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Sunday, October 29, 2006

Universal Health Care in 2008!

I'm not too anal retentive about the direction comments take on various entries. The discussion under my 2006 SD Voter's Guide has turned toward universal health care, and issue that, alas, hasn't come up on the South Dakota ballot. Maybe Erin and I will change that. After the election, we're going to call Jack Billion, whether he wins or not, and ask if he'd like to help us craft an initiated measure to create a statewide universal health care system. We invite any and all activists interested in the same issue to come help. Heck, if South Dakota is willing to spend tax dollars creating an unconstitutional abortion ban just to give activist lawyers and excuse to build their Supreme Court resumes, maybe South Dakota could create an actual program that serves genuine needs and challenges the status quo of corporate-capitalist health care. And note, if we can get universal health care on the ballot, it will not take the form of a constitutional amendment declaring health care a right. It will be an initiated law offering a specific policy solution to address the failures of the pseudo-free-market system. Below is the comment "Phaedrus" wrote (and my response) that got me thinking about this idea and spurred me to make it a separate thread:

Phaedrus said...

Universal Healthcare like every other kind of socialism saps the strength of innovation. There is no drive to improve such a system and it stagnates. Bread was 'universaly available' in the Soviet system as well. No hunger there ever right? Since it would be complete insanity for a government to try to provide the absolute best in medical technology and new therapy to every citizen - instant bankruptcy, what the people end up getting is the affordable mediocre medical treatment that won't stress the system.
It is only by opening it up to capitalism and the free market that the best things become available at all, and then those things eventually become cheaper and everyone benefits.

You are right when you say that democracy and the public good benefit by better health. You are wrong in thinking that can be achieved by declaring healthcare a universal right. It is the same as pretending that poverty could be eliminated if we took everyones money away and gave it back to everyone equally: causing productivity and economic growth to completely disintergrate. Canada's best doctors go the same place their best actors go. There's a very good reason for that.

coralhei said...

1. Note that I am not terribly uptight about keeping the discussion on the original topic. I wish universal health care were on the South Dakota ballot. South Dakota may lack the population necessary to create a statewide risk pool... although we already have the high-risk pool sponsored by the state to serve those good citizens whom the free market refuses to serve, so maybe we could cover everyone.

2. Phaedrus raises the red flag on declaring health care a right. Erin and I don't have to go that far. We can look at the matter purely in pragmatic terms. The private system isn't doing what Phaedrus says it should. Where are the absolute best technologies and therapies that the free market should be making cheaper and available to everyone? Health care costs are going up much faster than inflation. Fewer and fewer people can afford basic health care (like pre-natal check-ups, well-baby doctor visits, etc.). What good are the "absolute best" medical technologies and therapies if they drive families into bankruptcy even when they seek basic care for medical emergencies? Maybe "affordable mediocre medical treatment that won't stress the system" wouldn't be so bad.

By the way, Phaedrus makes analogies to the bread shortages in the Soviet Union. Why not make a better analogy, directly to the Soviet Union's universal health care system? Russians had better access to health care and better health outcomes under the Soviet system than they do under today's mafia-capitalism.

Phaedrus's analogy to the failure of food distribution in the USSR misses the point. Food distribution under the free market system works because we can make genuine free market choices. We have the time to decide which loaf of bread we want for supper, which bakery we want to buy from, or even whether we want to bake it ourselves. I can get all the information I need about bread costs and bread options from the bakery ads in the paper and by trying the bread from different bakeries each week to decide which bread best serves my needs. I don't need a complex insurance policy to obtain bread (and I don't get charged extra if I walk into a bakery to buy bread out-of-pocket). Take the preceding four sentences, try substituting "health care" for "bread" and "hospital" for "bakery," and you'll see the failure of Phaedrus's faith in the free market to provide health care.

Hospital patients cannot get the time or information they need to make genuine free market decisions about their health care. The doctors and nurses administering the care cannot tell the patient how much the shots and pills and procedures they are offering cost. When a man stumbles into the ER on a Saturday night with an appendicitis, the only people who can tell him how much the procedure will cost, the business office staff, are all at home sleeping and won't be in until Monday morning. South Dakota passes a law requiring hospitals to post their charges, but we only get a list of median charges for up to 25 most common general procedures, with no practical breakdown of specific charges within each procedure that a patient might reasonably be able to minimize through wise choices (assuming the patient is not unconscious, in labor, vomiting blood, terrified of dying, or experiencing some other distraction that might hamper her or his responsible free-market decision-making). The free market cannot work in a situation where real choice and information are not available.

I love the free market. I wish it worked all the time. But it doesn't. And when it doesn't, Adam Smith says government needs to step in and get the job done. Health care does not allow genuine free market decision-making. The free market is pricing more and more people out of health care. Universal health care might not get us the best erectile-dysfunction treatments, but it would get shots and check-ups to everyone who wants them and stop half of all bankruptcies to boot. When the free market can lower my health insurance premiums -- or heck, just limit the premium increases to the rate of my wage increases -- give me a call. Until then, I vote for universal health care, not because it's a right, but because it gets the job done better.

Sunday, October 1, 2006

State Fair Attendance Up... and Down!

The State Fair board has apparently had enough time to coordinate their spin and get all the principals on the same page so they can release their attendance numbers, which remained a closely guarded secret for almost a month after the fair wrapped up. The Rapid City Journal reports that daily average attendance and vendor sales were up from last year. But remember, the fair truncated this year's event from eight days to five. So while daily attendance was up from 19,000 last year to 26,000 this year, total attendance dropped again, from 158,000 last year to 133,000 this year.

Fair manager Susan Hayward said attendance and other indicators show that the move to the shorter fair was a success.

"We are pleased with the figures that have come in, and this has been the most successful fair season we have had in my four years as manager," Hayward said Friday as officials released the attendance figures.

Now remember, this is the same Susan Hayward who is on record saying that attendance figures "are no indication of how well the fair is doing." I'm willing to give Hayward the benefit of the doubt and assume that her earlier comments in the Huron Plainsman during the fair were taken out of context. Surely she meant to say attendance figures are no indication of how well the fair is doing, at least not until we can cherry-pick the figures that make us look better. We'll see how well the spin from the fair board and the political forces from Huron goes over during the 2007 legislative session.