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Paul Krugman: Medical Consumers, or Wards of State?
#1
Here is a great example of why I look at Paul Krugman as someone who is just professing to be an economist. The fact that he is a self-professed Socialist, and worshiping at the alter of Keynes, should be all one really needs to know about this little ferret faced fellow. After having been immersed in the concept of "Supply-Demand", and "Producer-Consumer" equations for so long, how could anyone Not look at a patient as a consumer, and all the attributes which go along with it? Unless you happen to be a Collectivist, of course, and look at everyone as a ward of the State. Then naturally everything else takes on an entirely different look. S5

Quote:Medical Consumers or Wards of the State?

Sheldon Richman

Paul Krugman wants to know: “How did it become normal, or for that matter even acceptable, to refer to medical patients as ‘consumers’?”

Let’s concede for argument’s sake there is something unattractive about viewing patients as consumers. Krugman writes, “Medical care, after all, is an area in which crucial decisions—life and death decisions—must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge.”

All true, but not necessarily decisive in answering Krugman’s question—because if we reject the patient-as-consumer model, we must then ask: What’s the alternative?

I believe the answer is this: If the patient is not a consumer he or she will be a ward of the State or a government-empowered insurance company. If the choice is between consumer and ward of the State, consumer doesn’t look so bad after all.

To see what ward status means, ponder Krugman’s thoughts on the Independent Payment Advisory Board, Obamacare’s Medicare cost-cutting apparatus:

“About that advisory board: We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. . . .

“And the point is that choices must be made; one way or another, government spending on health care must be limited” (emphasis added).

Much of what Krugman says here is correct. Resources are finite. Choices must be made. No matter how medical care is paid for, spending will be limited—regardless of what demagogues imply. But under Krugman’s patient-not-as-consumer model (which is largely in effect today), government experts make all the important decisions. Bureaucrats will have a global budget for medical spending, and it will be their job to stick to that budget. They will not be the patients’ agents. Advocates of this scheme insist the quality of medical care will not be cut along with costs. They assure us they will prohibit only “unnecessary” and “wasteful” procedures. But how objective are those categories? And why should we trust unaccountable bureaucrats and “experts” to make the right decisions, as though there were one-size-fits-all answers in medicine?

The upshot is that anyone who has his or her medical bills paid by the taxpayers will ultimately be at the government’s mercy. If you’re not a consumer you’re a ward of the State.

But won’t private medical coverage also have restrictions? The difference is that if medical coverage were offered in a freed market—no privileges, no licenses, no protectionism—the environment would be competitive. When government is in charge competition disappears or is vastly constrained to the point where it hardly matters. In a competitive environment entrepreneurs seek to discover what services best satisfy their customers’ requirements. Note well: This environment includes nonprofit solutions, such as mutual-aid societies, which through “lodge practice” managed to provide decent medical coverage to people of modest means in earlier times (tinyurl.com/cjca68).

Competition is a discovery process (Hayek). Government is the habitat of bureaucrats who pretend they know it all already.

Krugman cautions, “[B]ear in mind that we’re not talking about limits on what health care you’re allowed to buy with your own (or your insurance company’s) money. We’re talking only about what will be paid for with taxpayers’ money.” This is disingenuous.

After being taxed all their lives, how many elderly people are in a position to forgo Medicare in favor of private insurance? Government creates dependence, then exploits that dependence to justify its power.
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"Falsehood flies, and truth comes limping after it" - Jonathan Swift, 1710
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#2
Working Americans depend entirely on private insurance companies, not government, for their health care. Medicare, while certainly an expensive government program, is by no means comprehensive and does not displace or disrupt the private system.

Here is a philosophical question: Should all human services be a private commodity, provided on the basis of one's economic status?
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#3
(06-26-2011, 11:23 PM)Gommi Wrote: Working Americans depend entirely on private insurance companies, not government, for their health care. Medicare, while certainly an expensive government program, is by no means comprehensive and does not displace or disrupt the private system.

