Politics debate continued from multiculturalism thread

[Drogue]

Since the debate on socialism/communism/healthcare/monopolies managed to take aneeshm's thread off topic, I've carried it on here.

Originally posted by Ned
All monopolies are bad.

Have you studied economics? Do you have any idea what you're saying? All monopolies are not bad. The vast majority of monopolies are inefficient, although it is possible for a perfectly discriminating monopolist to be efficient, but more importantly the vast majority of competitive markets are also inefficient.

Now, as a tendency, you would be right, monopolies tend to be more inefficient than competitive markets. But there are many counter-examples called 'natural monopolies'. A good example are gas pipelines - it would be ludicrous to have many gas pipelines going to every single house just to allow competition, as it's multiplying the work.

This can also occur when there are 'network externalities', situations where it matters more that everyone uses the same product than that everyone uses the best product. Operating systems are an example here, where you want to be using the system that the most applications are made for, that is most compatable with others. This explains how Microsoft, with a generally-regarded inferior product, can dominate the market, simply because it already dominates it. It also works for mobile phone operators when it's cheaper to call someone on the same network than cross-network - it leads to people wanting to all be on the same network.

Lastly, this can occur simply when being a big company means you can do things cheaper. Supermarkets like Wal-Mart can undercut others because they can use more efficient means of transport, central warehousing, and various other management techniques that are more efficient than small shops.

Guess what? Healthcare is a prime example of the last of these examples. There is a tremendous benefit to having a centralised blood-bank, especially for rare blood types. There's benefit from being able to put in bulk orders for expensive machines, or anything with high R&D costs, as that greatly reduces the unit price. There's huge benefit from having a huge pool of resources - if a specialist doctor is at another hospital, a patient can be sent there rather than being treated by doctors who do not specialise in that particular condition. There's benefit from logistics of a central paramedic and ambulance service.

Healthcare will always be a monopoly, because it doesn't make sense to have it any other way. Can you imagine the inefficiency of having two ambulance services, neither of which works particularly well? Can you make a choice when you're unconscious? Would you accept having a heart-bypass operation from a doctor who specialises in a different type of surgery because the heart-bypass surgeon worked for a different company?

All monopolies are not bad, some are necessary. The difference between us is that I believe that if having a monopoly is the only solution, it is better to have it state-run so that it doesn't reduce output to increase profit; whereas you believe that it should be a private monopoly. Now, there is a good debate about the pros and cons of each, and I accept there is no perfect answer to whether or not it should be state-run. But that's a question of economics - what provides the best service for the least cost - and not of whether or not the person suggesting it is a liberal or a socialist.

[DRoseDARs]

Personally, I have to agree with aneeshm about monopolies, except the original is still a good game. It's all the rehashes and remakes and re-envisionings that suck.

[Arrian]

The thing is, if everyone could just cool their ideological jets for a little while, since the USA does it one way (private insurance + medicare/medicaid) and Canada and many European countries do it another way (socialized medicine) we should be able to study (in theory, dispassionately) the pros and cons of each, by gathering data from each set of customers - the public in each country - regarding their health needs and how they were met by the various systems.

But of course that would be far too easy. Instead, we should listen to politicians make ideologically-based arguments full of Truthiness.

-Arrian

[lord of the mark]

theres some confusion here, I think, not only about the left, but about the European right. Its absolutely not true, IIUC, that there are NO Europeans who share a "Republican economic ideology" There are some. Confusingly they are called "liberals" or "neo-liberals" and at least on the continent, they make up only a minority of the right, the majority of whom are Christian Democrats, who support a welfare state, but from generally a Catholic social ideology POV, rather than even a light pink socialist one. And even in Britain, where "dry tories" are rather more numerous than on the continent they have to face political reality. I doubt Maggie Thatcher like the national health service any better than most Republicans, or even national health insurance. But its already in place, part of the british scene - sometimes institutions have a certain "stare decisis", a social inertia that makes them hard to change. In general the US republicans have been far more successful at stoping new social programs than at reversing existing ones - in UK there is simply a larger base of existing ones.

Am i incorrect in the above?

[Ned]

Droque, you speak as information availability justified state monopolies in health care, for example.

