health care mandate

Well, at least we can agree that "Beer is here now, and it is good." If I'm reading you right, we also agree that an efficient system is paramount and that 'fairness' is, at best, a secondary objective. We simply don't see eye to eye on whether an uncompromisingly free market healthcare system will maximize aggregate utility.

My list of impediments to efficient markets was not intended to be comprehensive nor directly applicable to the healthcare debate. Rather, I meant to start slow and see if we could reach consensus on the fact that laissez-faire capitalism doesn't work flawlessly in every scenario. It sounds as if you agree with that truism but don't see sufficient distortion in the healthcare market to justify alternative solutions.

It's difficult to refute your hypothesis when there is little empirical data available with regards to privatized healthcare. In reality, the closest thing to your notion of an ideal solution is the United States, which we both agree is a disaster. The status quo in the US is inferior to existing socialized systems but you can argue that we're at some sort of local minimum. Perhaps further reduction of entitlements and government regulation will eventually make things better. You'd assert that a graph representing government interference on the x-axis and efficiency on the y-axis would look something like a Nike Swoosh.

There are pros and cons to privatization but assigning precise weights to each is an exercise in futility. The best I can do is enumerate some reasons why I don't think it'd work. Before getting to that, though, I'd like to more thoroughly examine your critique of my slapdash list of efficient market inhibitors:

I believe in the free market, that's why I believe it will yield better results. I am totally convinced that government regulations are based on corporate favoritism. Don't give the politicians the power in the first place. A monopoly cannot exist without government intervention (paraphrased Rand).

Externalities I believe are solved in the free market.
Asymetric information same thing, especially considering the internet's existence.
Barriers to entry are not possible in a free market.
Price inelasticity indicates either there are no other alternative industries or there is a monopoly taking place. If there is no monopoly and alternative industries, there will be incentive to offer a cheaper product. (This is how I understand price inelasticity, though I could be wrong).
Oligopoly, again, free market would allow another competitor to break it up...
Irrational actors, irrelevant in a free market...

I believe that most of the sentences excerpted from your reply are objectively incorrect. Monopolies (and oligopolies) can exist without government intervention. In fact, antitrust regulation is often the only antidote to such situations. The negative effects of externalities can be ameliorated via market incentives but efficient enforcement is nontrivial. Information asymmetry is not automagically solved by the market. Barriers to entry are entirely possible in a free market. Price inelasticity refers to the relative immutability of demand in the face of changing prices.

Your failure to perform basic research before dismissing each of these points illustrates a problem endemic to both the Libertarian and Republican communities. Your arguments are tailored to the lowest common denominator of the liberal collective and you've little incentive to go any deeper.

Why sweat the details? After all, time-constrained debates are 'won' by proffering ideas whose flaws are too subtle to be explored in a concise fashion. The Bill O'Reillys, Sean Hannities and Ayn Rands of the world offer talking points that are just complex enough to make us feel good about rejecting more simplistic alternatives. "Oh, those naive lib'ruls think that everyone should get a free pony. When will they learn that wealth creators need to be properly incentivized? Don't they understand the power of the Invisible Hand?" While there are plenty of entitled, lazy and/or idealist liberals, there are also pragmatists who believe in the free market but are interested in probing the limits of its effectiveness under various scenarios. Until freepers get serious about engaging this more realistic subset of progressives, debate will continue to stagnate.

It's just too burdensome to go into explicit detail about all the potential failings of deregulated healthcare so allow me to focus on your claim that "irrational actors [are] irrelevant in a free market." I pick this misconception because it neatly illustrates how right wing policy is naked venality masquerading as pragmatism. Rational market participants may not be adversely affected by irrational actors. In fact, the rationalists may even benefit from the existence of their irrational foils. However, a free market surely isn't such a great deal from the perspective of the irrational actors themselves. Saying "Irrational actors, irrelevant in a free market..." certainly sounds a lot better than "persons not smart enough to make good decisions are irrelevant to me because I don't give a shit about them."

In a free market, irrational actors will consistently achieve deficient returns on investment. At the macro level, this is clearly a suboptimal state of affairs. I concede that the system is self-correcting to some extent: many of these silly folk will eventually smarten up or "exit the market". Will some measure of the dreaded "central planning" degrade efficiency even further? I'm not so sure.

Right off the bat we see that laissez-faire capitalism doesn't work well from the perspective an irrational actor. People who act stupidly might be better off delegating resource allocation to some entity more intelligent, specialized and focused than themselves. Free market advocates see such inefficiencies as acceptable losses. I wonder what percentage of the population you're prepared to write off as collateral damage?