Here is a philosophical question: Should all human services be a private commodity, provided on the basis of one's economic status?

"G", the point Dr. Richmond was making is that every transaction in life, is an economic one. And if we are to assign legal status to one's body/self, then it is important to know just who retains that legal status. Does one's body belong to the individual, or does it belong to the State, or some other entity. He contends, like I do, that through Natural Law, my body is my sovereign property. And if it is my property, it is up to me to have the right to make decisions(transactions) regarding it's benefit.

His point is that the term patient is nothing more than a potential customer, accessing services through a venue that happens to be medical in nature. It's just as serious as going to a lawyer, or real estate agent. All involve the person's well being.

For some hack to come along and state that is it not the same basic relationship, is to say that that same hack wishes to change the natural right of the person, and give it to the State. And I am certain Krugman lacks the ability to even see this. After all he is much more brilliant than the rest of us "little people", who need the State to take care of them.

And lastly, assigning economic principles to economic status, is an attempt to segregate the "haves" from the "have nots". If the State did not have so many regulations and restrictions to the Free Market principles, that would not even be an issue.
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"Falsehood flies, and truth comes limping after it" - Jonathan Swift, 1710
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#4
Krugman is odious in his life and philosophy, and is a good model of the Keynesian elitist. What he believes now and endorses now (paraphrasing the President) is foolish and harmful.

However - things change over time, and eventually I hope culture matures to the point where we have enough wealth to secure comfort for all, and the individual maturity to not behave like welfare queens - but to focus on our abilities and earn our way through society as plusses, not minuses being kept by a nanny-state. This is exemplified by Roddenberry's utopian dream of a future Federation where money is no longer used, yet people rise to the ultimate of their potential.

The main problem with Keynesians like Krugman, is that they demand the utopian life, without earning it. We have applied metrics of today's reality to prove that the LBJ Great Society did not help - but hindered. This is a typically Humanist ideal that is worthless and spiteful to a society not ready to embrace it's high-blown standards of perfection.

Until mankind takes the uplifted step to maturity, such worts like Krugman will make things worse. He may see a future goal that has grandeur - but now he is just delusional.
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#5
I guess Krugman has not had his Botox treatment lately, but for him maybe it is actually a matter of life or death.

It is completely ridiculous of him to imply that all medical decisions are life or death. Certainly many medical treatments are discretionary or non critical and so fit well into the "consumer" model. For example, going to the doctor when you only have a cold or a sprain is one of these. Many countries and other entities have raised co-pays in order to curb frivolous use of doctors and the use of over generous insurance plans, state or private.

However, there is an economic aspect even to life and death situations. A person with a life threatening condition which requires and enormous personal expense may decide to die and leave the money to hisorher heirs.

By casting the problem as "life or death", Krugman plays on sympathy, generosity and guilt and implicitly suggests that "only gummint can salve all wounds". Typical leftist propaganda, which needs to be countered.
Jefferson: I place economy among the first and important virtues, and public debt as the greatest of dangers. To preserve our independence, we must not let our rulers load us with perpetual debt. We must make our choice between economy and liberty, or profusion and servitude. If we can prevent the government from wasting the labors of the people under the pretense of caring for them, they will be happy.
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#6
(06-26-2011, 11:47 PM)John L Wrote:
(06-26-2011, 11:23 PM)Gommi Wrote: Working Americans depend entirely on private insurance companies, not government, for their health care. Medicare, while certainly an expensive government program, is by no means comprehensive and does not displace or disrupt the private system.

Here is a philosophical question: Should all human services be a private commodity, provided on the basis of one's economic status?

