internal company documents.

In 1999, four years after Lilly sent study results to the U.S. Food and Drug Administration showing Zyprexa didn’t alleviate dementia symptoms in older patients, it began marketing the drug to those very people, according to documents unsealed in insurer suits against the company for overpayment.

http://www.bloomberg.com/apps/news?p...d=aTLcF3zT1Pdo

Quoting gwlaw99: Speaking as someone who had to try four variants of same type of drug to get one to actually work (some actually made my medical condition worse), I believe that things like "creating a new statin" are very beneficial and not just marketing. Also remember that statins were once completely new drugs that required billions in research to develop. With price controls, they may not have been profitable enough to develop in the first place.

I don't really get what you are complaining about. 10/12 of your prescriptions are available cheaply as generic. How is this bad? Generic insulin production is banned by US law against generic biologics. Granted a change in the law is opposed by Pharm companies, but there are good arguments for and against allowing generic biologics.

http://drugtopics.modernmedicine.com....jsp?id=417490

Can you explain your reasoning for this conclusion more fully?

What kind of changes are you proposing?

I also don't think you addressed my major point that innovation for completely new drugs for fighting cancer (8 million deaths per year world wide), heart disease (16.7 million deaths per year workd wide), etc. would be completely stifled by price controls as there would be no

Megan, your behavior during this diavlog was outrageous. I hope you have a chance to watch it and that you are shocked and embarrassed by how rude you were to Mark and how unfair many of your arguments were. If your only response to Mark's suggestion of "changing the culture" at hospitals is to snap about REEDUCATION CAMPS, you need to do a bit more reading, maybe some meditation, and check back again in a year. (I'm not an expert, but how about granting bonuses and payment based on health outcomes, rather than procedures?) You complained that Mark sounded like an 1890s-style socialist pamphlet, but you sounded like a McCarthy-era red-baiter. I'm pretty sure that's beneath you, and it's definitely beneath bloggingheads. Furthermore, I've lived in McAllen Texas, Megan, and you don't know McAllen Texas. It's not a place that young doctors want to go live - it's a place that almost no one wants to go live. It is one of the poorest counties in the country and one of the cheapest places to live. If you made $85,000 a year you could live like a prince. Hell, you can live pretty well on $25,000 down there. The

"there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. " Virtually everyone not here illegally has access to Medicaid programs. We're not talking about universal health care, we're talking about universal welfare.

Quoting TallDave: "there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. "

Virtually everyone not here illegally has access to Medicaid programs.

We're not talking about universal health care, we're talking about universal welfare.

What are the eligibility requirements for Medicaid?

Quoting TallDave: "there are very many people in this country who are incapable of procuring necessary health care when they desperately need it because of their financial and employment situation. "

Virtually everyone not here illegally has access to Medicaid programs.

We're not talking about universal health care, we're talking about universal welfare.

Try getting regular treatment for a chronic ailment when you're uninsured. Try getting insured if you have a chronic ailment when you don't have an employer willing or able to provide it. I really don't know what you're talking about.

Quoting yamascuma: Also, when Mark said that the government created the culture as it is, and Megan said "it just happened" Mark was right. The same thing is true of capitalism in general, which doesn't come into being without government intervention. C.f. Karl Polanyi, The Great Transformation.

Well put. BTW, how did you come across "The Great Transformation"? I've been interested in economics and anthropology (majored in both in college) for 20 years, and I only just came across it this year. Now all of a sudden I see it cited everywhere!

"Try getting regular treatment for a chronic ailment when you're uninsured. " You don't think Medicaid covers chronic ailments?

They're administered by the states, so vary from state to state, but generally you just need to prove you are a U.S. citizen and can't pay for it.

Quoting TallDave: "Try getting regular treatment for a chronic ailment when you're uninsured. "

You don't think Medicaid covers chronic ailments?

If you're eligible. I wasn't when I needed it.

Quoting TallDave: They're administered by the states, so vary from state to state, but generally you just need to prove you are a U.S. citizen and can't pay for it.

What's the eligibility requirement in your state?

Here Megan claims New York in an awful place for businesses to operate, one of the bottom three in the country. If this is true, why do thousands of companies--including some of the country's largest--inhabit the island of Manhattan? New Jersey is right across the river, and Connecticut isn't too far away either. All of these are knowledge-based businesses that could easily relocate. If NY is so horrible, why don't they move?

I have to wonder what libertarians who voted for Obama thought they were going to get. Of course Obama is going to nationalize health care if he can. I work in health care. It is not true that people die in this country because they can not afford health care. That is a myth. It is also not true that people with chronic conditions can not get care. I know a lot of people on medicaid who get all of their care and meds without charge. I know veterans who get care without charge. That is already available to people. Here in Indiana the state government created a program designed to help people get coverage and many of the people who could have gotten help did not want to even bother with the paperwork necessary to get it. A lot of the people who do not have health insurance, do not want it. The only way a program will provide all these people with care is if it is mandatory like car insurance. And I really do not think people are interested in something like that. The problem with health

Quoting Terrye: I work in health care. It is not true that people die in this country because they can not afford health care. That is a myth. It is also not true that people with chronic conditions can not get care. I know a lot of people on medicaid who get all of their care and meds without charge. I know veterans who get care without charge. That is already available to people.

The only way you're going to convince somebody that the undertreated poor don't really exist is if you loan them your ideological blinders. You also haven't been following politics very closely either. Obama has never endorsed single-payer. He's explained frequently why it's not worth the fight. Hell, there aren't even 60 votes in the Senate for the public option. Here's a tip: don't make up stuff. People will call you on it.

My favorite part was when Mark explained that liberalism's entire health care (and therefore deficit reduction) plan rested on Peter Orszag finding the "Holy Grail" of controlling health care costs.
As Bill Simmons would ask "where can I buy stock in Orszag completely failing to lower the deficit?"
Oh wait, I can!
http://www.ft.com/cms/s/0/68ca2d04-5...44feabdc0.html

claymisher: Make stuff up? I work for a home health care agency. I have clients who get home health care aid visits, their meds, counseling and phsyical ed through the state. This is what I do. I did not say there were no poor people, I said people were not dying because they are poor and can not get care.

Quoting Terrye: claymisher:

Make stuff up? I work for a home health care agency. I have clients who get home health care aid visits, their meds, counseling and phsyical ed through the state. This is what I do.

I did not say there were no poor people, I said people were not dying because they are poor and can not get care.

Let me get this straight, because you see poor folks getting care (and good for you too, btw), that means there are no poor folks not getting care. I'm not an expert at logic but I'm pretty sure there's a flaw in that.

Everyone is missing the one thing which will mess this all up. The Dems won't enact meaningful tort reform. All of the preventative medicine that gets done to prevent lawsuits probably runs several billion dollars. Now, doctors will get sued on one end and shafted by the government on the other.

As far as Obama endorsing a single payer system, I think it is Obama's intent to nationalize health care whatever he might say.

Quoting Terrye: As far as Obama endorsing a single payer system, I think it is Obama's intent to nationalize health care whatever he might say.

What, you can read minds? For the non-mind-readers out there, here's Obama saying why he's not pushing for single-payer, let alone nationalization:

Q Good afternoon, Mr. President. I am Paulette Garren (phonetic). As a self-employed individual, I spend approximately $8,000 annually on my health insurance premium, and it's a $2,000 deductible -- no dental, no vision, no prescription coverage. As my business is declining because of the economy we have, I am now in a situation where I'm taking savings to help pay for food and housing, because I also still don't want to lose my health insurance. And I will be frank and honest with you: I am a supporter of a single-payer system over any other system, because I do -- (applause) -- thank you -- I do believe that it will meet your three criteria and be the most economically feasible plan that we have.