Question: What do you do about markets in which a substantial fraction of participants act irrationally? Answer: When everything goes to hell, you'll say "I made a mistake in presuming that the self-interests of ... [market participants] ... were such that they were best capable of protecting their own" welfare. Every time the grand Libertarian vision of massive deregulation goes awry, it's the same story. As you stand among the charred ruins, you'll sulk about the underlying correctness of your theories and how a slight tweaking of market incentives could've prevented the entire fiasco.

Let's look at the concept of irrational consumers in the context of a privatized healthcare system. The most ubiquitous mistakes would be a failure to purchase insurance or shell out (co-)payment for preventative care. In general, people of modest means will not fall into these traps. Most humans are risk-averse and we'll extract more value from an insurance policy than we are forced to pay for it. Good deal!

For a less wealthy person, however, it's not such an easy decision. Perhaps proper healthcare would force some poor schmoe to forgo getting cable television. Especially in an "entitlements-free" society, any rational person ought to recognize that healthcare is more important than cable, smart phones or other trivialities. Proper healthcare might well be more important than nutritious food or a car. Unfortunately, people cannot be relied upon to act rationally. In this case, many will do the wrong thing and skimp on healthcare with catastrophic results. It's easy to say "not my problem" and blame the victim for being stupid. The issue with that is that nearly everyone is predictably irrational in certain situations. The poor are not necessarily any worse decision makers than the rest of us, they're just subjected to harsher circumstances. You and I don't need to prioritize so much: we'll purchase cable television, a smart phone, a cars and healthcare.

A large fraction of the US population is neither intelligent, industrious nor lucky enough to be born into wealth. You might think that they deserve to be marginalized but disregard them at your own peril. It is my belief that, if we allow a sufficient number of people to fall into destitution, the rest of us will be made to suffer indirectly. Not only does a social safety net help care for those who cannot care for themselves; it also protects the remainder of the population from crime and the general unpleasantness of constant exposure to masses of wretched lepers. Given (a) the law of diminishing returns and (b) the vicious cyclical nature of poverty, ignorance and crime; it's well worth it to lend a helping hand to the country's most vulnerable demographic. If not for them, do it for yourself.

Lest you claim that irrational behavior is a rare thing, explain the popularity of payday loans, lottery tickets, "rent to own", 'balloon' mortgages, etc. When left to their own devices, large quantities of people regularly do really stupid things. I'm all for letting them make their own mistakes for the most part. It's just more practical to curb the most excessively destructive behavior through regulation rather than watch the world burn for the sake of principle. Should we rescind limits on credit card interest rates? Allow the sale of tainted meat at a discount? Permit unlicensed medical practitioners to perform surgery (so long as they properly disclose their lack of credentials)? Let people use their organs as collateral at the casino? Taken to its logical conclusion, a world reliant solely upon personal responsibility to deter bad decisions would be a pretty bleak place.

IMHO, the reason that many right-wingers don't care about any of this is because they [believe that they] stand to gain personally. Deregulation often benefits those at the top to the detriment of the country as a whole. The deal gets even sweeter if they can ease their conscience with half-hearted claims about enlightened self-interest. If I ever get rich, maybe I'll go Republican myself. I'm just not sure how much cognitive dissonance I can bear.

Anyways, I promised a more rigorous list of reasons that universal healthcare is for the best. I need to wrap this up so here's a few off the top of my head:

• single payer system does not necessarily eliminate competition
  
• expensive and/or "end of life" treatment can remain privatized
  
• successful universal healthcare systems abound; there are zero successful free
  market healthcare systems
  
• like basic education, healthcare is something that pretty much everybody wants
  
• wasteful bureaucracy slashed
  
• sidestep debate on how to treat incapacitated patients or children
  
• catch problems before they become serious
  
• prevent emergency room treatment for routine problems
  
• this is getting tiresome; just google "merits of universal healthcare" or check out cthealth.server101.com/the_case_for_universal_health_care_in_the_united_states.htm

Incidentally, I didn't mean to suggest that the repeal of Prohibition proves that citizens won't let things get too bad. I merely assert that the Constitution is not the only fail-safe against infringement of liberty; a cascading failure of multiple safeguards is possible but somewhat less likely. In my opinion, there is no system of government that can succeed in the face of an ignorant and apathetic constituency. You're kidding yourself if you think that an objectivist society would be all sunshine and lollipops. What we really need is better education and a more responsible media. Politicians wouldn't be bought so cheaply if corruption were actually punished at the polls. Maybe we should consider ending the "winner take all" two-party system as well. In the near term, ain't none of that gonna happen. I reckon that we're due for some hard times before we get serious about changing anything.

