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The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that the person is either able to pay for it, or the cost through charity is trivial. This has the double benefit of not attempting to rectify one moral wrong (person does not receive care) by committing another (violent coercion by the state).

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   The most economically efficient way to pay for B is to allow the free market to drive the cost of care so low that...

Talking about free market efficiencies is a bit like talking about the effect of Newtonian forces on a spherical cow. Very useful to learn from in an undergrad setting but rarely sufficient to capture real world systems.

What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times. This is much more practical than a provably optimal result in an oversimplified model. Models can be very useful, but the map is not the territory.

>What you actually want from policy is something like a trajectory toward the best expected result in existing markets over reasonable times.

What I don't want from policy is you* deciding for me what results should be aimed for and then forcing me to maximize your personal pet project. If you have good arguments that something should be funded, you don't need to force me to do it.

*: The you here is proverbial. Feel free to insert Donald Trump as an example of the type of person who would have a say in my healthcare options.

I suspect this comment is largely mistargeted, policy is in no way equivalent to force, though some policies may engage it.

Unless you are arguing for a fairly pure form of anarchism (good luck with that, if so) you have policy work and the desire to improve it. It is a reasonable expectation that doing so empirically will vastly outperform doing so ideologically in any scenario like healthcare reform.

The point of this report is that the empirical evidence contradicts your hypothesis. These sorts of broad-strokes, ultra-rationalist arguments should be set aside whenever data is available.

Data is available on rapid price inflation that coincides with central planning initiatives in the US. Data also exists showing the systemic risks to nations created by these systems, such as the looming global demographic crisis created by the combination of social welfare systems and the baby boom.

We aren't talking about those abstract ideas, we are talking about health care and it's associated access and cost. As such, the data shows us the United States fares worse than similar countries on the measures of access and cost (both to the individual and the state)[1]. The United States also has the most "free market-like" system of comparable countries. How can it be that costs are so high and outcomes are no better if we are closer to a free market than others?

[1] https://thumbor.forbes.com/thumbor/960x0/https%3A%2F%2Fblogs...

Causes of price inflation and the looming demographic crisis are not "abstract ideas."

For literally decades the US did not open a single medical school due to lobbying from the medical industry. Even though we've tried to reverse the trend since the 90s, there are still fewer medical schools today than there were 100 years ago. When the government decides how many doctors there will be, it may get the number right or it may get the number wrong. But that's nothing akin to "free market-like." And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.

During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.

Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.

Start with the data!

> there are still fewer medical schools today than there were 100 years ago... it may get the number right or it may get the number wrong... And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.

http://www.nationmaster.com/country-info/stats/Health/Physic...

> Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability. Americans are very obese. Not having to pay a copay to visit the doctor is not going to change that. But obesity means we'll have more problems with newborns, lower life expectancy, etc.

https://obesity.procon.org/view.resource.php?resourceID=0043...

> During the New Deal era regulations wage caps were put on workers in the hopes of staving off inflation. Employers, wanting to entice good employees to work for them sought to get around these wage caps by offering health insurance. This then spread like wildfire, coincides with the time healthcare inflation separated from general inflation, and began the trend towards a lack of price transparency.

Except, of course, in the countries where it didn't spread like wildfire. Why all this crazy post-hoc history-building when you can just... empirically observe how the natural experiment played out?

Your modus operandi in this thread is the start with an ideology and then derive conclusions that are often wholly inconsistent with observed reality. There's nothing wrong with premises or theory-building, but when the data flatly contradict your conclusions... well, that's the difference between reality and fantasy.

>http://www.nationmaster.com/country-info/stats/Health/Physic....

By your link we're 52nd in doctors per capita. That's not great. Plus I'd already noted that we've made a concerted effort to undo the damage since the 90s. Are you suggesting that supply and demand has no impact whatsoever on the wages doctors are capable of demanding? Do you believe that artificially restricting the supply for decades has had no impact on wages whatsoever?

>https://obesity.procon.org/view.resource.php?resourceID=0043....

https://medicalxpress.com/news/2018-01-mortality-obesity-sta...

But obesity is not the only issue, general issues related to poverty are:

https://www.newyorker.com/tech/elements/why-america-is-losin...

Higher adolescent pregnancy rates, higher rates of HIV, etc.

=== Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.===

So best case scenario access and affordability to healthcare accounts for about 25% of improvements in life expectancy. Except the majority of people already have access to healthcare in the US. It's not as available and affordable as we'd like, and we're talking about how best to improve availability and affordability, but it's a tiny fraction of the problem of why US health outcomes are so bad.

It's clear you still don't understand my critique.

> By your link we're 52nd in doctors per capita. That's not great.

I think this sort of argument is innumerate. Statistical sciences provide us with many ways of testing the correlation between "value of care per dollar spent" and "average doctor salary".

None-the-less, I am tempted to point out that Cuba is #2 on this metric ;-)

Regarding the rest of your post, consider actually reading that New Yorker piece. The things you think it says, it DEFINITELY does actually not say.