When you were speaking, you mentioned that if we go with a public and a private option, that the public option will keep the private insurers honest. My concern is that we will end up in a situation like we have

claymisher: I think the plan is a Trojan Horse. I don't have to read minds. I have been watching Obama evade, lie, flip flop, and revise his policies for months now. I just do not believe a word the man says. Now if his fan club wants to continue to believe everything he says, fine, but I think he will bankrupt the country. And when he does, guys like you will blame Bush.

Quoting Terrye: And when he does, guys like you will blame Bush.

Damn right. It's Bush's fault.

Quoting Terrye: claymisher:

I think the plan is a Trojan Horse. I don't have to read minds. I have been watching Obama evade, lie, flip flop, and revise his policies for months now. I just do not believe a word the man says.

Now if his fan club wants to continue to believe everything he says, fine, but I think he will bankrupt the country. And when he does, guys like you will blame Bush.

It's funny that you mention that, because I've been reading between the lines of your posts, and I've concluded you're a kitten rapist. Go ahead and deny it, but the evidence is all there. Seriously, what's Obama's secret plan to nationalize health care? How's he going to get Dorgan, Nelson, Bayh, and Lincoln to vote for that? They won't even get on for the public option, let alone single-payer, let alone nationalization. I'd like to know. If he can pull that off he'd be history's greatest President.

Quoting claymisher: It's funny that you mention that, because I've been reading between the lines of your posts, and I've concluded you're a kitten rapist. Go ahead and deny it, but the evidence is all there.

Seriously, what's Obama's secret plan to nationalize health care? How's he going to get Dorgan, Nelson, Bayh, and Lincoln to vote for that? They won't even get on for the public option, let alone single-payer, let alone nationalization. I'd like to know. If he can pull that off he'd be history's greatest President.

There is a difference between efficacy in passing legislation and good leadership. Passing national health care will not be hard because he has 59 democrats and Specter to work with; he can lose 8 and still pass it with more than 50. Obama has gone on a mad dash toward nationalization of our economy. He's nationalized the automobile industry. He's effectively nationalized the cigarette industry. The banking industry isn't far behind. And health care will be there, too. He's eerily reminiscent of Juan Peron in his political agenda.

Quoting cognitive madisonian: There is a difference between efficacy in passing legislation and good leadership. Passing national health care will not be hard because he has 59 democrats and Specter to work with; he can lose 8 and still pass it with more than 50. Obama has gone on a mad dash toward nationalization of our economy. He's nationalized the automobile industry. He's effectively nationalized the cigarette industry. The banking industry isn't far behind. And health care will be there, too. He's eerily reminiscent of Juan Peron in his political agenda.

Fiat bought Chrysler. Ford is hanging in there (good job guys!). We'll see what happens with GM. A bunch of banks went under. The only companies that the government got involved with were companies that bankrupted themselves. They passed a law to let the Food and Drug Administration regulate tobacco. That's not nationalization. That's just sanity. You're making this stuff up. Do you think everybody reading this is stupid? Does this kind of exaggeration make you feel good about yourself? What's the point? In four years when none of your crazy predictions have come true are you got to eat your words? Or just get crazier, and figure that's

Quoting claymisher: BTW, how did you come across "The Great Transformation"? I've been interested in economics and anthropology (majored in both in college) for 20 years, and I only just came across it this year. Now all of a sudden I see it cited everywhere!

If I remember correctly, I read it in a graduate course in 19th-century European history. In my opinion, it's a very impressive book, and one that must be kind of confusing to the philosophically libertarian. Which is not to say that it's without its flaws--it's a bit "England-centric"--but the central conclusion (that free markets are created by state action and are not an inherent property of human society) seems as true now as it did then. Which, on the other hand, doesn't mean that libertarians don't often have intelligent perspectives to share or interesting ways of looking at problems. Just not so much in this diavlog.

I found this conversation pretty unhelpful. Humming and hawing aside, it seems pretty clear that neither Schmitt nor McArdle knows much about the health care system. So in the breach they fall back on their ideological predispositions: McArdle: Markets are awesome! Competition is awesome! Profits are Awesome! Schmitt: Government is wonderful! Medicare is a government program (and therefore wonderful)! I know much less than either of these two about health care or how to fix it. What I'd rather see is two academics, say one who has studied the insurance markets, and another who has done cross-country comparisons on health care spending and outcomes, in order to suggest how the system might be improved in the U.S. As an aside, one thing The Economist mentions frequently that Democrats won't touch, despite their invoking of the cost-control mantra, is the way in which the medical malpractice system drives up costs. Doctors have a huge incentive to perform every conceivable test and procedure for any conceivable condition, no matter how unlikely, for fear that they will be sued. Lawyers, in turn, have limitless motivation to file suit on highly dubious grounds. This is a huge contributing factor to rising health

Quoting yamascuma: Also, when Mark said that the government created the culture as it is, and Megan said "it just happened" Mark was right. The same thing is true of capitalism in general, which doesn't come into being without government intervention. C.f. Karl Polanyi, The Great Transformation.

Yama: This is so off topic that I hesitate to bring it up, but I can't resist. The thesis that "government intervention" created capitalism is a bit odd. (Sorry, I haven't read any Polanyi, or if I have it's been so long ago that I've forgotten, so I can't speak to his argument.) Capitalism depends on many, many factors. If you want to argue that enforcement of property rights, a stable medium of exchange, and maintaining and enforcing peace and tranquility over a long period of time in a broad geographic area are necessary for the development of capitalism, and that this is all you mean by "government intervention," then of course you're right and we have nothing to argue about. But when we talk about "government intervention" we usually mean governments stepping into markets that already exist to stop something happening that otherwise might (e.g., development of monopolies, or fraud), or to make something happen that would not

The government now has the authority to dictate exactly how cigarettes are made. As much as I deplore cigarette smoke, I deplore the government exercising such a gross abuse of authority in interjecting itself into an industry.

Quoting cognitive madisonian: The government now has the authority to dictate exactly how cigarettes are made. As much as I deplore cigarette smoke, I deplore the government exercising such a gross abuse of authority in interjecting itself into an industry.

Yeah, and potato farmers can't put lead in your food either. Good thing too.

Quoting cognitive madisonian: The government now has the authority to dictate exactly how cigarettes are made. As much as I deplore cigarette smoke, I deplore the government exercising such a gross abuse of authority in interjecting itself into an industry.

As claymisher has already noted, you're both exaggerating and forgetting that virtually everything else sold for human consumption is subject to government regulation. As I understand the new authority being considered for the FDA, it has almost everything to do with them being able to tell cigarette manufacturers what they may not add to their products, and nothing to do with how they should make them. By the way, I'm more or less a lifetime smoker, and I still have no problem with this recent move. It's about too late to matter as far as I'm concerned, but I'm all for preventing the tobacco companies from continuing to hook the next generation.

Quoting rfrobison:
As an aside, one thing The Economist mentions frequently that Democrats won't touch, despite their invoking of the cost-control mantra, is the way in which the medical malpractice system drives up costs. Doctors have a huge incentive to perform every conceivable test and procedure for any conceivable condition, no matter how unlikely, for fear that they will be sued. Lawyers, in turn, have limitless motivation to file suit on highly dubious grounds. This is a huge contributing factor to rising health care costs, but the Democrats won't touch tort reform because half their campaign contributions come from trial lawyers.

Wait, isn't that how the is market suppose to work? The doctors have the incentive to do a good job so they don't get sued. And judges sort it out in the end. Isn't that what libertarians always want?

