Don Boudreaux’s a great economist and a very wise man. Unfortunately people like him are scarce in political leadership—perhaps for good reason. I recommend regular reading of the Cafe Hayek site. Thanks for the pointer, Dr Harmon.

He is chair of an economics department widely regarded as on the extreme of mainstream economic thought.  He’s a utopian if he really thinks that eliminating medicare would make doctors more philanthropic.

My dad’s cousin confirmed much of this before he passed away (at age 101). He lamented “the old days”, when all the doctors would volunteer at the county hospital.

However, any realistic health care reform has to confront some shocking facts. According to the CDC, @75% of US health care costs result from “lifestyle choices”. Until we have a system that forces all of us to take responsibility for that which is within our control, we are not going to rein in health costs short of arbitrary rationing (which exists de facto under any system).

Equally shocking was the CDC report that expenditures during the last @ one year of life went from @$11,000 to @$150,000 in inflation-adjusted dollars per person. Given the lack of major advances in life expectancy, it is fair to ask if we are not making an idol of miniscule life extension.

As Paul Krugman pointed out recently, discussing the “death spiral of health insurance”, the current sharp increases are not driven by increases in cost, but rather by the healthy dropping out of the pools (as a cost savings during a recession), leaving heavier users and higher per capita costs. Reform needs to address the need to keep the pool large to keep costs down, per capita.

Finally,  we need to deal with the fact that the US has subsidized drug costs for the rest of the world. How ironically Marxist that our drug prices have been based on our ability to pay. Hence all the folks taking adantage of the lower prices in Canada and Mexico.

My “ideal system” would cover all catastrophic costs (above e.g. $10,000) and all preventive care. But all in between would be patient responsibility. Plus I would incorporate some mechanism to surcharge those whose lifestyles create greater cost. (Life insurance already does that.)

Wilkins, if you think that handing the keys of compassion to bureaucrats is going to make the system better, you have another think done.

Cell phones drop in price and increase in features, not due to some suspect philanthropy, but because of competition. Your system of forced benevolence has NEVER worked, and never will. I’d rather live in a free market system where I can use my limited means to take care of my family than to have them taken from me, and then told by bureaucrats that I have still been excluded from care—as has happened to my family in England.

John Wilkins, I don’t know about that. Rising unemployment in my community has led one of our doctors to hold a free clinic one day a week for those recommended to him by churches in the community. A local phramacist is providing prescriptions at cost. No one made either man do this. Both saw a need that awakened their compassion.

RE: “He is chair of an economics department widely regarded as on the extreme of mainstream economic thought.  He’s a utopian if he really thinks that eliminating medicare would make doctors more philanthropic.”

I always enjoy the strings of assertions JW puts together for his comments.

RE: “an economics department widely regarded as on the extreme of mainstream economic thought.”

No it’s not.  It’s not “widely regarded” as “on the extreme” of anything other than huddles of collectivist idealists.

RE: “He’s a utopian if he really thinks that eliminating medicare would make doctors more philanthropic.”

As he didn’t say anything of the kind, one wonders why JW said it.

Oh yeh . . . it’s just the usual rhetorical style—deny something in an assertion that the writer never made in the first place.

Standard op.

Heh, Sarah.  Well, I will at least agree that GMU has carved out a nice little niche for extreme, if smart, free-marketeers.  Still, I’m always equally amused that anybody to the right of GMU, say econ departments of Princeton, Stamford or MIT, are “collectivist.”  I suppose its just an example of the human mind’s tendency toward manicheanism. 

If you read the letter, he seems to imply that:
Physicians provided free care before medicare.
Therefore medicare crowded out free care.

I inferred that he would argue that without medicare, physicians would provide free care.  He did say “something of the kind.”  In fact, this is a very common assertion that conservatives make:  government charity often replaces personal charity.  It’s actually an argument I have some sympathy towards.  But I also don’t think it eradicates the government’s responsibility for the general welfare. 

Your assertions about my own rhetorical style are sometimes precise and correct, but often they seem to ignore my central point (I don’t blame you.  After all, how would someone with a completely different foundational view understand my central point?)

RE: “Well, I will at least agree that GMU has carved out a nice little niche for extreme, if smart, free-marketeers.”

No you don’t—because I didn’t say that either.  So you “agree” with me about nothing.  Another—typical—sophism—now you’re pretending to “agree” with something I did not state.

RE: “Still, I’m always equally amused that anybody to the right of GMU, say econ departments of Princeton, Stamford or MIT, are “collectivist.”

Since they’re not “to the right”—that’s another rhetorical maneuver.

RE: “I inferred that he would argue that without medicare, physicians would provide free care.”

No—you denied what he did not assert.  Again—a typical rhetorical ploy from you.

RE: “but often they seem to ignore my central point . . . “
’ Right—because you get at your central point—which is one with which I never agree and we’ve clearly established that—through sophism.  Not very good sophism, either.  It’s fairly transparent rhetorical gamesmanship.

I try to on occasion point it out—just to make sure everybody notices and to memorialized it.