I would just like to say that most doctors prefer to work in the US than in an socialized medicine country. Most drug companies make their profits in the US that allows them to conduct research in the first instance. And, where possible, the sick of the world prefer health care in the US than anywhere else in the world -- all for a reason.

[Drogue]

Originally posted by DRoseDARs
Personally, I have to agree with aneeshm about monopolies, except the original is still a good game. It's all the rehashes and remakes and re-envisionings that suck.

You do realise you just agreed with Ned, not aneeshm

Originally posted by lord of the mark
theres some confusion here, I think, not only about the left, but about the European right. Its absolutely not true, IIUC, that there are NO Europeans who share a "Republican economic ideology" There are some. Confusingly they are called "liberals" or "neo-liberals" and at least on the continent, they make up only a minority of the right, the majority of whom are Christian Democrats, who support a welfare state, but from generally a Catholic social ideology POV, rather than even a light pink socialist one. And even in Britain, where "dry tories" are rather more numerous than on the continent they have to face political reality. I doubt Maggie Thatcher like the national health service any better than most Republicans, or even national health insurance. But its already in place, part of the british scene - sometimes institutions have a certain "stare decisis", a social inertia that makes them hard to change. In general the US republicans have been far more successful at stoping new social programs than at reversing existing ones - in UK there is simply a larger base of existing ones.

Am i incorrect in the above?

Relatively so. There is a good base of economic conservatives in the UK who believe in small government and individual choice. They tend to believe in traditional family values too, so a Christian Democrat position too. Some of these I'm sure would like to remove the NHS, however most don't, because to most people, healthcare is an anomoly.

In most public services there's a debate between efficiency and equity. Take education - it's more efficient (in many senses) to have it privatised, however it would be inequitable. So some people want it privatised and some want it state-run, depending on which side of the fence they fall on. On healthcare, efficiency tends to fall on the same side as equity, the state-run angle. Now this isn't clear-cut at all, there's still a lot of debate, but it's worth looking at how little the US gets for the huge extra amount it spends on per capita healthcare each year.

So we do have Republican-like politicians, it's just for healthcare, they make an exception. I don't know too much about the rest of Europe, but I'm not aware of much Republican-like policies or parties doing well, it's more, as you say, about Christian Democrats vs Social Democrats.

[Ned]

And, btw, I am no fan of Microsoft's monopoly becuase it has used its power abusively.

[lord of the mark]

Originally posted by Drogue

You do realise you just agreed with Ned, not aneeshm


Relatively so. There is a good base of economic conservatives in the UK who believe in small government and individual choice. They tend to believe in traditional family values too, so a Christian Democrat position too. Some of these I'm sure would like to remove the NHS, however most don't, because to most people, healthcare is an anomoly.

In most public services there's a debate between efficiency and equity. Take education - it's more efficient (in many senses) to have it privatised, however it would be inequitable. So some people want it privatised and some want it state-run, depending on which side of the fence they fall on. On healthcare, efficiency tends to fall on the same side as equity, the state-run angle. Now this isn't clear-cut at all, there's still a lot of debate, but it's worth looking at how little the US gets for the huge extra amount it spends on per capita healthcare each year.

So we do have Republican-like politicians, it's just for healthcare, they make an exception. I don't know too much about the rest of Europe, but I'm not aware of much Republican-like policies or parties doing well, it's more, as you say, about Christian Democrats vs Social Democrats.

cmon, are you saying Maggie Thatcher wouldnt have opposed the NHS if it were proposed in a US like environment? My sense was she accepted that it was there, and it would take an impossible amount of political capital to recreate private health care, but that she certainly didnt accept it as an anomaly.

Certainly some enthusiastic Brit Thatcherites whove come over here (Im thinking of Andrew Sullivan) are not supporters of national health insurance here.

[Arrian]

And, where possible, the sick of the world prefer health care in the US than anywhere else in the world -- all for a reason.

The counterpoint, of course, is that the vast majority of the sick people of the world cannot afford US healthcare.

-Arrian

[Drogue]

Originally posted by Ned
Droque, you speak as information availability justified state monopolies in health care, for example.

Not quite, you already have a monopoly in the US due to the problems of competition in healthcare. I believe it should be state-run due to incentives.