== And it's a major part of the explanation why US doctors make 2x+ what their counterparts in countries like Germany make.==

That is a nice thought, fortunately NPR has done the actual reporting on this. It seems like the answer is government interference [1]:

"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."

On administrative costs it seems like government mandates on benefits and payment rates keep those costs 50% lower. Also, they have an employer-based system:

"On top of that, administrative costs are almost 50 percent lower. That's not because the German health system is simple and streamlined. With its employer-based system, multiple insurers and ever-changing rules, German health care is as complicated in many ways as the U.S. system. But administration is much simpler because nearly everybody gets the same benefits, payment rates are uniform and virtually everybody is covered."

==Most of the differences in outcomes between us and other wealthy nations amount to lifestyle/culture much more-so than affordability and availability.==

You have provided no evidence to back up this claim. What makes you so certain that it's true?

==Not having to pay a copay to visit the doctor is not going to change that.==

Might this encourage more people to visit health providers more frequently? This might lead to earlier detection/treatment and lower long-term costs. Why have you dismissed this potential outcome?

[1] https://www.npr.org/templates/story/story.php?storyId=919310...

>"But the biggest reason German health costs are so much lower, experts say, is that doctors are paid less. This largely reflects Germany's concerted efforts to keep costs down over the past two decades."

Yes, this supports my statement. I said the medical lobby has artificially constricted the supply of doctors. Limited supply means higher wages. I'm not familiar with the German system, they may have done other things such as price fixing to keep wages lower. Personally, I'd prefer having "too many" doctors. This would give me more personal choice to choose the one I like the most while simultaneously keeping prices reasonable.

>You have provided no evidence to back up this claim. What makes you so certain that it's true?

Here's the first article that came up when I googled the subject. https://www.newyorker.com/tech/elements/why-america-is-losin.... It talks about issues of poverty, adolescent pregnancy, etc.

===Most experts estimate that modern medical care delivered to individual patients—such as physician and hospital treatments covered by health insurance—has only been responsible for between ten and twenty-five percent of the improvements in life expectancy over the last century. The rest has come from changes in the social determinants of health, particularly in early childhood.====

>Why have you dismissed this potential outcome?

As noted above the majority of improved health outcomes are not the result of access to healthcare at all. Let's be generous and use the highest percentage in the stat provided above: 25%. So now we're only at 25% of healthcare gains at all, and the fraction of that that isn't actually affordable either by the individual themselves, through their insurance coverage, or provided by charity. We're talking a really tiny fraction of gains here.

> Here's the first article that came up when I googled the subject... [cites article laying down the case for increased social welfare funding, which doesn't even justify the stated claim]

Oy... talk about (not quite) winning a battle but losing the war.

Also, this whole methodology toward argumentation just reinforces the top-level critique. The important word in "start with the data" is not "data", it's "START". I.e., begin by understanding the problem. Then solve the problem. Don't walk around with a hammer trying to bash things.

== I said the medical lobby has artificially constricted the supply of doctors.==

In the free market, money equals influence. As long as AMA determines who is/isn't a doctor, they have an incentive to make it as hard as possible to become a doctor.

==The rest has come from changes in the social determinants of health, particularly in early childhood.==

Now you have to prove that free and easily accessible access to health care won't have a positive impact on the social determinants of health. It stands to reason that part of America's reluctance to visit doctors is rooted in the historical costs associated with visiting doctors. If we can remove that stigma through cheaper and more accessible care, it stands to reason that we can improve the social determinants of health over the long term.

Here's an example: In Canada, one can visit a dietician as part of their health insurance, this could have a positive impact on obesity, which would lead to healthier population.

Taxation is not violent coercion by the state and it is disingenuous to describe the former as the latter.

I would argue it is coercive, but so is the property system underpinning the market in the first place. Adding a redistribution element to a system of private property doesn't introduce violent coercion, it merely changes how it is being used to allocate resources.

As Adam Smith wrote: "Civil government, in so far as it is instituted for the security of property, is in reality instituted for the defense of the rich against the poor, or of those who have some property against those who have none at all."

That quote doesn't mean what you think it means. Taken in context, that quote is talking about the origins of civil government and how it is often corrupted as stated in that quote. It is used as an argument for why there must be a separation of powers to ensure fair judgement and protect the property rights of both the poor and the wealthy.

https://www.health-tourism.com/medical-tourism/usa-research/

The ultimate market victory - completely avoiding the destroyed free market healthcare system and travel abroad to parasite on universal healthcare.

I assume you are also pushing for multiple roads between 2 towns, all competing on toll price.

The competition is before the road is built..

Regarding "violent coersion of the state", by this, I assume you mean.. taxes.

At this point in the world's history, we are not individuals who can wander off into the wilderness on our own, to live and die as God might have intended. We are members of a vast, global social fabric. We benefit from it. We pay into it. There's no way to avoid the coersion/evils or really deny the benefits/goods that this society provides. We can only discuss things relatively speaking, on a whole, in balance.

