“ I gather that in law school, you not only never took a course in economics — having been assured…
Kendra Anthrope

What’s especially amusing is you claiming all of these things about a member of the Federalist Society.

I guess the Federalist Society will now let anybody in. Are you a member of the Diogenes Club, too?

put all women in the “social safety net”?

Why wouldn’t women just buy health insurance?

Convert people, once they get sick, to a “social safety net program,” or price them out of the insurance market?

Why wouldn’t people buy health insurance before they get sick?

And under rivalrous conditions of “no barriers to entry” (a/k/a a free market) why would anyone get priced out of the insurance market? As only one example of many, no one has been priced out of the smart-phone market because the natural tendency in free markets is for prices to decrease and quality to increase. Just repeal or abolish all prior legislation hindering rivalry among insurance carriers and healthcare providers (which includes physicians, of course) and prices in healthcare will follow the normal downward trajectory of prices in other unregulated (or at least, less regulated) sectors. A good place to begin would be the repeal of the McCarren Ferguson Act.

I am still waiting to hear how private, for-profit insurance administrators actually lower costs or improve health outcomes

For the same reason that private, profit-seeking administrators in the smart-device and PC sectors lower costs and improve quality: competition. (This is just basic economics.)

We’ve already determined as a society that we won’t simply turn people away who need emergency care

In fact, society already determined that long before EMTALA. The assumption that lawyers in government will make us good people by crafting and enacting legislating requiring us to “be good . . . or else!” is nonsense. What such legislation — like most legislation — has done is to harm the interests of the very people it was supposed to help. See:

“In passing EMTALA [in 1986], Congress responded to anecdotal evidence [of poor patients being turned away from the emergency department for inability to pay] and crafted a politically expedi­ent solution. As an unfunded mandate, EMTALA disproportionately burdens the hospitals and doc­tors that, as a part of their professional commitment, have traditionally provided most of the health care to patients who are unable to pay. EMTALA is emblem­atic of the ongoing financial and regulatory burden that is making hospitals and providers less able and increasingly less willing to provide such care.”

“Policymakers could shift health policy to a value-based system that emphasizes personal freedom and expands private health care coverage. Such a system, driven by free-market principles of con­sumer choice and competition, will yield much bet­ter value than one driven by reams of outdated regulation, misguided government subsidies, and the good will of doctors and other medical professionals who provide “free” care in today’s profes­sionally discouraging environment.”

And this:


Emergency department overcrowding in the United States: an emerging threat to patient safety and public health

“The ED is required by law to treat all patients, even when reimbursement is not guaranteed. This precedent was set by the Emergency Medical Treatment and Labor Act (EMTALA), a US law mandating that ED patients cannot be turned away, regardless of payer status. Because refusing patients access to the ED would be an unsafe practice, the Health Care Financing Administration (HCFA) now strictly enforces EMTALA, making ED services the first and only health care in the US to be guaranteed by law. The ED has become the only guaranteed access to health care of 44 million uninsured Americans. Of the 100 million patients presenting to US EDs annually, over 15 millions [15%] are uninsured.”

By causing the severe overcrowding of EDs, overall quality of care has declined, and with it, overall healthcare outcomes for patients using EDs.

Like most intrusive top-down federal legislation, EMTALA appears to be harming the interests of the very group it was intended to help. This quandary is typical of most federal legislation: it either tends to have the exact opposite effect on some group it was intended to help; or it helps the group for which it was intended but at the cost of harming the interests of some other unintended group. (Federal seat-belt legislation is a good example of this: overall traffic-related deaths have remained static, but the distribution of deaths has changed: fewer drivers are dying in accidents at the cost of more pedestrians doing so. The total number of traffic-related deaths pre-legislation and post has remained the same. Look up “The Peltzman Effect.”) All government legislation has unintended consequences that are bad for private citizens (some, or all) but good for lawyers (both in the private and public sectors).


As for claiming “I’m quite sure you know that I could draw up a list of specific outcomes that are less favorable in the US as a volley” I don’t think you could. I think that you think you could — since you apparently subscribe to Ms. Conway’s idea of “Alternative Facts” — but in fact you cannot. Health outcomes are facts. The only way you could show that a single-payer, nationalized, universal, or socialized medical program had better healthcare outcomes than a decentralized, private, profit-seeking system, would be to compare apples to oranges, rather than apples to apples. That sort of dishonest comparison is, in fact, done all the time when comparing those two systems, and is the reason one has to 1) know some basics of economics and 2) always “look under the hood” of studies and surveys to uncover how terms are defined or specifically what is being discussed.

