[Martin Taylor 2007.07.15.12.45]
[From Rick Marken (2007.07.09.0950)]
Richard Kennaway writes:
>Rick Marken (2007.07.09.0930)]
Here's a remarkable quote that was in Paul Krugman's column today:
"We have always known that heedless self-interest was bad morals; we
know now that it is bad economics." F.D.R. in 1937
I guess "we" stopped knowing that at some point. I'd say in the early 1980s.
Argument from authority?
No. Just an interesting historical observation. I personally agree
with FDR's sentiments; heedless self-interest is immoral from my point
of view. I wish more people felt that way too but there is certainly
no way to convince people of that if they don't want to set that
reference on their own. I think there is also data that shows that
heedless self interest is, indeed, bad economics. But that depends on
what one considers bad economics. Krugman quoted FDR in the context of
the single payer health care issue. The data shows that single payer
systems (which Krugman and I see as oriented toward wise common rather
than heedless self interest) produce much better outcomes for far less
than a private insurance system. That seems like good economics to me.
But it might seem like bad economics to private insurers for whom good
economics is huge profits.
The following isn't PCT, but offers two bits of evidence on the so-called health care problem. (I say so-called, because the argument seems to have been an ideological one about who pays rather than a data-driven one about what leads to good public health). Marken [2007.07.05.1020] said:
If you have data on a system that works better than single payer (in
terms of the variables that matter to me: cost and outcomes) then
that would be great. I'd love to hear about it. I'm more interested
in implementing what works rather than what is _supposed_ to work
based on some theory or ideology.
1.There was an article in "American Scientist" that looked at the relation between health care costs, income disparity, and public health outcome (Clyde Hertzman, Health and Human Society, American Scientist v89, Nov-Dec 2001, pp 538-545). The study suggested that there is effectively zero correlation between cost and outcome (paying more neither helps nor hurts), but there's a fairly strong relationship between income disparity and public health -- more disparity, worse life expectancy and worse child mortality. It includes a fairly dramatic graph showing the relation between mortality rates and the share of income obtained by the poorest 50% of the population across American states and Canadian provinces. The graph suggests that the difference in public health performance in Canada and the US can be attributed almost entirely to the greater income disparity in much of the US, not to the manner of paying for health care. (Or, since correlation can't show causation, that there is a a common factor influencing both mortality and income disparity). There were also graphs showing some data for different countries, but that was less helpful.
2. After reading that article, I created a little spreadsheet from the CIA World Factbook, in which I related per capita income, GINI index of income disparity, and health care outcome (defined in terms of child mortality and expected life span). I wanted to see whether the study's relationships held over a wider range of societies.
My result was that over a rich enough range of per capita income (if I remember rightly, the cut-off was somewhere around 1/4 to 1/3 of US per captia income), average income had no relation to public health, but for lower incomes, it did (agreeing with Hertzman). At all income levels the Gini index did affect the outcome. Taking our both of those effects left a residual variation, which identified some countries as having better public health than one might expect from their income average and oncome disparity index.
I don't have the spreadsheet. It was a lot of work to create, and one of my attempts at using a "sort" command destroyed the inter-relationships among the columns in a way I could not easily recover. So I have to go from memory. What I do remember was that Canada was neither good nor bad; it lay more or less where one would expect from the two indices.
By a substantial margin, the best country for health after allowing for income level and income disparity was Cuba, and the worst were the former Soviet republics of central Asia. The US was not much better than those republics, so it's not a question of the political system. Neither do I think it's a question of the unreliability of data in the World Factbook.
What is clear is that if you don't want to pay much for good public health, you don't have to, provided you can arrange to avoid the kind of great income disparities prevalent in the US and in the former Soviet Union. Furthermore, even if a jurisdiction does arrange for (what I think to be) a morally defensible distribution of incomes, different ways of managing public health make a difference.
I don't think you (US psople) should look to Canada for an example of how to run a public health system. Canada is perhaps better than the US, but it's just neutral in its accomplishment. You should look to Cuba, which succeeds brilliantly despite its low income, and ask what it does right that other dictatorships don't.
There is a PCT point, to follow in another message if I have time.