Megan fails to consider other contributing factors to health care costs. We pay insurance companies and MD's way more then other countries. Why? I thought libertarians despised unions and like it when companies can negotiate down workers salaries. Well, imagine the health care system as a big company with the insurance and MD folks as their workfroce. In order to make this business leaner and meaner we are just going to have to negotiate down the overbloated salaries of some of its workers. Either that or the company goes bust and then we'll all be out of a job. Now that would suck!

As an aside, one thing The Economist mentions frequently that Democrats won't touch, despite their invoking of the cost-control mantra, is the way in which the medical malpractice system drives up costs.

It's true that you always have to look out for the lobbyists and where the campaign cash is coming from for Congress. Although nothing is as dirty as defense contracts, healthcare also brings out the usual graft, corruption and influence peddling. The last big medical bill (prescription drug benefits) that became law was gamed to death by Pharma. There are conflicts of interest galore. Another one to watch is stock holdings. As the WAPO reports today:

The first big congressional moment on health care comes Tuesday in the Senate's Health, Education, Labor, and Pensions Committee, which will consider a liberal-leaning proposal that includes the creation of a "public plan" meant to be a government-administered alternative to private health insurance.

On that 22-member panel, at least eight senators have financial interests in the health-care industry worth a minimum of $600,000 -- and potentially worth as much as $1.9 million. The investors include Sen. Johnny Isakson (R-Ga.), a senior member of the panel, who holds at least $165,000 in

As an aside, one thing The Economist mentions frequently that Democrats won't touch, despite their invoking of the cost-control mantra, is the way in which the medical malpractice system drives up costs. Doctors have a huge incentive to perform every conceivable test and procedure for any conceivable condition, no matter how unlikely, for fear that they will be sued. Lawyers, in turn, have limitless motivation to file suit on highly dubious grounds. This is a huge contributing factor to rising health care costs, but the Democrats won't touch tort reform because half their campaign contributions come from trial lawyers.

Quoting claymisher: Wait, isn't that how the is market suppose to work? The doctors have the incentive to do a good job so they don't get sued. And judges sort it out in the end. Isn't that what libertarians always want?

To a point, sure. I'm not saying patients shouldn't be able to sue doctors for screwing up, but it seems obvious that the lottery culture that our current tort system has created, and Democrats' reliance on money from trial lawyers, is at least partly responsible for runaway health care costs. Hyper-litigiousness has a price. If we go

Quoting rfrobison: I would argue it is far more accurate to say governments help to create conditions whereby markets "arise naturally."

Governments did play a role in the whole slavery & colonialism business that got capitalism off the ground. Does that settle your hash?

Quoting Ray: Governments did play a role in the whole slavery & colonialism business that got capitalism off the ground.

Does that settle your hash?

Not sure how to respond to that. Yes, governments played a role in slavery (and by definition, colonialism). As to whether those things "got capitalism off the ground," I'd say there's a lot to dispute in that sweeping statement...but I'm not gonna take it on right now.

Thanks for the heads-up, Wonderment. Politico reports that Nancy DeParle was paid $5.8 million the last three years by health firms. She has divested, of course. http://www.politico.com/news/stories/0609/23688.html

Quoting holyworrier: Thanks for the heads-up, Wonderment.

Politico reports that Nancy DeParle was paid $5.8 million the last three years by health firms. She has divested, of course.

http://www.politico.com/news/stories/0609/23688.html

Sigh. Anyway, everybody should read Atul Gawande's commencement address: http://www.newyorker.com/online/blog...t-address.html Of course McArdle would say that's all too hard (waah) so it'll never happen.

Quoting rfrobison: To a point, sure. I'm not saying patients shouldn't be able to sue doctors for screwing up, but it seems obvious that the lottery culture that our current tort system has created, and Democrats' reliance on money from trial lawyers, is at least partly responsible for runaway health care costs. Hyper-litigiousness has a price. If we go to a government-dominated health care system in the absence of meaningful tort reform it'll be even worse. Hell, sue the government for a billion dollars for your improperly treated hernia [the preceding was hyperbole-no flames, please, flamers]. They'll never even notice the difference...but the taxpayers will.

So you'd say there's market failure?

Quoting yamascuma: If I remember correctly, I read it in a graduate course in 19th-century European history. In my opinion, it's a very impressive book, and one that must be kind of confusing to the philosophically libertarian. Which is not to say that it's without its flaws--it's a bit "England-centric"--but the central conclusion (that free markets are created by state action and are not an inherent property of human society) seems as true now as it did then. Which, on the other hand, doesn't mean that libertarians don't often have intelligent perspectives to share or interesting ways of looking at problems. Just not so much in this diavlog.

I haven't read it yet (it's on my nightstand) but from what I gather he tracks the history of markets from the beginning. So the question is, when did capitalism emerge? Here's a quick summary of what I learned in my anthro classes about economics: in small-scale societies production and exchange are completely embedded in social relations. Not only do you know everybody you trade with, you know their parents, aunts, uncles, grandparents, cousins, and vice versa. Reciprocity, social status, fairness, kin relations, etc factor into every exchange. The defining feature of capitalism, impersonal exchange, is not present. You couldn't just

I would be interested in reading a book over this subject, but one geared towards someone who does not know that much about economics. Any suggestions?

My guess would be tort reform would be part of increased government regulation, or that is what should happen. If there is not government regulation, however, torts should be allowed. Tort litigation is a nice fill in for no government regulation, i.e., behave or pay.

Quoting bjkeefe: As claymisher has already noted, you're both exaggerating and forgetting that virtually everything else sold for human consumption is subject to government regulation.

As I understand the new authority being considered for the FDA, it has almost everything to do with them being able to tell cigarette manufacturers what they may not add to their products, and nothing to do with how they should make them.

By the way, I'm more or less a lifetime smoker, and I still have no problem with this recent move. It's about too late to matter as far as I'm concerned, but I'm all for preventing the tobacco companies from continuing to hook the next generation.

The bill essentially does two different things. The first I have no problem with: having bigger labels, stopping misleading phrases like 'light' etc.
Then there's the part about the government dictating the amount of ingredients in the cigarettes. That is entirely different. Banning all flavors except menthol (which, if I understand correctly, is the most popular flavor amongst African-American smokers). This is a corrupt deal between the government and Phillip Morris to further government intrusion in the market place while also helping one particular company.

Quoting claymisher: So you'd say there's market failure?

Hmm, I'm not sure I'd call it a "market failure" so much as a market that has been distorted by subsidies. That is, I believe the "market" for malpractice--I'm not even sure that's the right term--is subsidizing lawsuits through contingency settlement fees and the like. It's a bit simplistic to say that if someone (like me) is broadly in favor of market mechanisms, that he or she must support every market that exists. There are markets for illegal drugs, the services of prostitutes, political favors, what have you, that I wish didn't exist but do. I'm not a very good libertarian, though I have a libertarian streak. In any event, I merely wished to say that our current tort system pushes medical costs higher than they would otherwise be. One possible reform, aside from capping punitive damages, say, would be to do something I think is done in the U.K., which is to make plaintiffs pay a modest penalty when they lose a lawsuit, above and beyond court costs. This would discourage frivolous litigation. I can hear the protests already, but well-heeled attorneys should be willing to pay any such penalty on behalf of their clients if

One possible reform, aside from capping punitive damages, say, would be to do something I think is done in the U.K., which is to make plaintiffs pay a modest penalty when they lose a lawsuit, above and beyond court costs. This would discourage frivolous litigation.

I generally support capping punitive damages. We already have enough disincentives to frivolous lawsuits. I'm surprised though that the people who never want to cap executive pay want to cap lawyer pay (% of the judgment). Why doesn't the argument that good people won't do the job without high compensation only apply to CEOs and not lawyers?