Originally posted by Ned
I would just like to say that most doctors prefer to work in the US than in an socialized medicine country.
Firstly, perhaps because of other reasons (most people prefer to work in the US regardless of profession, and would still if you have state-run healthcare system).

But secondly, says who? Any evidence for that? Plus there's the pay issue - US doctors earn more. However we still have plenty of them here, so much that they have to ration medicine places at university because too many people want to become a doctor.

Originally posted by Ned
Most drug companies make their profits in the US that allows them to conduct research in the first instance.

That's exactly the problem. US healthcare is ridiciously expensive. You pay far, far more both per capita and as a percentage of GDP than anywhere else and yet the WHO rates it as the 15th best healthcare system in the world. You spend 15% of your GDP on healthcare, whereas Europe is like 6-10% or so, and are ranked better. There's very, very good evidence and studies (mostly American, incidentally) that show that a state-funded healthcare system operate sat lower costs than an insurance funded system for a given quality of care.

Originally posted by Ned
And, where possible, the sick of the world prefer health care in the US than anywhere else in the world

How many people do you know from developed countries come to the US for healthcare? I'm not aware of it happening much at all. Those from developing countries, who can afford it, go to the US because Western Europe doesn't open it's healthcare to non-residents. You can't go to a hospital in the UK and pay for it. That's why people choose the US.

US healthcare is consistently ranked as lower than the majority of Western Europe's, and yet costs a lot more. As an economist, it's quite easy to see why - you have an inefficient system that costs an awful lot of money.


Ned: If you're interested in the issue, here is a US written report called The U.S. Health Care System: Best in the World, or Just the Most Expensive. Succinct and covers the points quite well.

[Drogue]

Originally posted by lord of the mark
cmon, are you saying Maggie Thatcher wouldnt have opposed the NHS if it were proposed in a US like environment? My sense was she accepted that it was there, and it would take an impossible amount of political capital to recreate private health care, but that she certainly didnt accept it as an anomaly.

Well, Thatcher was no economist, but I'm not sure. Most who actually know about the issue would be for it - see the report above comparing the US healthcare system to the rest of the developed world.

[Arrian]

Assuming, of course, that one accepts/agrees with the basis for what the report considered to be good/better healthcare.

I honestly don't know what their definition of ideal healthcare was, but I could certainly imagine someone having a different opinion as to what constituted ideal health care, and thus disagreeing with the report.

-Arrian

[Dauphin]

Originally posted by Ned
I would just like to say that most doctors prefer to work in the US than in an socialized medicine country.

One of my best mates is a doctor at a major London hospital, he also worked in Atlanta for a year on an exchange. His parents are both GPs and a whole load of his friends are doctors (many of whom also did a US exchange). The group consensus appears to be that if they were to leave the UK, they would go to Australia, and no way in hell would they want to go to the US.

But I accept that this might be considered merely anecdotal.

[Ned]

US Heathcare ranked lower? On what measure? Quality? Quantity? Or some other, less obvious, socialist criteria such equality of service or access or whatever.

Doctors make more here because we have private medicine.

The better doctors make more than others.

The better hospitals and clinics charge more than others.

People choose doctors here. If they don't like the doctor or the service they get, they have choices.

The poor have access to medicine, better access in many cases than the middle class.

You cannot deny that in many, if not most of the socialized medicine countries, healthcare is rationed one way or another.

You cannot deny that without the US providing a source of profit, the pace of development of medicine and drugs would slow to a trickle or stop entirely.

The socialized medicine countries rely on the US for advancement of the science of medicine. You take profit out of anything, and you get nothing. Money moves on. You provide free markets, you get amazing progress, amazing service, and a satisfied client.

[Ned]

Originally posted by Dauphin


One of my best mates is a doctor at a major London hospital, he also worked in Atlanta for a year on an exchange. His parents are both GPs and a whole load of his friends are doctors (many of whom also did a US exchange). The group consensus appears to be that if they were to leave the UK, they would go to Australia, and no way in hell would they want to go to the US.

But I accept that this might be considered merely anecdotal.

There is a reason some white bread Brit might want to avoid our "multi-cultural" US cities.