I think a productive use of our time is thinking about (and experimenting with) how information technology could better support our emerging social fabric so that we could make the best collective decisions: that is, enable even more personal freedom.

Law is violent coercion. This isn’t libertarian philosophy class, it’s the real world.

In many places in the real world, universal government insurance is already in place. This isn’t some hypothetical.

The fact that some people or nations behave in a particular way does not in any way determine whether that behavior is moral.

No, but the fact that it results in demonstrably better outcomes in pretty much every case does.

States in and of themselves aren’t moral under your framework because they can only exist by threat and use of force.

But some of us are interested in solutions for the real world instead of the debating the merits of unfeasible utopias.

I, too, would enjoy a stateless peaceful utopia of equitable commerce, but that has zero bearing on how we should decide public policy. Foraging for utopias is the same kind of naïveté Marxists trot out again and again and were it ever enacted at scale it would lead to the same kind of human suffering.

I don't see how you can define the state taking money from the wealthy to buy healthcare for the poor as violently coercive but not also define a corporation withholding necessary care from a poor person as violently coercive.

Doing nothing is not violent or coercive. It may be morally wrong for a person to do nothing, but it's not violent or coercive.

I disagree with the asymmetry. Withholding care isn't actually 'doing nothing' and has the ability to be violent or coercive. Take a life-saving but expensive pill. 'Doing nothing' in the case of someone who needs but can't afford the pill would be actually doing nothing - that person could waltz in, walk behind the counter, take the pill, swallow and walk out. Bada-bing bada boom, problem solved no violence or coercion. Healthcare providers don't actually do that though, someone who tried to walk in and take the pill would be met with violence in order to prevent them from accessing the pill until they had paid. That violence is coercive.

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Since the mods are rate-limiting me, here's my reply to your post below:

>Otherwise every person in every situation who demands to be paid for their work, including doctors who demand to be paid by the state in a universal healthcare system are all being coercive.

I agree that this is coercion.

>When taken to that level, the word coerce ceases to have a useful meaning.

Well no, when taken to that level coerce retains it's meaning perfectly, it just happens to illustrate that the market system has coercion baked into almost every aspect. Here, this guy says it better than I can:

But there is no neutral construction of “coercion” that would ever support such a distinction. As Hale aptly demonstrates, coercion occurs when there are “background constraints on the universe of socially available choices from which an individual might ‘freely’ choose.”

In a world of scarcity, all economic rules–including rules that create private property ownership, contract laws, and so on–impose background constraints on the universe of choices individuals can make (e.g. the choice to move into a building and sleep in it without paying anyone anything). When we talk about the economy, we are not arguing about whether we want coercion. We are arguing about what coercion we’d like.

http://www.demos.org/blog/10/28/13/libertarians-are-huge-fan...

Demanding to be paid for your work is not coercive. Otherwise every person in every situation who demands to be paid for their work, including doctors who demand to be paid by the state in a universal healthcare system are all being coercive. When taken to that level, the word coerce ceases to have a useful meaning.

If you are able to help them, and you refuse to do so unless they do something for you (i.e. labour to earn money to pay your fees) then it is absolutely coercive.

By that measure any salary a doctor demands, whether it's paid for by the patient or the state, is coercive. Or for that matter, any salary any person demands in exchange for work is coercive. I feel like it ceases to have a useful meaning when used in this way.

It's only coercive when we're talking about the means to survive. If you offer someone a choice between death or some action, you are coercing them to act.

And I don't think that "ceases to have a useful meaning". I think it just doesn't let you argue that your system is better based on absence of "coercion".

I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.

Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?

>I don't believe for a second that you understand the word "coerce" to be limited only to situations of life and death.

I don't think it's necessarily limited to that, but I do think all such situations are coercive. Whether someone is having a gun pointed at them, or being denied healthcare, they are being coerced. That said, I do think most coercion does ultimately amount to the threat of death or suffering, even if it becomes very indirect in practice.

>Do you or do you not believe that doctors in the UK are coercing the government by demanding a fair salary in exchange for the lifesaving services they provide?

Trying to evaluate the actions of individuals in a wider system is not very helpful. Are the doctors being coercive? Yes. But they're also being coerced in turn by the individuals they rely on for survival (i.e. the people they buy food from) so it's hard to ascribe blame. It's the system as a whole which is coercive.

And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.

The only hypothetical system I know of that would actually be free of coercion would by something like anarcho-communism, where people have free access to the means of survival, and it is produced by people's free choice to work for the benefit of others. But I'd guess you think such a system wouldn't work.

>And this is my point. Both market based healthcare and state provided healthcare rely on coercion to function, so you can't distinguish them morally on that basis.

Can you honestly not see the moral distinction between me intentionally shooting you with a gun and me not applying first aid after someone else has intentionally shot you with a gun?

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