Quoting Wonderment: I generally support capping punitive damages. We already have enough disincentives to frivolous lawsuits.

I'm surprised though that the people who never want to cap executive pay want to cap lawyer pay (% of the judgment). Why doesn't the argument that good people won't do the job without high compensation only apply to CEOs and not lawyers?

I think there might be a good argument that reducing the size of the slice that a lawyer can take could increase the incentive for bigger judgments.

Quoting Wonderment: I generally support capping punitive damages. We already have enough disincentives to frivolous lawsuits.

We do? Then why do we have so many lawsuits? I haven't seen any cross-country comparisons, but I'd be willing to bet the U.S. far exceeds its developed-country counterparts in terms of civil court actions per person.

I'm surprised though that the people who never want to cap executive pay want to cap lawyer pay (% of the judgment). Why doesn't the argument that good people won't do the job without high compensation only apply to CEOs and not lawyers?

Because lawyers are the Devil's spawn and CEOs are poor, misunderstood, goodly souls. HA! In theory CEO pay is capped by shareholders, who elect board members, who determine compensation. It's obvious in recent years this system hasn't functioned well, but one good thing about the downturn is that shareholders and corporate boards are finally waking up to their fiduciary responsibilities. But in the end, a CEO who performs badly hurts the owners of the company. It's their problem and nobody else's. In general a ceiling (or a floor) is a bad thing to impose on a price--in this case, CEO pay. Set the cap too high

Quoting rfrobison: In general a ceiling (or a floor) is a bad thing to impose on a price--in this case, CEO pay. Set the cap too high and it will have no effect at all. Set it too low and you create a shortage. The best and the brightest will go from the regulated to the unregulated part of the economy, creating weaker companies and hurting social welfare.

I hear that statement alot, and it is never justified. It is always seems to be more of an article of faith then a reasoned conclusion. Take for instance William Shockley, the father of the transistor, while he was doing his work*1 at Bell Labs he was getting peanuts compared to what many CEOs get today*2. Somehow I doubt companys are really paying that much, because they cannot get people of quality for less then 20 million dollars. I mean, I doubt running a company is harder then, literally, making all of modern electronics possible. If CEO pay was capped, many of them may leave. However, I am sure others just as qualified would step in and be happy to get the reduced pay. We as Americans have the unfortunate tendency to attribute everything to the

Quoting Starwatcher162536: I hear that statement alot, and it is never justified. It is always seems to be more of an article of faith then a reasoned conclusion.

Take for instance William Shockley, the father of the transistor, while he was doing his work*1 at Bell Labs he was getting peanuts compared to what many CEOs get today*2.

Somehow I doubt companys are really paying that much, because they cannot get people of quality for less then 20 million dollars. I mean, I doubt running a company is harder then, literally, making all of modern electronics possible.

If CEO pay was capped, many of them may leave. However, I am sure others just as qualified would step in and be happy to get the reduced pay.

We as Americans have the unfortunate tendency to attribute everything to the person as the top. Just because some guy beat the market for 5 years running, doesn't make him some financial genius. There will be plenty of people out there that meet those specifications from chance alone.

Also, if we did do something along the lines of pay restrictions, I feel it would make for more sense to not pass something along the lines of "CEO shall not

No, I have seen to much dealing with corruption between Unions/Gov't to want broad stroke goverment involvement in this. I was simply commenting that America has way to much of a hero worship culture. If caps were placed on CEO's (Like for say bailed out companys), I highly doubt it would create a drain of quality personnel in that field.

Quoting Starwatcher162536: No, I have seen to much dealing with corruption between Unions/Gov't to want broad stroke goverment involvement in this.

I was simply commenting that America has way to much of a hero worship culture. If caps were placed on CEO's (Like for say bailed out companys), I highly doubt it would create a drain of quality personnel in that field.

Yeah, I get your point about "hero worship." The business press in particular bears a huge share of the blame. CNBC shows, coverage in Forbes and Business Week and the like. These people were supposed to be skeptical journalists, but in the end acted largely as cheerleaders for the market mania. Understandable, maybe, but investors, consumers, and the media all have watchdog roles to play. The government can't do it all. In general, outside of cases of breaking criminal and commercial law, I think people should take their own lumps if their investments go bad. That's why I'm so unhappy and alarmed by what the government is doing with the auto industry bailouts. I don't think they should be in the business of picking winners and losers. It's sad when workers and consumers take it on the chin for corporate

Quoting rfrobison: Hmm, I'm not sure I'd call it a "market failure" so much as a market that has been distorted by subsidies. That is, I believe the "market" for malpractice--I'm not even sure that's the right term--is subsidizing lawsuits through contingency settlement fees and the like. It's a bit simplistic to say that if someone (like me) is broadly in favor of market mechanisms, that he or she must support every market that exists.

There are markets for illegal drugs, the services of prostitutes, political favors, what have you, that I wish didn't exist but do. I'm not a very good libertarian, though I have a libertarian streak.

In any event, I merely wished to say that our current tort system pushes medical costs higher than they would otherwise be. One possible reform, aside from capping punitive damages, say, would be to do something I think is done in the U.K., which is to make plaintiffs pay a modest penalty when they lose a lawsuit, above and beyond court costs. This would discourage frivolous litigation.

I can hear the protests already, but well-heeled attorneys should be willing to pay any such penalty on behalf of their clients if they think their cases are

Quoting Starwatcher162536: I hear that statement alot, and it is never justified. It is always seems to be more of an article of faith then a reasoned conclusion.

Take for instance William Shockley, the father of the transistor, while he was doing his work*1 at Bell Labs he was getting peanuts compared to what many CEOs get today*2.

Somehow I doubt companys are really paying that much, because they cannot get people of quality for less then 20 million dollars. I mean, I doubt running a company is harder then, literally, making all of modern electronics possible.

If CEO pay was capped, many of them may leave. However, I am sure others just as qualified would step in and be happy to get the reduced pay.

We as Americans have the unfortunate tendency to attribute everything to the person as the top. Just because some guy beat the market for 5 years running, doesn't make him some financial genius. There will be plenty of people out there that meet those specifications from chance alone.

Also, if we did do something along the lines of pay restrictions, I feel it would make for more sense to not pass something along the lines of "CEO shall not

Quoting rfrobison: Ultimately unless you want to trash the entire capitalist system, you'd never be able to make a system of executive pay caps stick.

Really, why not? There's no reason why a bill capping CEO salary couldn't be passed. The Cap could be based on the size of the company or the number of employees. If made large enough - say $10 million a year, it would work. BTW, there is a "cap" on CEO pay for Defense Contractors. Lockheed or Boeing can pay their CEO anything they want but they only get reimbursed by DoD for costs up to $500,000. As for the "free market", if giant corporations like GM and AIG want bailouts - they're not the "free Market"

Quoting claymisher: I hear you, I'm a baseline libertarian myself, but when I add up the exceptions I'm not even close anymore. It's still where I start from anyway.

Universal health care would help a little with the malpractice lawsuit problem. In many cases part of what makes the injured so desperate for a big settlement is that their care is going to cost them a fortune in the future. If they had that guaranteed already the payout would be lower (especially considering the 30% in fees to the lawyer). But we route our safety net through the courts first.

That's an interesting hypothesis. Guess we'll see how it works in practice as I think some type of universal health care scheme is coming. I'm a natural skeptic/worrier about government intervention in the economy, but it seems to me pretty clear that something is badly out of kilter with the U.S. system. What those who celebrate the status quo are ignoring is that the U.S. ALREADY spends far more of its national income on health care than its "socialist" European counterparts, for no better results--and by some measures, worse. I am disappointed that the Republicans are not

Quoting rcocean: Really, why not? There's no reason why a bill capping CEO salary couldn't be passed. The Cap could be based on the size of the company or the number of employees. If made large enough - say $10 million a year, it would work.