Certainly not to try to convince you of anything—as we both know, we hold antithetical, mutually opposing worldviews.  What you think “good” I think “bad”—what you think “corrupt” I think “pure—what you think “truth” I think “rank lie” . . . and so on and so on.

Two people holding two opposing gospels in one organization.

Nevertheless, it’s always nice to point out the rhetorical maneuverings, as I find the time.

Well Sarah, you did catch me on my typo.  I did mean “left” of GMU.  Which I suspect any department to their left you consider collectivist.   

re: “Another—typical—sophism—now you’re pretending to “agree” with something I did not state.”

Actually, I agree with a writer in Slate, not you, that GWU has a brilliant economics department, if extreme.  I did not say I agree with you.  You’re disagreeing with an assertion I did not make, although I’ll be charitable about understanding why you may have thought I was discussing your non-assertion.

I admit, the other commentators - such as Sherri -  seem to have understood a bit better my central point, as they responded to it and provided counterexamples. 

You assert that I denied what he did not assert, but then ignored my explanation.  I note that there is a difference between implication and assertion.  I may have made a logical mistake, but not the one you mention. 

Others seemed to have understood and came to the author’s defense.  I gave an example from the letter - my central point - which you seem to avoid.  Sherri, however, was quite able to hear it and then responded with a plausible counterexample.

There’s very little rhetorical gamesmanship on my part.  You believe you are pointing out some truth about how I argue, but it usually looks like an excuse to avoid hard thinking through repeatedly asserting that we have different understandings of the world. 

However, I suspect you think you understand my worldview more than you actually do.

RE: “You assert that I denied what he did not assert, but then ignored my explanation.”

Yes—I did.  Because pretending to argue against something that the writer with whom you disagree foundationally never said at all is a consistently used ploy of yours, used practically every single time you comment on a post.

I’ll keep pointing that out as I find time.

RE: “You believe you are pointing out some truth about how I argue . . . “

Yup.  Only I’d use the word “assert” rather than “argue.”

RE: ” . . . but it usually looks like an excuse to avoid hard thinking through repeatedly asserting that we have different understandings of the world.”

If I ever need to try to avoid hard thinking, John Wilkins, it won’t occur when engaging with your comments.  I’ll pick a commenter who actually forces hard thinking, rather than a guy who can’t back up his foundational worldview with any coherence or consistency or rational integrity, and so instead indulges in little sophisms and cheap rhetorical maneuverings.

To recap, you started out with the usual string of assertions, then capped it with the usual “I disagree with what he says” which he didn’t say.

I’ve merely asserted completely contrary to your assertions—and then pointed out the maneuverings you use rhetorically.

None of this has accomplished a thing regarding you and me—but then, that’s never the point when I engage your bluster and crude attempts at deconstruction.

Heh, “deconstruction.”  That’s a big word, Sarah.  Don’t let it trip you up.  I’m not convinced you know what that means.  What I have seen doesn’t encourage me. 

You imagine he didn’t say something that he did, actually, infer, as other commentators have noted (and actually defended).  Again, that you can’t follow the thread is amusing and revealing.  Others did.

Sometimes you’re smart, and I am humbled.  Other times you miss the point.  As you did here.  Keep trying, Sarah.

John, you don’t know what you are talking about. There are several issues in the statement, “Medicare crowding out a sizable chunk of private-sector philanthropy.”

First, with pretty much all Medicaid should be considered to be charity work with Medicare also becoming charity work as well. Just today it was announced that there was a one month hiatus in the 21% cut of Medicare announced today, but Medicare physician fees continue to increase at a rate less than inflation. Medicaid between 2003 and 2008 increased by 15% but inflation was 20% during that time. In the same time period, Medicaid reimbursement relative to Medicare went from 69% to 72% - an effect due to falling Medicare rates increasing even slower. I most certainly lose money with all my Medicaid patients. I used to say that I break even with Medicare. That is becoming less true. (Note that small businesses that “break even” don’t survive. Some profit is necessary.) With my Medicare cancer patients, I definitely lose money as well.

Another issue is that Medicaid providers can’t charge anyone less than the Medicaid rates. Thus, if I have a uninsured patient, I can’t ask them to pay me $100 or two chickens or whatever. That is fraud, and the government will fine me gazillions.

A simple solution to the uninsured is to allow physicians to deduct charity care from their taxes. Tomorrow, I have scheduled a case that my bill will probably be in the five figures - putting Humpty Dumpty back together after he got pummelled (when reviewing the CAT scans with the radiologist today, he commented that he had never seen a worse case). I am sure that I won’t see a dime because the patient has no insurance. It is scheduled late in the day meaning I will get home after my kids have gone to bed. It is frustrating.

Hi Robroy,

I sympathize with your plight, and you are right that there are several aspects to the incentive structure as it currently is.  Your suggestion is a good one.

I don’t understand what I got wrong, but we seem to agree that coordination remains a pretty big problem.  There are lots of reasons why (how much is a life worth?  Who gets the bill?).  I just don’t think the economists’ answer is a particularly revealing one, or the right one, and have good reasons to disagree.