POLICY: Not Too High on The Hog

My, hopefully, final reply to the “we spend more because we do it better” argument from the free-marketeers is up over at Spot-on, called Not Too High on The Hog—a reply to David Hogberg. As ever come back here to comment.

I have my research, analysis and data. And the free marketeers, like David Hogberg, have theirs. Jonathan Cohn, whom I defended from another free-marketeer David Gratzer a few weeks ago here, has his views–belief in the need for what’s called a single-payer system–most of which I agree with. And Hogberg, who recently responded to the rhetorical questions I asked of the free-marketeers in the American Spectator, has his.The free health care market crowd claim that, compared to other nations, Americans are buying better care with all the extra money spent on doctors and hospitals and medicines and care. I say that the differences between care in different nations are a wash and are basically dependent on cultural factors anyway. So the important point is the consequence of spending all that money, and who’s suffering because of the way that we spend it. More

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  1. Barry,
    Don’t forget the other end of the age spectrum – the very small. Enormous amounts are spent on infants at the frontier of viability. For many of them (about two thirds, as I recall without Google help), this begins a lifetime of very expensive care for their huge disabilities. And many, perhaps most, of these dollars come from the government: low birth weight correlates with economic status (translation = Medicaid). I see this all the time and wonder what we can or should do about it. I cringe at quality-of-life criteria for making these kinds of decisions for people of any age, but it’s hard for me to imagine any other yard stick. Personal choice is important, but as you point out, it matters very much who is paying for those choices.

  2. So long as our culture implicitly believes that being poor is the result of a character flaw or moral failing, and therefore poor people don’t deserve care if they can’t afford it, then I have no problem deciding that someone has lived long enough. After all, those “free market” types believe that obviously poor people have certainly done so and should die now and reduce the surplus population.
    “Their own resources?” NO ONE can directly afford the cost of heroic end-if-life care except for the disgustingly rich. I guess that just proves everyone’s point, right? The poor, no matter how hard working, no matter how honest, no matter how much they sacrifice for their children or their elders, don’t deserve anything and should die, and the rich are obviously, by dint of their own “success,” blessed by God and therefore should get whatever they want no matter how pointless.
    This is the state of our culture. It is cruel and thoughtless and, ironically, Darwinian in that only the most vile, detestable sort of behavior is rewarded with even the simplest of common human decency.

  3. Matthew,
    Good article. I wonder if you are aware of any studies that quantify how much the U.S. spends on the “nearly dead” as a percentage of GDP compared to similar spending in other countries. Failing that, I would be interested in your “guesstimate” if you have one. I have seen estimates in Health Affairs stating that total medical spending (including out-of-pocket payments) by and on behalf of the 65 and older population accounts for about half of total healthcare spending in the U.S. I have not seen comparable data for other countries.
    Eric – People should be able to spend their own resources any way they like including for heroic care at the end of life for themselves, family members or relatives. I feel differently (and strongly) when taxpayers are footing the bill.

  4. Matthew-
    Who should decide if any money gets spent on anyone’s 93 year old grandparent?
    Who should determine whether you should be able to spend any of your money provide any care for your elderly relative or friend?
    The problem with your theory is that necessarily a disinterested group will control whether you or your family or friend can get any care of any kind.
    And while Oakland’s owners appear to be getting a better deal for the money… NY has gone to the playoffs 11 years in a row and has 4 championships…
    Oh- you mean that there can be reasonable, yet wholly different measures of ‘successful’ outcomes?
    And do not forget our friends here in AZ, the Bidwell family– they have been unable/ unwilling to field a competittive team– essentially forever– yet expect fans to pay more and more each year to come out and support them.