BTW, there is a "cap" on CEO pay for Defense Contractors. Lockheed or Boeing can pay their CEO anything they want but they only get reimbursed by DoD for costs up to $500,000.

As for the "free market", if giant corporations like GM and AIG want bailouts - they're not the "free Market"

Ocean (hope you don't mind my giving your "handle" a handle): I'll try to answer your points in reverse order. First, I agree (nearly) completely with your point about GM, AIG and other bailout recipients. And the government, as (the) major stockholder in these firms, now presumably has the right to set pay for CEOs who have, in effect, become bureaucrats. On the other hand, one could argue that these companies, being particularly bad off, ought to have the best CEOs that (taxpayers') money can buy... Re: Defense contractors. I don't think there is much difference between these firms and others, except that their sole customer is in Washington (and allied capitals). There may be rules earmarking a certain

Quoting cognitive madisonian: The bill essentially does two different things. The first I have no problem with: having bigger labels, stopping misleading phrases like 'light' etc.
Then there's the part about the government dictating the amount of ingredients in the cigarettes. That is entirely different. Banning all flavors except menthol (which, if I understand correctly, is the most popular flavor amongst African-American smokers). This is a corrupt deal between the government and Phillip Morris to further government intrusion in the market place while also helping one particular company.

To the extent that I understand what's in the new regs, I support at least the concept of the FDA being able to restrict or prohibit flavorings and other additives, particularly if some of those others are designed to increase the addictive potency. Also haven't looked into this closely, but on the surface of it, I agree: the menthol exemption stinks. (Pun partially intended.)

Quoting Wonderment: I generally support capping punitive damages.

I don't. I think it's important to have that big stick lurking to keep the slimiest companies somewhat more honest. What I've often wondered is whether we could set up a system so that the punitive damages did not go to the plaintiff (the plaintiff only gets compensatory damages, as the judge or jury sees fit), but instead went to someplace beneficial to society. Naively, perhaps into the Medicare/Medicaid "fund." Of course, I guess you risk setting up another bad incentive that way -- judges as agents of the government might think that getting to the top of the list for directing awards to a government program would be to their political benefit, for example. But leaving aside where the money goes, exactly, who here thinks my idea about the punitive damages being given to some neutral third party has any merit?

But leaving aside where the money goes, exactly, who here thinks my idea about the punitive damages being given to some neutral third party has any merit?

I'm only a pretend lawyer, but I don't think you necessarily solve the problem of exaggerated compensation (assuming there is such a problem) that way. You still have to put limits on compensatory awards (How much is the value of a human life lost? How much should a torture victim be awarded for suffering a few years in Gitmo?) It seems to me that juries and judges should have some ability to "punish" in addition to reasonable compensation. Bernie the Pyramid Schemer rips you off for your life savings of 100,000? Don't you deserve a little more than the 100 grand plus court costs? The principle of restitution to third parties does exist at least in criminal law. A relative of mine, for example, recently had a DUI. Part of the fine package included restitution to a drunk drivers victims' fund (even though there was no victim in my relative's DUI). Come to think of it, I like the idea of requiring Dick Cheney to pay

Quoting Wonderment: I'm only a pretend lawyer, but I don't think you necessarily solve the problem of exaggerated compensation (assuming there is such a problem) that way.

Maybe not solve, but it does remove some incentive for exaggerated punitive damages (I wasn't asking about compensatory damages).

You still have to put limits on compensatory awards (How much is the value of a human life lost? How much should a torture victim be awarded for suffering a few years in Gitmo?)

Seems to me that's what the trial process is for -- the judge and/or jury get to decide, on a case-by-case basis (to coin a phrase). This seems better to me than arbitrary limits, generally speaking.

It seems to me that juries and judges should have some ability to "punish" in addition to reasonable compensation. Bernie the Pyramid Schemer rips you off for your life savings of 100,000? Don't you deserve a little more than the 100 grand plus court costs?

I could go along with "pain and suffering," to include hassle, time lost, and like that, as part of the compensation, but generally, it seems to me if you get everything you lost back, and all your recovery

Omigod! This Megan needs to SHUT UP and LET THE OTHER GUY TALK for a minute!!! I've been listening to this for an hour trying to hear the guy's point of view but she interrupts him every time he starts talking.

Punitive damages go to the party entitled to punitive damages... so no merit.

Quoting rfrobison: Ocean (hope you don't mind my giving your "handle" a handle):

I do mind though. Give rcocean another handle please. "Ocean" is mine. And I'm not giving it up! Thanks.

Yeah, I saw one of your posts on another thread. Sorry about that. Guess I'll just have to stick with "rcocean." See ya round.

Thanks! See ya.

Quoting Starwatcher162536: I would be interested in reading a book over this subject, but one geared towards someone who does not know that much about economics.

Any suggestions?

I was hoping somebody would answer this too. If it doesn't exist somebody should write it. I'll let you know when I get around to reading the Polanyi book how it is. Cosma Shalizi has a terrific post about "Nations and Nationalism" by Ernest Gellner that how explains one big step in the economic/political coevolution. Here's the punchline:

To recap: industrialism demands a homogeneous High Culture; a homogeneous High Culture demands an educational system; an educational system demands a state which protects it; and the demand for such a state is nationalism. The theory is coherent, simple, widely applicable, convincing, and empirically testable (which tests, to all appearances, it passes).

Quoting claymisher: I was hoping somebody would answer this too. If it doesn't exist somebody should write it.

I'll let you know when I get around to reading the Polanyi book how it is.

Cosma Shalizi has a terrific post about "Nations and Nationalism" by Ernest Gellner that how explains one big step in the economic/political coevolution. Here's the punchline:

Not having read the post (but I will, I love Cosma), I'll just add that you could throw into that mix the ideas of having things like contracts and enforcement mechanisms and third-party adjudication that people trust. Maybe this falls under a broad definition of education, though.

Quoting rfrobison:
Let's say D.C. passes legislation capping pay at $1 million a year. That sounds like a lot of money to me. Personally, I'd be willing to run IBM for half that, but never mind. Now, Ms. Lopez, who runs IBM, is used to making $20 million a year. The board doesn't want to lose her, so what do they do? Well, they could buy a huge mansion and let her live in it rent-free, give her a company jet, subsidize her kids' education, pay for her domestic help, clothes, vacations...the list is endless. And these are not likely to be the best use of IBM's limited capital. They have nothing to do with selling computer-related services.

Or they could "demote" her, give the CEO job to a figurehead, and pay her for a job title not covered by the rules. In extremis they could let her move to London or Zanzibar or someplace where they don't have such caps and run the company from there. Do you really want to drive talented executives overseas (and take their tax payments with them)?

Thus, CEO caps are not a great idea, IMHO.

Excellent reply. No doubt Corporations could fudge a little on the caps, but basically if its compensation under the

Quoting claymisher: I hear you, I'm a baseline libertarian myself, but when I add up the exceptions I'm not even close anymore. It's still where I start from anyway.

Universal health care would help a little with the malpractice lawsuit problem. In many cases part of what makes the injured so desperate for a big settlement is that their care is going to cost them a fortune in the future. If they had that guaranteed already the payout would be lower (especially considering the 30% in fees to the lawyer). But we route our safety net through the courts first.