"G", the point Dr. Richmond was making is that every transaction in life, is an economic one. And if we are to assign legal status to one's body/self, then it is important to know just who retains that legal status. Does one's body belong to the individual, or does it belong to the State, or some other entity. He contends, like I do, that through Natural Law, my body is my sovereign property. And if it is my property, it is up to me to have the right to make decisions(transactions) regarding it's benefit.

good argument when it is about sex and abortion, bullshit with healtcare. as it is now, your body belongs to them who make maximum profits in healtcare, and the state serves them. where is freedom in blackmailing the citizen to pay too much for healtcare? your choices are to die, or to be financially ruined. freedom my ass.
"You know, Paul, Reagan proved that deficits don't matter." Dick Cheney
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#7
(07-04-2011, 08:34 PM)quadrat Wrote: good argument when it is about sex and abortion, bullshit with healtcare. as it is now, your body belongs to them who make maximum profits in healtcare, and the state serves them.

The state serving them is certainly a good point, but it's a completely different issue.

(07-04-2011, 08:34 PM)quadrat Wrote: where is freedom in blackmailing the citizen to pay too much for healtcare? your choices are to die, or to be financially ruined. freedom my ass.

Define "too much". There is no should with a transaction, merely an agreed upon price between two people.

The state, as you pointed out earlier, makes this worse, not better. Because of laws, insurance cannot carry across states and doctors cannot advertise prices for procedures. This makes it much harder for a person to shop around for insurance or healthcare. And this doesn't better by getting government more involved in healthcare, because "the state serves them".

Another big part of the issue is that people don't treat health insurance like any other insurance. It's a payment plan. I don't expect my car insurance to pay for my oil changes and tire rotations, I only expect them to step in if I get into an accident. Similarly, health insurance shouldn't be used to pay for routine doctor visits. Through college I carried a health insurance with a $4k deductible that was very cheap. I paid for all of my normal expenditures, but if anything serious had happened I was out a maximum of $4,000.
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#8
Stolz25, when I was first starting work, no insurance plan paid for routine doctors appointments. We had "major medical insurance", or catastrophe insurance, like you. We even paid for our first two children (obstetrician and hospital bill) out of or own pocket. So, I agree that folks should not expect to pay routine medical expenses trough insurance. First of all, it is not cost effective, since the insurance company (or government) gets their cut. Second of all, it induces dependence. The current situation is kind of a mission creep that occurred when employers started adding all kinds of benefits to employment packages. Then of course, the gummint got in the act, claiming wall to wall health "insurance" was a "right". How politicians like to buy votes.
Jefferson: I place economy among the first and important virtues, and public debt as the greatest of dangers. To preserve our independence, we must not let our rulers load us with perpetual debt. We must make our choice between economy and liberty, or profusion and servitude. If we can prevent the government from wasting the labors of the people under the pretense of caring for them, they will be happy.
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#9
(07-05-2011, 01:52 PM)Stolz25 Wrote: Define "too much". There is no should with a transaction, merely an agreed upon price between two people.

The state, as you pointed out earlier, makes this worse, not better. Because of laws, insurance cannot carry across states and doctors cannot advertise prices for procedures. This makes it much harder for a person to shop around for insurance or healthcare. And this doesn't better by getting government more involved in healthcare, because "the state serves them".

Another big part of the issue is that people don't treat health insurance like any other insurance. It's a payment plan. I don't expect my car insurance to pay for my oil changes and tire rotations, I only expect them to step in if I get into an accident. Similarly, health insurance shouldn't be used to pay for routine doctor visits. Through college I carried a health insurance with a $4k deductible that was very cheap. I paid for all of my normal expenditures, but if anything serious had happened I was out a maximum of $4,000.

you pay for surgery as much as for a home. too much. medication that costs you $ 100+ would cost you 50 cents in 200 countries. too much. a bridge in your teeth costs as much as a car, a good one. too much. the average income of american doctors and dentists is about $ 250,000 per year. too much. they don't work longer hours than a plumber, or break more sweat. the only solution is to nationalize healthcare, to turn it government run completely. that doesn't mean a loss in quality, your military is state-run, and those guys pride themselves with their excellence. all routine medical expenses should be paid for by insurance, or tax-financed. the private sector and private billing can be restricted to cosmetics, all the stuff that's unecessary for maintaining health.
"You know, Paul, Reagan proved that deficits don't matter." Dick Cheney
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#10
(07-05-2011, 09:37 PM)quadrat Wrote: you pay for surgery as much as for a home.

