Much remains to be known about the murderer of UnitedHealthcare CEO Brian Thompson. I don’t know what “brain fog” is and whether Mangione, the young man charged with the murder, suffered from it as was reported. But there is certainly much mind fog in the support he received after his arrest and, more generally, in ideas about health insurance that lie around in the zeitgeist.
For many people, health care and health insurance are special goods because they deal more directly with life, death, and bodily integrity. Food, clothes, and housing would also be candidates. Moreover, individuals do make trade-offs between health and other goods or activities such as smoking, drinking, and mountaineering. The source of the problem lies in the unbridgeable gap between scarce resources and infinite human desires—the subject matter of economics. Wealth can only partially bridge the gap. For nearly 100% of mankind before the Industrial Revolution, the partial solution did not exist, as it still doesn’t for many inhabitants of the third world who are exploited by their own governments.
A sign held by one of Mangione’s supporters in a demonstration read:
Privatized healthcare is a crime against humanity
Privatized? How was it before it was privatized? And who privatized it? Perhaps the implicit mind-foggy model is that, 100,000 years ago, healthcare was made freely available by benevolent governments but, as “neoliberalism” started its assault on nirvana, they gradually privatized it, or accepted its privatization, until the crime reached its zenith today after millennia of combat between the individual and the collective.
Even in a rich society, healthcare is not a “right” except under at least one of three conditions. First, you obtain it through voluntary and private contracts. Second, you enslave somebody (some physicians, nurses, shareholders, or taxpayers) to provide it to you. There is a third possibility: that some public health insurance or healthcare is made publicly available at subsidized prices by the rules of a “social contract” à la Buchanan to which unanimous consent is arguably plausible, or perhaps by spontaneous-order rules à la Hayek. The justifications of this third possibility are more demanding than most people think and must be handled with great care.
In rich countries, everybody can get a minimum of healthcare through a varying mix of the three conditions or justifications above. In the United States, publicly financed healthcare accounts for about half of total health expenditures. But remember that these countries became rich because, in economic life generally, the first condition—private contracts—was privileged. In matters of healthcare, the United States may remain the country that diverges the least from the private contractual ideal.
Private health companies are not in the business of denying what their contracts obligate them to provide to their customers, who can go and shop elsewhere. But they do have to control their costs, lest they would be unable to offer their services to anybody because nobody would voluntarily invest in these companies. Economic analysis shows that competition between private insurers will bring the lowest prices for feasible insurance while providing a diversity typical of markets. The more you pay, the more likely it is that your insurance will cover a given claim, and mutatis mutandis if you choose a policy with less coverage. Note also that the more consumers in this market are directly or indirectly subsidized by the state, the more they bid up healthcare prices.
We should not forget that the health industry is one of the most regulated in America, and that regulation limits competition. Most Americans get their healthcare insurance from their employers, an unfortunate sequel of WWII wage controls. They have to change jobs to switch insurer. Moreover, employers rather than insurance companies are often the ones trying to control insurance costs. (See “How American Health Insurance Got So Infuriating,” Wall Street Journal, December 20, 2024.)
Partial or total nationalization of healthcare insurance or delivery cannot solve the problem of the unescapable allocation, by prices or other means, of what consumers want given the necessarily limited supply. Not all Americans can get the healthcare that, say, Elon Musk or Bill Gates must be getting. If the allocation by prices is abolished, waiting lines and bureaucratic decisions will be the new rationing mechanism. In Canada, where health insurance is a monopoly (at the provincial level), the median time between referral by a general practitioner and an appointment with a specialist is 15 weeks; another 15 weeks then elapse between the appointment and the start of treatment. These waiting times have tripled since 1993 despite recurrent and grandiose political attempts at internal reform of the system. (See Fraser Institute, Waiting Your Turn: Wait Times for Health Care in Canada, 2024 Report.) Not counted are the delays to see a general practitioner and the lack of amenities and privacy in hospitals, which are, formally or informally, all public. These problems are endemic in nationalized healthcare.
We should beware of the simplistic argument that the state’s takeover of health insurance and healthcare would solve all problems. It certainly did not in the Soviet Union. But even a much lighter implementation would likely increase discontent among Americans, who are accustomed to being treated as customers, not as public wards. It would probably not restrain mind-foggy wackos and perhaps excite them even more—now against public officials. But this last bit is not sure: once a society has reached that point, individuals may have become submissive and resigned.