Hey look, I'm a genius.* Let's look at malpractice in New Zealand:

There is an alternative approach, which was developed for people who have been injured by vaccines. Vaccines protect tens of millions of children, but every year one in ten thousand or so is harmed by side effects. Between 1980 and 1986, personal-injury lawyers filed damage claims valued at more than $3.5 billion against doctors and manufacturers. When they began to win, vaccine prices jumped and some manufacturers got out of the business. Vaccine stockpiles dwindled. Shortages appeared. So Congress stepped in. Vaccines now carry a seventy-five-cent surcharge (about

When we were taking the company public I had the pleasure of interviewing numerous individuals for the various management positions, that we needed to fill, required to make the company acceptable to the financiers were were dependent upon in getting the IPO done. I didn't see any brilliant game changers during that process as many of them got their reputation based on the luck and not necessarily brilliant management or people skills. If anything it tended to reinforce my belief that good timing in life is at least if not more important than ones actual abilities. I also believe there is a sufficient talent pool out there to replace these over compensated egomaniacs with individuals that would be satisfied with lesser compensation, I defiantly don't believe that it is the governments job to mandate the pay level of individuals though.

You hit on one of the reasons why Megan remains one of my favorite bloggers. She's very good at finding the fly in the ointment. In this case, she's dead-on, too. The reason why so many fabulous cost-controlled drugs are available to Europe, the VA, Medicare, etc., is because drug companies are able to make their R&D budgets back (and then some) in the private market. Take away the one market that they can rape for high profits and you kill the goose which lays the golden glucose-absorption meds. To point out that "free" health care will probably kill more people than it saves is to be a killjoy, especially given the current momentum of public opinion. I'm glad we have a few killjoys like Megan still out there, even if they are just shouting in the wilderness. Even if you are a fan of public health care (which I'm not... I share Megan's skepticism), critics are important, because addressing the criticisms forces advocates to refine and improve their ideas, which will ultimately lead to a less flawed system.

Quoting cognitive madisonian: Not bad, but anyone calling themselves a libertarian who voted for Obama is seriously deluded or not actually a libertarian.

I call myself a libertarian and voted third-party, but I disagree. Most people (not me, but most people) see voting in Presidential elections as an act of choosing the lesser evil. They don't vote for the candidate they want, but to stop the other person. John McCain may very well be the most anti-libertarian Republican to run for the office of President in a general election in my lifetime. Worse than Ford, Nixon, or either Bush (and that's clearing a very high bar!) I mean, the guy co-authored a bill which suppresses free speech. Obama has taken a lot of positions to which a libertarian may object, but nothing quite so disqualifying as that.

Quoting DoctorMoney: The problem is that care isn't about innovation. If you want to argue that the government shouldn't tax pharmaceutical companies at all to spur innovation, you might make some headway.

But you can't lump pharma and health care providers together as if their financial incentives are at all the same. It's like saying that we'll get better TV programming if we tax Samsung at a lower rate.

Health care access is a delivery system and drug research is content. We don't have a content problem in the US, we have an access problem. So every moment we sit here talking about innovation is one in which we are not discussing our actual problems.

That discussion would be fine and dandy, if we weren't deluged with liberal think-tanks telling us we could pay for greater access simply by capping the *outrageous* profits of "Big Pharma." If we can all agree that making the drug companies our corporate whipping boy doesn't actually solve any problems (and creates many more), then we can move on to a real debate about how to make sure people have access

Quoting Tara Davis: Even if you are a fan of public health care (which I'm not... I share Megan's skepticism), critics are important, because addressing the criticisms forces advocates to refine and improve their ideas, which will ultimately lead to a less flawed system.

I'm a fan of public health care and I endorse this message. I'm not sure Mcardle's the best critic on this issue though.

Quoting Tara Davis: That discussion would be fine and dandy, if we weren't deluged with liberal think-tanks telling us we could pay for greater access simply by capping the *outrageous* profits of "Big Pharma."

If we can all agree that making the drug companies our corporate whipping boy doesn't actually solve any problems (and creates many more), then we can move on to a real debate about how to make sure people have access to adequate health care to those who otherwise can't get it without breaking the bank and/or taking services away from those who can afford better-than-adequate.

Tell this to an uninsured cancer patient looking at a $50,000 price tag for a single dose of chemo.

Quoting JonIrenicus: The part about people living longer is true I think. People died earlier decades ago, and that saves expenses. As treatments get better and people live longer, I do not see how the net cost of health care can go lower all things being equal. Now maybe this can be offset with some hidden efficiency, that is the hope, but living longer, and more advanced treatments must make the cost of surviving more expensive.

Hi Jon, As long as I've been here, I don't think I've yet addressed you directly yet. That's a shame. A lot of people who post regularly--once you've read a bit, you can pretty much guess what they're going to say on any given issue. Some say it well, others less well, but most people are at least somewhat predictable...Yours Truly no exception, I suppose. You're not like that, or at least less so than most. Some might take that as a sign of intellectual incoherence, but I find it intriguing. OK, enough of the love letter and on to the substance: One thing that could and eventually must be done is to raise the age of eligibility for Medicare (and Social Security) significantly. I know, that makes me a heartless

Quoting rfrobison: ... One thing that could and eventually must be done is to raise the age of eligibility for Medicare (and Social Security) significantly. I know, that makes me a heartless weenie to some, but the fact is when these programs were devised people died a lot younger. If 60 is the new 40, there's no reason why people at age 65 should get free unlimited medical care on Uncle Sam's dime for 20 years or more. People who are in good health should not be eligible for Medicare (or whatever the equivalent ends up being) until AT LEAST age 70 or 75. Furthermore, the rich tend to outlive the poor. Medicare benefits should be taxable on a sliding scale for people above a certain income...

I think this is an overstatement as medicare is not exactly free for life; nor does it cover all medical costs. The first question that my parents are asked when they go to a new doctor or clinic is who is your secondary insurer. That is because medicare underpays for services and either the patient must make up the difference, the provider eat the difference or a secondary insurer makes

Quoting rfrobison: OK, enough of the love letter and on to the substance: One thing that could and eventually must be done is to raise the age of eligibility for Medicare (and Social Security) significantly. I know, that makes me a heartless weenie to some, but the fact is when these programs were devised people died a lot younger. If 60 is the new 40, there's no reason why people at age 65 should get free unlimited medical care on Uncle Sam's dime for 20 years or more. People who are in good health should not be eligible for Medicare (or whatever the equivalent ends up being) until AT LEAST age 70 or 75. Furthermore, the rich tend to outlive the poor. Medicare benefits should be taxable on a sliding scale for people above a certain income. Same for Social Security.

How old are you? Do you know what happens to people when they get old? You might be in for a surprise.

Now all of this is a pipe dream. McCain was fricaseed for the suggesting the much more modest reform of cutting the tie between employment and health insurance--a hugely expensive, inefficient subsidy that completely insulates health

Quoting claymisher: How old are you? Do you know what happens to people when they get old? You might be in for a surprise.

I'm 42. In other words, I'm just young enough for the system to go broke before being able to benefit from it. Of course some provision should be made to provide health care for the needy and the elderly. But the fact is the system is quickly headed for insolvency. It is also true that the vast majority of Medicare beneficiaries COULD bear a much greater share of the cost of their own health care than they do. The system AS IT STANDS is the greatest theft of resources from the young and relatively poor to the old and relatively wealthy imaginable. It's a perversely regressive tax. I can't fathom why any liberal or progressive can in good conscience support the system as it stands. The only thing that gives me (grim) hope is that the inevitable collapse will make a new and fairer system possible.

McCain was nailed for wanting to crush the employer-based system and replace it with nothing. There's a difference.