As just one example: it’s very common to claim that European single-payer systems have led to lower infant mortality rates than those in the U.S. Completely untrue. What’s never stated is how those single payer systems define “infant mortality”. In the U.S., if a baby is born dead, it gets recorded under “still birth” and not “infant mortality”; but if it’s born alive and then five minutes later dies, it gets recorded under “infant mortality”. Not so with many European single payer systems. There, if a baby is born alive but dies a few minute later, it’s defined as a “still birth”, and not “infant mortality.” Some of the European systems have a threshold period of 24 hours: if the baby is born alive but dies sometime in the next 24 hours, it’s defined as a “still birth”, and not as “infant mortality.” That has the salutary effect on that country’s statistics of making the “infant mortality” rate look smaller than it really is when compared to the U.S. definition.

That’s just one example of dishonest comparison between single payer and private-profit-seeking systems that allows advocates of the former to naively believe they can find just as many facts showing excellent outcomes of the former as advocates of the latter claim they can show.

You have to “look under the hood” when making these sorts of comparison.

So, in sum: no, I do not think you can volley with me on the factual issue of lowered healthcare outcomes being the result of top-down, government rationing of medical resources in single payer systems. Though you can try, if you wish.

That’s precisely what insurance companies do anyway.

Wrong. “Rationing” here means, “the resources either don’t exist because of overuse, and therefore there’s an actual shortage” or “the resources are legally mandated to be unavailable to someone who wants or needs them.” Under a private system, the so-called “rationing” means simply, “This isn’t covered by the policy you chose to buy from us, so we won’t pay for it”; it doesn’t mean the patient can’t, or won’t, find some other means of acquiring those resources.

If a middle-income earner can’t afford a 150-foot yacht, it’s not because yachts have been “rationed.” If he’s grocery shopping and has already bought $100.00 of food for his family and prudently decides that he can’t really afford an additional purchase of ice cream or turkey burgers, it’s not because ice cream and turkey burgers have been “rationed.” If he subscribes to cable for a certain package of channels he’s entitled to watch, but instead wants to go to a movie theater and watch a movie with a live audience, if the cable company says, “Enjoy! But that’s at YOUR expense. That’s not part of the package you purchased from us”, that’s not “rationing” of movies. Same with health insurance.

The policy spells out what payments by the carrier you’re entitled to on a particular plan; one assumes the purchaser has some incentive to read the “fine print” on the policy. If it says, “With this plan, we’ll pay for X-rays but not MRIs”, you can’t reasonably claim the carrier is “rationing MRIs” by not paying for one if and when the patient needs one.

You have a naively Utopian notion of resources: you believe they’re infinite, rather than scarce, and that the only thing preventing someone from accessing and consuming as much of a resource as he desires is the greed of the resource owner. It’s cute, but wrong.

It is quite obvious that Canada’s system is somewhat underfunded at this point, I don’t think that’s in dispute.

What a coincidence! The NHS is “somewhat underfunded”, the Canadian system is “somewhat underfunded”, the New Zealand system is “somewhat underfunded”, the Danish system is “somewhat underfunded”, etc. It appears that the trend of all single-payer systems in the world is to end up “somewhat underfunded”. Must be bad luck. Or maybe incompetent administrators (But all of them? Globally?). What’s funny about your phlegmatic admission is that all of these systems started off by promoting the idea that “the U.S. spends too much of its GDP on healthcare; a whopping 16–18%! That’s too much! We believe that no more than 9–10% of a country’s GDP ‘ought’ to be spent on healthcare!” Then when healthcare is offered for free and there’s a deluge of demand — with the result that, e.g., seniors with painful hip fractures have to wait over a year for orthopedic surgery, and are diffidently told by government to stay on painkillers — the cry goes up, “We’re not spending enough on healthcare!” Right. So maybe they ‘ought’ to be spending 16–18% of their GDP on healthcare . . . just like the U.S.

Canada’s system is not “underfunded”. The bean-counters who work behind the scenes determining how “the people’s money” is being spent are doing exactly what they were hired to do: to spend as little of “the people’s money” as possible, while making access to medical care as wide as possible. That those twin goals are contradictory perhaps never occured to them, but then again, if it did, they might not have a job.

Canada’s system is not “underfunded”; it’s simply incompetent. It cannot fulfill its promise of free medical care for all. The solution has already been suggested by many in Canada, and to a limited extent has already been put in place: privatization.

In the meantime, those Canadians who can afford to do so in time, health status, and income, will do what they always done when rationing of medical resources has made it impossible for them to get the treatment they need in Canada: they come to the U.S.

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