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A piece of art, especially from AI, can be interpreted in many ways
READER COMMENTS
Peter
Dec 26 2024 at 10:37am
No objection to your overall gist but a minor quibble with “In rich countries, everybody can get a minimum of healthcare through a varying mix of the three conditions or justifications above.”. I don’t know if you mean “can” as in “we have the ability to implement it in the future should we wish” or “in practice right now” but at least in the US the latter isn’t in place. You can generally get a minimum level of EMERGENCY healthcare, even though that also isn’t absolute either for wards of the state, but outside that there is no minimum universal healthcare.
There are many Americans who can’t afford insurance, can’t afford the deductibles or copays much less full cost out of pocket, and likewise still don’t qualify for Medicare, Medicaid/Quest hence can’t access affordable routine medical care such as preventative medicine or treatment of chronic conditions. The ER isn’t going to prescribe you blood pressure medication for example, much less pay for your ongoing chemotherapy.
If I wasn’t a vet, there is no way I could afford the $20,000 a month ($16,000 after private insurance) in medications I take, and will take the rest of my life. I’m not the only person in that boat but I can say if I wasn’t a vet I’d probably die as a result or have to go to prison just to receive continual treatment. My mother is in that boat as well with untreated diabetes in a slow death spiral because she can’t afford the medicare medication copays but has too many assets (i.e. owns her trailer) to qualify for means tested programs and is to old and disabled to work.
I don’t know the solutions here as like you said, UK’s NHS didn’t solve that either but I did just want to point out the tired trope of “All Americans right now can receive a minimum level of healthcare for free” reality isn’t true in absolute terms nor generally if we mean minimum, as most people would, to be more than “the ER will give you a temporary sling and tell you to not use your broken arm”. We are a rich enough country there is no reason flu shots aren’t universally free especially given productivity and health costs saved in the aggregate most likely vastly outweighs the cost.
Roger McKinney
Dec 26 2024 at 12:11pm
What about Medicaid?
Peter
Dec 26 2024 at 3:12pm
Medicaid/Quest is means tested and not just straight across net income as most people seem to think. It’s a problem with things like SNAP as well where you basically have to be genuinely destitute including effectively no assets and income is gross, not net, hence so you have cases where your defined fixed gross income is $12 over the monthly limit (my case btw) whereas my mother’s assets are too high though her income low enough; you have to pass both tests. So like I said, if not the VA I have zero idea how I’m coming up with that $20,000 a month nor can my mother in the now come up with the couple hundred hence her slow progressive death spiral from treatable diabetes these past two year.
We aren’t unique here nor is the problem novel, you generally always have to draw a cutoff lines somewhere and will always have edge case tragedies though that’s a different article. It was more just a comment that within the US that perpetual myth everyone has a affordable (i.e. free in some cases) access to a minimum (basic) level of healthcare is false outside sure most people have access to an ER that will make sure you don’t die until a couple minutes after they discharge you from the ER but that’s it and I’m pretty positive most people don’t mean that low or a bar when they suggest all Americans have access to a minimum level healthcare and instead mean things like “can get a broken arm casted or antibiotics (ER won’t prescribe those either btw)”
Pierre Lemieux
Dec 26 2024 at 10:58pm
Peter: I did mean the latter but, as you point out, I neglected the people who are not poor enough to get Medicaid but not “rich” enough to purchase health insurance plus co-pays and deductibles. Interestingly, the average household in the bottom quintile of revenue earns, after tax and especially government transfers, $45,000 a year (including transfers in kind like Medicaid), while many people in the second quintile would not be poor enough to get Medicaid. No wonder that only two-thirds of able-bodied working-age people in the first quintile do not work; it’s not worth it. Note also that Medicaid services reimbursed to people in the first quintile bid up the prices of healthcare for everybody, including poor people in the second quintile. See my review of Gramm et al.’s The Myth of American Inequality. Certainly, giving those governments a monopoly of healthcare would be a catastrophe!
steve
Dec 26 2024 at 11:26am
Health care in Canada also costs a lot less. If they were willing to spend more on specialists they could decrease wait times, though note that actual health outcomes in Canada are pretty good. It’s also notable that Canada generally ranks worst in wait times and that is the nation you have chosen while there are other nations with universal government financed care that have shorter wait times than the US. In particular it’s often easier to see your PCP in other countries since the US is tilted heavily towards specialist care.
https://www.commonwealthfund.org/publications/surveys/2021/oct/comparing-nations-timeliness-and-coordination-health-care
2) Ultimately, we decide what is and is not a right. Private property rights did not exist under many monarchies. (Note that Dubai, beloved by some people here is a monarchy.) I would agree that for now health care is not a right. (Before responding assume I have read hundreds of hours on this argument.)