Sorry, not buying that. The McCain plan

Quoting claymisher: Everybody agrees that new medical practices, treatments, and technologies are good for society. That requires innovation. So let's try to think clearly about where innovation comes from. Markets don't innovate. Corporations don't innovate. Only people do. Who's the greatest innovator in the history of medicine? I'd say it's Ignaz Semmelweis, the man who figured out that doctors should wash their goddam hands (try commercializing that one). Then there's the guys who developed penicillium. And pretty much every Nobelist. You can play this game all day long and the for-profit capitalists will barely get any points on the board at all. Private sector research is vital and necessary, especially for the grunt work of clinical trials, but on the whole most innovation comes out of the public sector, or at least from guys who will never make on dime on their discoveries.

OK, so what are markets good for? They're good for sorting the good ideas from the bad ideas. You throw a bunch of stuff up and see what sticks. It'd be bad to have any kind of system that took final positions on the right treatment for everything and shut out

Quoting Unit: Clay,

you're missing the point about markets. Sure it's always just individuals that act, discover etc...but what matters is the joint and coordinated action over time, the tinkering you mention, the feedbacks etc...Such dynamics is much more important than you seem to think: slowly, one customer rejection at a time, producers adapt their product to better satisfy their customers. It's the same with chemotherapy. I don't see the problem with chemo going away if you put price-controls on it, in fact, it would seem to me that the problem would get worse. Instead, the better you align incentives, the higher the chance that the self-correcting process will work. Oncologists that get a reputation for preying on dying patients will be shunned etc...

Don't give me that patronizing bullshit. You think I don't already know that bullshit econ 101 crap? I'm not missing the point. You're missing the point. Doesn't the free market Panglossian bullshit ever get old? Who the fuck said anything about price controls? I'm talking about aligning interests correctly. It's a triumph of the power of ideology that you've convinced yourself that oncologists torturing people for money is a good system because somehow the victims

Quoting claymisher: [..]

I agree with you on the overall points. If I were to do a thought experiment to try and see what system is best for driving innovation, I would come up worth something remarkably like our current system. Still, I find there are some areas that could use a greater coupling with the markets. For instance, you agree with the assertion that the market is a fantastic mechanism for sorting out the winners and the losers. Does this mean we should insert some sort of bookie like system* to determine the allocation of funding for various gov't research? If this system was in place, I doubt canards like a "feasible missile defense system" would get much funding....
*Private investors could agree to match the money put into the project by teh Gov't in exchange for some sort of limited patent rights (Would have zero control over the flow of information though, all that would remain public)

Quoting claymisher: Who the fuck said anything about price controls?

I plead guilty. Maybe Unit was responding to my post. Surely, you would agree that price controls are necessary if any public health care system is to work?

Quoting Francoamerican: I plead guilty. Maybe Unit was responding to my post. Surely, you would agree that price controls are necessary if any public health care system is to work?

No need to apologize Franco, I was actually responding to Clay. The fact is that my definition of markets is pretty comprehensive: it has to involve more than say a hundred people and the medium of exchange does not have to monetary. To me if a market happens it's already a success in some ways. While it fails if it does not arise at all. I said price controls because I don't see any other way to reduce profits or whatever limitations are being explored currently to reign in the evil oncologists....

Quoting Unit: No need to apologize Franco, I was actually responding to Clay. The fact is that my definition of markets is pretty comprehensive: it has to involve more than say a hundred people and the medium of exchange does not have to monetary. To me if a market happens it's already a success in some ways. While it fails if it does not arise at all. I said price controls because I don't see any other way to reduce profits or whatever limitations are being explored currently to reign in the evil oncologists....

"Evil oncologists" aren't being blamed by anyone for anything that I'm aware of. Drug producers who feel that any price is fair - tens of thousands of dollars for a single dose of a possibly life saving drug, e.g. - they're deserving of plenty of blame. Insurers who screen their customers by their lack of need for insurance services are a good target for blame, as well. Health care is a perfect example of an arena in which markets, certainly unregulated or under-regulated markets, are a horribly inappropriate mechanism. Patients are not generally in a position to negotiate rationally, and when

Monopsony: One buyer/consumer, many sellers/producers. In Monopsony the buyer rather than the seller has market power. According to classic microeconomic theory, under monopsony, the buyer sets quantity where Marginal Expense(derivative of the supply curve) crosses the demand curve. The effects of this are not always obvious. In general monopsony pushes prices fairly close to the Marginal Cost curve. This is often below Average Total Cost. Contrary to popular belief (and Megan) Medicare and Medicaid are exceptional at bargaining for prices. So exceptional they get service below cost. Hospitals can cover the price of doctors and other variable inputs to the health care process, but they do not get fully compensated for buildings and equipment which require long term investments. It's also not great for PR to reject war veterans and dying grandmothers. Keep in mind those on Medicare and Medicaid have drastically reduced cost incentives for getting care and tend to over consume compared to those in the private sector. For every surgery Medicare/Medicaid gets a 5,000 dollar price break on, someone in the private system picks up that cost. If you look at individual health insurance premiums, there is clearly a disconnect

Quoting AemJeff: "Evil oncologists" aren't being blamed by anyone for anything that I'm aware of. Drug producers who feel that any price is fair - tens of thousands of dollars for a single dose of a possibly life saving drug, e.g. - they're deserving of plenty of blame. Insurers who screen their customers by their lack of need for insurance services are a good target for blame, as well. Health care is a perfect example of an arena in which markets, certainly unregulated or under-regulated markets, are a horribly inappropriate mechanism. Patients are not generally in a position to negotiate rationally, and when you do get sick, you can forced out of the market entirely because insurers have no mandate to cover people who actually need the coverage. (And sick people get dropped from insurance rolls all the time, or are denied coverage, or if they're covered, are denied benefits.)

You seem to believe that we're operating in a free-market right now? Look, half of all payments are made by the govt. and 90% of all payments are made by a highly regulated and privileged third-party. We talk about "insurance" for those who have it, but it's actually

To most libertarians, patents are generally frowned upon. Blaming free market capitalism for over priced drugs is a bit of a stretch. Patent laws are typically designed to give monopoly power to corporations and increase economic rents. Most evidence has shown that a lack of patents would increase innovation as each company would release drugs yearly, or monthly, rather than whenever their latest patent expired. Further research shows that big Pharma tends to spend less than 20% of it's revenues on research. In comparison, almost 30% is spent on advertising. Clearly social welfare is not being served. Michele Boldrin and David Levine wrote a book covering the fundamental problems with patents. It's is available (for free) here: http://www.micheleboldrin.com/research/aim.html

How is this noticeably different than buying a house? Few people will buy more than a couple houses in their lifetimes. What about the evil real estate agents? How ever will we cope? Citing a market failure where undeveloped markets exist is a classic fallacy of the statist. I don't know the mechanisms that would gradually develop to mitigate the problem of greedy oncologist. Just the same as I don't know how farmers will know how many apples to produce, but they do, year after year. Sure some people will get screwed. The farmer might not sell all his apples, or be left wishing he had more. Even first time entrants to these markets can calculate the amount they wish to provide at the prevailing market price. Government allocation does this rather poorly, and rather than screwing a few people on the price of an unnecessary treatment, people actually die from lack of care and resources. It's easy to call libertarians blinded by fairy lands, but how is your panacea any less fantastical?

70% of Venture Capital spending takes place in Silicon Valley. I wasn't aware that Silicon Valley had been relocated to New York. I think business figured this out before Megan.

Quoting NateS: How is this noticeably different than buying a house? Few people will buy more than a couple houses in their lifetimes. What about the evil real estate agents? How ever will we cope?

Citing a market failure where undeveloped markets exist is a classic fallacy of the statist. I don't know the mechanisms that would gradually develop to mitigate the problem of greedy oncologist. Just the same as I don't know how farmers will know how many apples to produce, but they do, year after year. Sure some people will get screwed. The farmer might not sell all his apples, or be left wishing he had more. Even first time entrants to these markets can calculate the amount they wish to provide at the prevailing market price.

