by Madeleine Kando
Two of my favorite authors are Thomas Sowell and Paul Krugman. They are both economists, but at opposite ends of the political spectrum. Sowell is a conservative, Krugman is a liberal. They have very different opinions on the health care issue and I have had fun imagining them sitting opposite each other arguing this issue. Their conversation might go something like this:
Sowell: How could the government, of all institutions, make health care less expensive and still effective? Other countries have gone that route. It might have made health care cheaper but it is of less quality. One fourth of the people in Canada have to wait 6 months for surgery, 10 weeks for an mri. I cannot think of anything that the government runs more efficiently than the market does.
Krugman: Actually the US health care system is very inefficient and it does not accomplish what it promises to do, i.e. insuring the sick. Health care can’t be marketed like a loaf of bread or TV set. Buying a tv set is a choice but you don’t decide when you’ll get sick. And when you do get sick the cost of treatment can be very high if you want to stay alive. Very few people can afford to pay for a coronary by-pass surgery out of pocket. It’s the difference between buying a tv and buying a small airplane.
Sowell: But what is the first thing that government run health care will accomplish? It will undermine self-rationing. When you pay the full price of going to a doctor, you go there when you have a broken leg but not when you have the sniffles or a minor skin rash. When the government makes health care “affordable,” you go there for sniffles and a minor skin rash.
Krugman: That argument is all wrong. The great bulk of medical expenses are caused by a small number of people who require very expensive treatment, not by people who go to their primary care physician, even if it is just for sniffles. Unlike shopping for a tv set, where you can opt to not buy a big one if your budget doesn’t allow it. You cannot ration a coronary by-pass surgery by saying: ‘oh, I think I’ll just buy half a by-pass surgery. I cannot afford a full one’.
Sowell: The lure of something for nothing may be seductive when you are in good health. But it can become a bitter irony when you are waiting months for surgery to relieve your pain or when your life hangs in the balance while some bureaucrat decides whether you can get the best medication or something older and cheaper. Who do you want to control your health care decisions: you or some government bureaucrat?
Krugman: First of all, we are not talking about government run health care, we are talking about government run insurance. Competition is fine and it will not go away. Many countries have universal health care without everything being run by the government. And to answer your second argument: right now it is not you who makes the decisions, it is the insurance company and they are trying their darndest to NOT cover you.
Krugman: But let me ask YOU a question, Mr. Sowell. What do YOU propose to do? You say you didn’t have insurance when you were young, and paid everything out of pocket. Would you go without insurance now, at a later stage in your life? Aren’t you grateful for Medicare? It seems to me that you are denying reality at all costs in the service of an ideology.
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Tuesday, October 6, 2009
by Madeleine Kando