You do understand what surgery costs, right? And that much of that cost is due to lawsuits on the rare occasions things go wrong.

(07-05-2011, 09:37 PM)quadrat Wrote: medication that costs you $ 100+ would cost you 50 cents in 200 countries.

Agreed, and we have government to thank for that one. Between the FDA taking forever to approve new drugs and the government enforcing patents on the drugs that do exist, they can charge pretty much whatever they want when they get one that works.

(07-05-2011, 09:37 PM)quadrat Wrote: the average income of american doctors and dentists is about $ 250,000 per year.

Don't know where you got this, but I can't confirm the numbers anywhere. I'm seeing an average of $150k.

(07-05-2011, 09:37 PM)quadrat Wrote: they don't work longer hours than a plumber, or break more sweat.

This is irrelevant. Their work is obviously worth more than a plumber, not to mention harder to learn. I've been a plumber, and I can teach you plumbing in under a month. Go visit a doctor with that much training and see what it gets you.

(07-05-2011, 09:37 PM)quadrat Wrote: the only solution is to nationalize healthcare, to turn it government run completely. that doesn't mean a loss in quality, your military is state-run, and those guys pride themselves with their excellence.

Government is most of the problem here already, and you think adding more will help? Also, I was in the military, the military hospitals don't compare to private ones. I spent 3 years bouncing from military hospital to military hospital with a simple rash they couldn't get rid of. First private physician I saw when I got out got rid of it in a matter of weeks.

(07-05-2011, 09:37 PM)quadrat Wrote: all routine medical expenses should be paid for by insurance, or tax-financed. the private sector and private billing can be restricted to cosmetics, all the stuff that's unecessary for maintaining health.

Again, that's not insurance. It would seem you didn't read my previous post at all, aside from the too much sentence.
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#11
well, if you embrace to get ripped off, you got what you want.

(07-06-2011, 05:57 AM)Stolz25 Wrote:
(07-05-2011, 09:37 PM)quadrat Wrote: the average income of american doctors and dentists is about $ 250,000 per year.

Don't know where you got this, but I can't confirm the numbers anywhere. I'm seeing an average of $150k.

(07-05-2011, 09:37 PM)quadrat Wrote: they don't work longer hours than a plumber, or break more sweat.

This is irrelevant. Their work is obviously worth more than a plumber, not to mention harder to learn. I've been a plumber, and I can teach you plumbing in under a month. Go visit a doctor with that much training and see what it gets you.

exactly. they can't work as plumbers, and so they will gladly agree to do a doctors work for $ 50,000 per year, if left with no choice. it's either you protecting your life standard, or them. there's a lot of anti-union threads around here that celebrate whenever workers, teachers, state employees get screwed, high time to target doctors, hospitals, and drug makers.
"You know, Paul, Reagan proved that deficits don't matter." Dick Cheney
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#12
(07-06-2011, 12:48 PM)quadrat Wrote: exactly. they can't work as plumbers, and so they will gladly agree to do a doctors work for $ 50,000 per year, if left with no choice. it's either you protecting your life standard, or them. there's a lot of anti-union threads around here that celebrate whenever workers, teachers, state employees get screwed, high time to target doctors, hospitals, and drug makers.

Doctors do get screwed much of the time. They come out of college on average $180,000 in debt. They on average make about $150,000.

I don't know what you have against them, but screwing over doctors will only make things worse. No one is going to spend 8 years in school and go 180k in debt to make 50k per year, so while you might get cheap healthcare for a few years, it'll look much more expensive when you can't get healthcare at all. As for drug makers, I've already explained why that one is your beloved government's fault.
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