3) Mangione is a criminal and should be in jail. That said, it’s not that hard to understand why many people are angry about health insurance companies in general and United specifically. They are sometimes denying payment for care which they had approved. If you have an emergency and go for emergent care, which in their policy they claim they will reimburse, they are refusing to pay since you didnt get prior approval. I could fill pages with examples but let me try to shortly cite one, remembering how awful it may sound it was worse in real time.
One of my ICU nurses had a 2 y/o who started seizing. Most seizures stop after a short while but hers did not (status epilepticus). She called 911 and convinced them to take her child to the pediatric hospital, not the slightly closer general ED at the very small local hospital. The child ended up in the pediatric ICU for a week and eventually did OK. The insurer refused to pay. By their reckoning she should have called her PCP first and the child should have gone to the local, smaller (and cheaper) hospital first.
In context, while UH denies a lot of claims on appeal they also approve a lot, after the pt and hospital/physician staff have gone through the time and expense of the appeal. It looks very much as though their economic model is to deny payment, even to care they approved, but mostly pay when challenged hoping that a lot fo people wont bother challenging.
Steve
Jose Pablo
Dec 26 2024 at 2:06pm
It looks very much as though their economic model is to deny payment, even to care they approved, but mostly pay when challenged hoping that a lot fo people wont bother challenging.
That is standard procedure in other industries, for instance with bank fees. The business incentive to doing this is there. It clearly shows that “something is different” whith Healthcare. It doesn’t cost you a lot in client turnover in the banking case and in the healthcare industry you don’t want to renew your contract with that client (that now has a pre-existing condition) anyway.
there are other nations with universal government financed care that have shorter wait times than the US
And in a lot of those nations the combination of universal government financed care + very affordable private healthcare insurance (often included as a perk provided by your employer), provides you with a very satisfactory service that most Americans would consider “a dream” and at a very reasonable cost (and this could qualify as “the understatement of the year”).
When you “live” both models there is little doubt (in reality none) of which one works way way way better.
steve
Dec 26 2024 at 3:07pm
I sometimes suggest people read this piece in Reason by Matt Welch, one of their editors. In it he describes his lived experience of health care in France vs the US. Payment in particular is very easy. Compare that with paying via the US insurance system where the Commonwealth Fund routinely rates the US at bottom in payment efficiency. This gels with nearly every study done on happiness on health care showing that people in the rest of the first world are generally happier with their health care than people in the US. So Pierre, like all libertarians chooses Canada as a point of reference when people could look at other OECD countries where wait times are shorter, for both primary care and specialist care, and its easier to pay. Cheaper too!
https://reason.com/2009/12/07/why-prefer-french-health-care/
steve
Dec 26 2024 at 3:19pm
Two things I forgot to add. I actually read the Fraser report which most people dont do. They just skim for highlights to prove a point they want to make. First, it only measures wait times to see specialists. It doesnt look at wait times to see your PCP which is at least as important. However, when you look at the wait times for specific specialists you see that wait times vs what would be considered a normal average wait time, they just arent that far off, especially for those with more urgency like cancer care or cardiovascular surgery. A large part of the difference looks to be solely driven by waits for orthopedic surgery, the most elective of the group.
Second point? The big profit maker in US hospitals now, the one area that nearly every hospital is trying to actively increase? Orthopedic surgery. Coincidence?
Steve
David Henderson
Dec 26 2024 at 6:02pm
Steve,
That IS a horror story. Was the ICU nurse stuck paying a 5-figure bill?
Matthias
Dec 26 2024 at 6:49pm
Healthcare spending doesn’t seem to have much to do at all with health outcomes.
So if you only care about bang-per-buck of health outcomes to healthcare spending, and system that keeps spending down will look good.
Outright bans are inefficient, but you could heavily tax healthcare spending.
Btw, Britain has total healthcare spending a bit more than half the US level (in terms of percentage of GDP) and Singapore has less than half of Britain. All have similar-ish health outcomes. Well, Singapore perhaps a bit better. I guess it depends on whether you control for obesity as an input or take it as an outcome.
Britain’s famously has the single payer NHS. While Singapore doesn’t even have much of traditional health insurance: the first line of spending comes from people’s individual healthcare savings accounts.
Apparently, if you look at total healthcare spending not as a percentage of GDP, but as a percentage of disposable income, the US ceases being an outlier and just sits square on the trendline of countries around the globe. Make of that what you will.