Government allocation does this rather poorly, and rather than screwing a few people on the price of an unnecessary treatment, people actually die from lack of care and resources.

It's easy to call libertarians blinded by fairy lands, but how is your panacea any less fantastical?

and by the way, the US are at the top of rankings for cancer survival rates, this despite poor health

Quoting Unit: You seem to believe that we're operating in a free-market right now? Look, half of all payments are made by the govt. and 90% of all payments are made by a highly regulated and privileged third-party. We talk about "insurance" for those who have it, but it's actually "insulation": even a cold is covered. I would not presume to be able to know who to blame and for what. As an impartial spectator the idea that there are some key players out there that are too greedy (and blame-worthy) and that the solution is to force them not to be greedy sounds unconvincing to me. As usual I would feel more confident in blaming an abstract "lack of competition".

As an aside, insurance co. are blamed for denying coverage and cutting cost, but they're also blamed for paying too liberally for very expensive and possibly unnecessary procedures (hence increasing costs).

I'm not impartial in this debate, that is certainly true. I think the market is poorly regulated, with nothing like an optimal set of incentives in place. The "key players" to blame are all the large corporate entities whose interests are served by placing obstacles

Quoting NateS: How is this noticeably different than buying a house? Few people will buy more than a couple houses in their lifetimes. What about the evil real estate agents? How ever will we cope?

Citing a market failure where undeveloped markets exist is a classic fallacy of the statist. I don't know the mechanisms that would gradually develop to mitigate the problem of greedy oncologist. Just the same as I don't know how farmers will know how many apples to produce, but they do, year after year. Sure some people will get screwed. The farmer might not sell all his apples, or be left wishing he had more. Even first time entrants to these markets can calculate the amount they wish to provide at the prevailing market price.

Government allocation does this rather poorly, and rather than screwing a few people on the price of an unnecessary treatment, people actually die from lack of care and resources.

It's easy to call libertarians blinded by fairy lands, but how is your panacea any less fantastical?

Ooh, you called me a "statist." Oh that hurts soooo much. I distinguish between markets that work great and markets that

Quoting AemJeff: I'm not impartial in this debate, that is certainly true. I think the market is poorly regulated, with nothing like an optimal set of incentives in place.

The "key players" to blame are all the large corporate entities whose interests are served by placing obstacles between sick people and needed treatments. Chemo providers are just the most outrageous examples of pharma raping the sick. Insurance companies are special in that they have the power to define any sick person out of the pool, apparently at whim (though I'm sure there are a few rules.)

Insurance companies aren't in the business of making people healthy. In fact, an insurance company that improved health outcomes would attract a bunch of sick people and suffer the adverse selection death spiral that health care economists are all familiar with. No, health insurance companies compete with either other by being the best at lowering costs by trying to keep sick people out and by rejecting claims. That's why they have armies of people going through your files trying to reject you for a pre-existing condition AFTER you get sick, so they can

Quoting Unit: and by the way, the US are at the top of rankings for cancer survival rates, this despite poor health habits such as obesity etc...

Prove it.

Quoting Unit: No need to apologize Franco, I was actually responding to Clay. The fact is that my definition of markets is pretty comprehensive: it has to involve more than say a hundred people and the medium of exchange does not have to monetary. To me if a market happens it's already a success in some ways. While it fails if it does not arise at all. I said price controls because I don't see any other way to reduce profits or whatever limitations are being explored currently to reign in the evil oncologists....

I can't tell if you're being sarcastic or not. Maybe you don't know. Anyway, maybe if you take off your ideological blinders you'll see solutions that you can't see now.

Quoting claymisher: Insurance companies aren't in the business of making people healthy. In fact, an insurance company that improved health outcomes would attract a bunch of sick people and suffer the adverse selection death spiral that health care economists are all familiar with. No, health insurance companies compete with either other by being the best at lowering costs by trying to keep sick people out and by rejecting claims. That's why they have armies of people going through your files trying to reject you for a pre-existing condition AFTER you get sick, so they can keep the premiums you've been paying for years but not have to pay you when you get sick. Just last week there were House hearings on health insurance rescission. Here's a woman who when diagnosed for breast cancer had her insurance cancelled because she hadn't disclosed she'd had acne:

http://www.youtube.com/watch?v=dT_2GjSkzHE

Yay! The market works!

More video from the hearings:

http://www.youtube.com/results?searc...escission&aq=f

This is why the first step, the very first thing to be done on the path to reforming the system, is to mandate that nobody can be denied coverage for any reason short of

America has the most expensive health care in the world for mediocre results. Copying any existing system would be an improvement.

I don't know why I even do this, but here goes: There is only one nation on earth with people as fat as the US http://www.food.gov.uk/healthiereati...atesworldwide/ Guess where Argentina ranks health wise? http://www.photius.com/rankings/healthranks.html Seventy fucking four. US life expectancy, 77.7, Argentina, 73.4 This isn't even including the fact that the US uses far less favorable forms of recording life expectancy. Most of the countries in the top 10 simply ignore deaths among babies that are younger than a certain age. Do you honest to god think CUBA and Slovenia have the same level of health care as the United States? They do according to the ranking system developed by the WHO. America has a system that does not tax health care. It's not wildly absurd to assume things that are untaxed get consumed at a higher rate than they would normally. We also have the best hospitals in the world, and produce an order of magnitude more doctors than any other country. CANADA sends patients from TORONTO (liberal metropolitan paradise) to DETROIT, the uncontested WORST city in American because there are

Quoting claymisher: http://www.youtube.com/watch?v=dT_2GjSkzHE

Yay! The market works!

More video from the hearings:

http://www.youtube.com/results?searc...escission&aq=f

While I agree with your general premise; wouldn't it be better to include a link to the actual hearing instead of just the cheery picked clips on you tube.

Quoting NateS: The failures of socialized systems are far more glaring than "evil oncologist out to get me."

Hey asshole, that happened to my father, so I'd appreciate you fucking off with the scare quotes. He spent the last three months in total horror for no reason, so I hope you fuck off and die. Get cancer you fucking asshole.

Quoting claymisher: Prove it.

I'm traveling right now but try this: http://www.becker-posner-blog.com/ar..._care-bec.html

Your ethuggery is amusing. Perhaps if you had spent less time spamming the comments to the blogs you could have gotten a job and helped pay for his care.

Quoting NateS: Your ethuggery is amusing. Perhaps if you had spent less time spamming the comments to the blogs you could have gotten a job and helped pay for his care.

Fuck you. You're an asshole.

Fascinating

http://www.dailymail.co.uk/news/arti...t-targets.html Would you be happier if he died after waiting in an Ambulance for 5 hours?

Quoting NateS: Perhaps if you had spent less time spamming the comments to the blogs you could have gotten a job and helped pay for his care.

What an awful thing to say. You're a shit. Fuck you. If you could fucking read you know that Medicare paid for pointless chemo anyway. And if you want to compare bank statements, it's on, asshole. Not that it makes me a better person.

I don't see your point. You could be making all this up. Your language gives me no reason to have any respect for anything you say.

Quoting NateS: http://www.dailymail.co.uk/news/arti...t-targets.html

Would you be happier if he died after waiting in an Ambulance for 5 hours?

Fuck you, asshole. We can do better than the UK's system. For the 40% more we spend it won't be hard.

Quoting NateS: I don't see your point. You could be making all this up. Your language gives me no reason to have any respect for anything you say.

You started it, asshole. Fuck off.

Fuck, fuck, fuck.

Quoting NateS: Fuck, fuck, fuck.

That's the least dumb thing you've posted yet. You're making progress.