Sorry for the confusion. I ran with what I thought was your metaphor. I forgot or missed entirely the part about broccoli consumption in the article. I thought you were just picking out the grossest food you could think of and applying it ("absurdist extrapolations"). Do I think the government will do this, no, it seems they are trying to scare us away from vegetables if anything, but ration coupons were issued during the depression and right now a lot of people already depend on the government for food. I was more addressing the dependence of the population on government for survival.

I disagree that dystopian extrapolations are worthless, and I absolutely disagree that repealing the Volstead Act is proof that we the citizens won't let it get that bad.

-Medicare/Medicaid/Social Security - $50 trillion guaranteed
-Patriot Act

Those are two big ones, no? If the federal government says "you can't drink beer today or any other day past yesterday" you think about it. If they say they're going to slowly bankrupt itself while at the same time removing civil liberties craftily from the constitution, ultimately forcing the burden of it's gargantuan debt on the taxpayer, and limiting their ability to get out from it in any way, and then disguise that language in a "help for those who can't help themselves" compulsory program for health care and retirement...you don't think about it. The consequences, if you even bother to think about them, are a hundred years away. Beer is here now, and it is good.

I believe in the free market, that's why I believe it will yield better results. I am totally convinced that government regulations are based on corporate favoritism. Don't give the politicians the power in the first place. A monopoly cannot exist without government intervention (paraphrased Rand).

Externalities I believe are solved in the free market.
Asymetric information same thing, especially considering the internet's existence.
Barriers to entry are not possible in a free market.
Price inelasticity indicates either there are no other alternative industries or there is a monopoly taking place. If there is no monopoly and alternative industries, there will be incentive to offer a cheaper product. (This is how I understand price inelasticity, though I could be wrong).
Oligopoly, again, free market would allow another competitor to break it up...
Irrational actors, irrelevant in a free market...

Sorry gotta wrap this up real quick, yes I am not a fan of the epa, end the fda, privatize schools, fire and police are for another topic as this is one libertarians have difficulty agreeing upon... seems there may be some "mob" rule with competing agencies...

I'm genuinely confused as to whether you're mocking my ramblings on the subject of broccoli. Are you being sarcastic? Speaking metaphorically? Do you actually think that broccoli offers the most calories per dollar and that we'll be forced to eat it after an economic collapse? I'm having trouble extracting coherence from the first two paragraphs of your reply.

I don't think that mandatory dietary restrictions will ever happen, regardless of whether the government has the constitutional authority to implement them. My point was that the Constitution is not the only thing protecting us from government overreach. I only brought it up because this absurd nightmare scenario is directly cited in the article. I'm not sure what you're getting at with the regards to Prohibition. That dark episode seems to support my thesis: government programs come and go and our democratic process allows for an orderly repeal of unpopular legislation. Compromising liberty for the sake of convenience is not something that should be taken lightly but it happens all the time in any functional society. The Volstead Act clearly illustrates the worthlessness of dystopian extrapolations; we tried banning alcohol and subsequently gave up on the idea (long before 1984).

I agree that "bankrupting a nation and enslaving it's people via entitlement programs" sucks worse than "turn[ing] people away for health care they can't afford" but that seems like a bit of a false dichotomy. It's reasonably likely that our nation is headed for default and/or austerity and that entitlement programs bear much of the blame for this. That being said, isn't "we're doing it wrong" just as valid an explanation as "we shouldn't be doing it at all"? What makes you so confident that complete privatization will yield superior results?

Market forces are just something that society leverages in order to achieve optimal resource allocation. It's a useful tool but not the only one at our disposal. According to utility theory, free market principles are only efficient when certain criteria are met. Externalities, asymmetric information, barriers to entry, price inelasticity, oligopoly, irrational actors and many other factors render it inappropriate for certain markets. I tend to accept this tenet as indisputable but suppose I can't take anything for granted without knowing how much Kool-Aid you've consumed. Do you agree that a substantive government should exist in any form or should we just have "one guy who sits in a small room at a desk, and the only thing he's allowed to decide is who to nuke."? Are you one of those guys who argue for the privatization of the EPA, FDA, police/fire department, K-12 education, etc.?