Pierre Lemieux
Dec 26 2024 at 11:28pm
Steve: I would take some time and space to reply to all your experience-based comments, but let me just make a few short points:
Health care in Canada costs less in the sense that individuals don’t see the bills and because Canada is a poorer country. In both this country and the US, public financing of health care is 8% of GDP. (You can make these calculations from Figure 7.3 and 7.11 of the OECD’s Health at a Glance 2019–the issue I have conveniently under my virtual hands, but I would be surprised if a more recent issue showed a very different picture).
The report you quote is not all at the glory of the Canadian government.
When one says something like “we decide what is and is not a right,” one should always say who is “we.” It is problematic except if we is unanimity (unanimity as the only acceptable moral criterion is treated differently but with the same basic economic methodology by Buchanan and de Jasay).
If I am not mistaken (from my experience of some years ago buying private health insurance both before and after Obamacare), prior authorization is only required if you buy PPO or HMO insurance, which has the advantage of costing less (for a reason).
Physicians tend to think that everybody should get as much of their services as they want or “need,” as bloggers, priests, and winemakers do!
Craig
Dec 27 2024 at 8:42am
“Health care in Canada costs less in the sense that individuals don’t see the bills and because Canada is a poorer country. ”
Per capita spending lower? I digress a bit but I wouod suggest comparing prices might be one thing but comparing actual costs might be another. If the good/service is orices such that its not the result of a market process does it really cost less? A doctor is a doxtor, an MRI machine is an MRI machine and the bricks in the hospital have to be laid, the currency unit you might stick next to it could be X or Y but if the government makes up the figure does it accurately reflect the true cost?
Pierre Lemieux
Dec 27 2024 at 1:38pm
Craig: On your first question, health expenditures per capita (H/P) is equal to the proportion of health expenditures over GDP (H/GDP) times GDP per capita (GDP/P).
Your second question is valid. If, like in France and the UK (or one Canadian province), the remuneration of doctors is determined by political (that is, force-based) negotiations between the government and trade unions, the resulting input price (doctors’ wage) does not represent the opportunity cost of doctors, that is, what doctors are worth at the margin to consumers in terms of the other goods or services they could produce. One could say, though, that the distortion is not as bad as if the Minister of Health determined the remuneration based on what his gut (that is, the commander-in-chief’s gut and The People’s gut) tells him who must work as a doctor and who may not.
Jose Pablo
Dec 26 2024 at 11:53am
We should beware of the simplistic argument that the state’s takeover of health insurance and healthcare would solve all problems.
Yes, we should. And simplifications on this issue are aplenty. A good starting point would be assessing the bare facts.
The US healthcare system is extremely frustrating even for healthy clients. I can only imagine how frustrating it should be for individuals with serious medical conditions
This is from anecdotal personal evidence but good private insurance in Europe costs around one-fifth of what it costs in the US. And deductibles are unheard of in the European private insurance market (and copayments are limited to out-of-network treatments)
Again from personal experience, private treatment (paid directly to providers, no insurance involved) costs around 1 tenth (like 10%!!) in Europe.
Private health insurance companies make even more money in the European markets than in the US. A market many of these companies don’t even dare to serve (except, tellingly, through service agreements with domestic insurance companies)
All this is comparing private providers with private providers, leaving alone the state’s provision of medical services (except, and this is not, maybe, a minor issue, for the effects of having the single buyer as a direct competitor of the private providers).
Something definitely smells rotten in the American healthcare system/industry. I haven’t seen so far a comprehensive plausible explanation for this but sure some aspects are relevant:
Doctors are richer than in Europe, but, despite this fact, there are fewer of them (this doesn’t smell like a properly working S-D curve)
The administration is a nightmare. I have seen doctor’s offices with more administrative positions than doctors.
The demand is pretty inelastic, particularly so for serious conditions. And even more so when your insurer is paying for your treatment.
Medical treatment is not a commodity + Costs of treatment are extremely opaque (there are, for instance, huge differences between what you pay as a “private patient” and what your insurance pays for the same treatment … even more, the direction of the difference is unpredictable, can go both ways) + You don’t shop around for medical treatment (like you do for cars or groceries) + there are huge transaction costs (reading your health insurance contract will suck the life out of your veins).
Under these conditions “competition” only gets you that far.
The professional who tells you what you need is the same professional who provides you the service. We have been advised not to ask our barber whether we need a haircut. And yet, we ask our doctors what we need and find ourselves in a very bad position to question their biased position while in pain in the Emergency Room.
