Comments on: The Costs of Healthcare

By: I Heart The Mudflats » Sunday Wrap Up - 10th May 2009

I Heart The Mudflats » Sunday Wrap Up - 10th May 2009 — Sun, 10 May 2009 13:43:31 +0000

[...] Akhbar The Great - The Costs of Healthcare [...]

By: akhbarthegreat

akhbarthegreat — Sat, 09 May 2009 07:03:56 +0000

I think you’re probably right about the importance of distinguishing between insurance and out-of-pocket, but you’re somewhat missing my point in the following sentence. I’m not *just* quibbling about the proper argument for establishing something that is obviously true. Even if we all agree that there are terrible inefficiencies in our healthcare system, the problem I’m pointing to doesn’t go away, because what’s really at issue is not the existence of that problem, but rather the scale and nature of it. The argument I’m complaining about (though it does more or less make sense for purely public spending) doesn’t just cheat to come up with a conclusion that is true anyway, it exaggerates the scale (by including the out-of-pocket stuff we shouldn’t be worried about) and conflates distinct issues (there are substantively different things to be said about inefficiencies within the private insurance system and inefficiencies within the public healthcare system).

By: Dan

Dan — Sat, 09 May 2009 00:21:05 +0000

Fair enough. I agree that it is worth considering the two separately. The distinction between out-of-pocket and insured expenses seems like another relevant distinction, perhaps even more so. I suspect that the valid, slower argument would have a similar conclusion to the invalid, quick one. Then again, all I know comes from reading blogs.

By: akhbarthegreat

akhbarthegreat — Fri, 08 May 2009 22:49:11 +0000

Just to build on that, spending can obviously also be driven up by higher costs. If we are paying more for the same care than Europeans, that is a prima facie problem regardless of whether it is the government or individuals paying for it. But, again, this has to be unpacked with the private sector spending. If *all* spending were public, you wouldn’t need to do this for these purposes - if we’re spending more and getting less, then something is wrong, period. This argument simply doesn’t make sense when you include private sector spending.

By: akhbarthegreat

akhbarthegreat — Fri, 08 May 2009 22:34:14 +0000

That’s absolutely true. That’s why I say “one needs to know a lot more” to conclude that private sector spending is a problem. That is, there are things which drive up private spending that are problematic, and things that drive it up which aren’t. In either case, the quick argument for inefficiency that works for public spending doesn’t apply. That’s why I think it’s important to look at the two seperately, rather than as an aggregate, as if we were already on a fully socialized system.

By: Dan

Dan — Fri, 08 May 2009 22:19:12 +0000

It’s fine for rich people to spend out-of-pocket money on healthcare rather than yachts. But for ordinary people with health insurance, much of the fees they pay go towards sustaining the elderly and the seriously ill. If that spending is inefficient, then that *is* a broader social problem.