If you agree that we should aim for a system that provides the best care at the lowest aggregate cost, it's hard to see how an "every man for himself" attitude makes any sense. Other countries (both poor and wealthy) have managed to implement universal healthcare and have far outperformed the US in both [average] cost and quality of care. Can you point to any Libertarian success stories? Preventative care and early treatment drastically reduce the overall cost of treating many health issues. Unfortunately, when left to their own devices, a large fraction of the population will let problems fester rather than shell out a few bucks for preemptive care. For the same reason that they buy lottery tickets and don't save for retirement, idiots will forgo health insurance. Perhaps a selfish person could say "not my problem" but even that argument doesn't hold water. Never mind infectious disease: desperate people do desperate things and that works out badly for everyone. There's an argument to be made for refusing expensive treatment for which a frank cost/benefit analysis is required. It just doesn't seem wise to limit access to low cost, high impact assistance.

yes, I think with the collapse of our economy it will be very likely the gov't will mandate broccoli consumption. people will eat even broccoli if they have no other source of food.

the people are what stop it. prohibition was repealed, and that was just alcohol. alcohol!

it sucks to turn people away for health care they can't afford, but what sucks much worse is bankrupting a nation and enslaving it's people via entitlement programs. all these arguments for health care are predicated on the US being "the wealthiest nation in the world", not having trillions of dollars of debt looming quite closely over their heads. hopefully we've all gotten past this inaccurate portrayal by now.

I'm not clear on whether you're suggesting that Obamacare is (a) worse than the status quo, (b) worse than some hypothetical "free market" solution or (c) all of the above. I'll go ahead and assume that you think the government should remain completely uninvolved in healthcare. Your "slippery slope" argument is straightforward enough and seems to be a knee-jerk Libertarian response to just about everything. I concede that where to draw the line with respect to government overreach is rather arbitrary.

IMHO, you can't just shoot down every idea on the basis of absurdist extrapolations. Obviously, the "where does it end?" argument suggests that the government might mandate broccoli consumption. Do you really expect that to happen? We still have checks and balances to protect us from extremists. All other things being equal, I too prefer elegant solutions. Unfortunately, they don't always work.

I reject the notion that nothing can be objectively right or wrong unless the division between the two is rigidly defined. I believe that gray areas can exist without encompassing the entire spectrum of possibility. If the government can set the age of consent at 18, what's to stop them from raising it to 35? If DUI laws kick in at 0.08 BAC, what's to stop big brother from lowering it to 0.001? We can play this game all day and abolish government completely but I don't think you'll like where it ends.

I recognize that existing healthcare legislation is deeply flawed. Also, I didn't mean to suggest that a free market solution is what we have now. Rather, I'm saying that Obamacare brings us a step closer to a sensible (i.e. single payer) system with better cost controls and superior outcomes. I further assert that a completely laissez faire solution must permit refusal of care to the poor/uninsured or force the taxpayer to foot the bill. Each of these options sucks in its own unique way. Which do you support?

we don't currently have a "free market" in the health care industry. It seems like you indicated that we do in your last paragraph, and that's how we got to "double the cost" for worse health care (liberals love that line). As far as protecting people from their own detrimental decisions, it's something you cannot do without a totalitarian society. "We need laws that protect them from their own myopia." This reasoning justifies total infringement on every freedom you are afforded by the constitution. Your health care, your food, your money, everything you are able to do with your life will be by the grace of government. As our money becomes worth less and we hit financial crisis after crisis based on these standards we believe should be provided by government, we will be slaves to the system we demand for ourselves. The more everyone is crippled by their excessively large government's decisions, the more they will be dependent on it to survive, and will continue to vote against their best interest.

Unless we're seriously willing to deny care to anyone for whom there is no reasonable expectation of an ability to pay, there's no denying that the healthcare market is 'unique'. That this inconvenient truth leads to poorly defined boundaries of federal authority is unfortunate. "Rule of Law" trumps all so maybe mandates should be ruled unconstitutional. IANAL but I certainly hope that the Obama administration can find some way to make it work.

Setting aside the legality of it all, I'm baffled by the strident opposition to Obamacare (is that term derogatory?) on ideological grounds. Are people really willing to chant "personal responsibility, market forces and freedom" and just step over wretched fools suffering from easily curable maladies? Alternatively, are we willing to let the taxpayer foot the bill for all the poor idiots that lacked the foresight to purchase insurance? Are we ok with a system that costs twice as much in exchange for lesser results as compared to the rest of the world?

I've plenty of issues with the new healthcare legislation but[, with a few minor adjustments,] it seems like an improvement over the status quo. The idealist in me hates compromising the elegance of a free market solution. As a pragmatist, though, I recognize that human beings act irrationally. Left to their own devices, many people won't adequately prepare for injury, old age or other predictable problems. We need laws that protect them from their own myopia. Call it a "nanny state" if you will but such models have worked well for every other industrialized nation in the world. Is it more important to have a functional government or to avoid a 'messy' one?