Healthcare in the US is a disaster and frustration with it is totally understandable. I am surprised it is not even bigger given that the situation is totally unacceptable. I guess that this is because most people are covered either by their employers or by the government and so they are mostly unaware of the costw of such an awful service and because only a low % of clients do test the real quality of their insurance (for the most part to discover that what is written in their contracts is not even near what they thought it was).
The fact that a single-buyer solution also has problems is very little consolation.
Pierre Lemieux
Dec 26 2024 at 11:44pm
Jose: A small rejoinder on your large comment (where, as usual, much is likely true)… There is a danger, though, of idealizing Europe—where, moreover, there is much diversity. Globetrotters like us may sometimes be victims of that. When I lived in France 25 years ago, the public system (which does not have an insurance monopoly) certainly felt much better than the Canadian system and was certainly simpler than the American system (which, of course, is not perfect, but it is the Swiss model with lots of historical and rent-seeking glitches). And certainly in France, doctors are not rich (I think that data would show this). And, if one follows the news, it has much deteriorated over the years, especially outside of Paris. Just recently, a report of Le Monde reported on the increase of the co-pay to see a doctor and the discontent of the plebs.
Oh! and French public expenditures are 9% of GDP, which may roughly corresponds to the 8% in the US given the difference in GDP levels. (Source: see my previous response to Peter.) That the US public expenditures on health are not the summum of efficiency, we can probably agree on.
Roger McKinney
Dec 26 2024 at 12:30pm
Having worked for a healthcare insurance company as an analyst for 17 years, I have an unusual perspective. Few people understand how messed up the US system is. But none of it is the fault of insurance companies. All the problems people associate with insurance is the fault of government.
No industry is more regulated. The AMA, a union for doctors, has bribed politicians for over a century to restrict the supply of doctors to keep their incomes high. Medicare, Medicaid and employer subsidized insurance create unlimited demand. The results are a disaster.
The Center for Medicare and Medicaid, CMS, doesn’t try to control costs. It surveys annually what doctors charge for thousands of procedures then takes the average and pays that amount. Federal law makes it a crime to charge anyone less than it charges the government. So for safety, insurance companies contract with doctors and hospitals on a percentage of the Medicare price for a procedure. 105% is the minimum so as to not break the law. Many specialists contract for 300% of Medicare. Medicare only sets the base.
Insurance originally paid only for certain hospitalizations. But over decades, interest groups bribed politicians to pass laws forcing companies to cover more things until today there is nothing not covered.
People will be happier under a system like the UK because complaints are driven by envy. Canada and the UK deny ten times the claims that US insurance deny, but people don’t care because they worship their government. They care in the US only because they think someone is profiting from it. People will put up with terrible healthcare as long as the government provides it and will be content.
Matt
Dec 26 2024 at 12:55pm
Christy Ford Chapin’s book Ensuring America’s Health is a good historical overview of the development of the modern U.S. medical system. In the late 1900s and early 20th century, doctors provided charity care to indigents and made up the loss by charging higher fees to wealthy patients. So doctors weren’t “enslaved,” but they weren’t really compensated either. However, doctors couldn’t do much for most ailments, so the overall quantity of medical care provided was pretty low. The historical fiction book …And Ladies of the Club provides a pretty good illustration of the level of medicine provided in the postbellum era.
Chapin’s book is an interesting read. My basic takeaway is that AMA pressure + path dependence created the modern U.S. system rather than sending the U.S. down an NHS-type path. The AMA strongly resisted “corporatization” of health care in the early 20th century (they were apoplectic about the idea the idea that doctors might be mere employees working for a salary rather than maintaining autonomous practices) and did their best to blackball physicians who participated in early economic experiments in doctors’ groups, which were similar to modern HMO/managed care organizations (e.g., by denying hospital admitting privileges to participating physicians). As costs continued to rise, the AMA begrudging allowed the insurance industry to play a role. From there, a combination of path dependence and political wrangling (outrage over continued high costs, continued AMA intransigence, introduction of insurers as a major player, political opposition to socialized medicine) begat the Frankenstein’s Monster system we all know and love.
I see three core issues. First, the incentives of the three major private-sector players (patients, insurance companies, doctors) are hopelessly misaligned. This is probably inherent to any model that separates providers from payors. Second, the continued development of medical science continues to create new medical techniques, and consumers demand the cutting-edge. Third, quackery inevitably begets a political response, which invites regulation of treatment and drugs.
Despite the risk of quackery, I’m mostly in the “free market” camp these days, especially if there’s a way to limit the industry and market power of doctors’ cartels (I’ve been told the modern AMA is active in limiting the national supply of doctors, though I don’t know if that’s true). But the risks to dismantling the structure of a large, complex sector are certainly significant, and I don’t pretend to be an expert on how to get from here to there.
Pierre Lemieux
Dec 27 2024 at 2:10pm
Matt: The Chapin book looks interesting and I just ordered it from the library. Indeed the capture of government by special interests in healthcare production is a central topic. A recent Wall Street Journal (or was it in a Financial Times article?) referred to the federal control of the supply of physicians at the request of the AMA.
I would however correct the second sentence of your penultimate paragraph:
You can see what’s problematic in that by thinking of a statement that would run:
Or
On a free market, it’s difficult to think how misaligned incentives could exist or not be eliminated. They can only persist when they originate in market power maintained by government intervention and government-granted privileges.
John Clark
Dec 26 2024 at 3:32pm
Private insurance works well for things like fire insurance and car accident insurance; many homes survive for centuries without a fire and most cars “die” due to parts wearing out rather than a catastrophic accident.
Thus the insurance pools the risk of this (usually) unlikely event and it does a decent job of it.
With something like healthcare where not only is almost everyone guaranteed to get very ill at some point in their lives, but proper preventative care can minimize the costs and suffering associated with what would otherwise be a catastrophic illness, private insurance as a primary funding mechanism does not make much sense.
Unlike a fire or car insurance company they are almost guaranteed to be forced to pay up for almost every client and the more they deny preventative care, the more cost they create down the road (giving them more incentive to deny that as well).
Pierre Lemieux
Dec 27 2024 at 2:23pm
John: There is something true in what you are saying, but consider the following.
Death is certain but life insurance exists. Maritime insurance is several centuries old, and was invented when the probability of a ship and its cargo sinking was high. Car breakdown is also certain but repair insurance exists in the form of warranties (partial warranties–perhaps that is what you are after). The latter insurance is so much in demand on the market that no car manufacturer offers a lower price instead–although supplementary coverage you can buy at purchase plays this role. The same argument can be made for warranties on many durable goods and even in financial hedging products, which are insurance.
Problems occur when governments impose mandates and prohibitions that prevent producers from offering consumers what they want. If you are not an anarchist, you will find exceptions but note that they are rare or complicated to justify.
Ahmed Fares
Dec 26 2024 at 4:18pm
Pierre Lemieux sees a problem with Canadian healthcare, but then attributes it to the wrong reason. It’s actually unions which are the problem.
Many years ago, we had a shortage of hospital beds here in Alberta. As I recall, the ratio was 8 beds per nurse and Alberta increased its healthcare budget by 5%. Right after they did that, the nurses went on strike and got higher pay as a result. Instead of getting more nurses and by extension more hospital beds, we just ended up with higher-paid nurses.
Recently, Alberta reduced its wait times by using the money saved from outsourcing its in-house unionized laundry services to the private sector, which saved millions and reduced wait times.
It’s always unions.
Craig
Dec 27 2024 at 12:15pm
See something like ibuprofen and one can go to W! and it will be very cheap. I would suggest unions may be an issue but the true core problem of health care is that its nature still largrly defies mass production/econonies of scale; a labor intensive industry focused on the human condition itself.
Pierre Lemieux
Dec 27 2024 at 2:42pm
Craig: Is that right? The healthcare industry is certainly more capital-intensive than, say, life insurance or higher education or religion. (Religion needs churches, which are costly capital goods, but with not much equipment inside. AI bots cannot administer confession.) I hear that complex surgeries–say heart bypass–are done if not on an assembly line, at least just as if. In the US, MRI machines are not often idle. (In Quebec, where there profit incentives in healthcare have been formally eliminated, veterinarians, who are businessmen, discovered that hospital MRI machines were often idle and started hiring them for their furry customers until a furious clamor rose from the human plebs.)
Pierre Lemieux
Dec 27 2024 at 2:26pm
Ahmed: You are right that trade unions are a major problem, which of course comes from labor laws giving special privileges and powers to these organizations. More generally, rent-seeking is the problem.
Craig
Dec 27 2024 at 12:25pm
One problem with health care is that, in general, the more you need of it, usually there is some nexus with you being unable to produce.
Pierre Lemieux
Dec 27 2024 at 2:29pm
Craig: Private disability insurance exists, but one can argue that the maximum payout is relatively easy to fix: few people die older than 120!
Comments are closed.