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Ryan didn't claim that society benefits more than the individual, he just said that society benefits "as well as the individual". This is an important distinct
by geebee 17y ago
Ryan didn't claim that society benefits more than the individual, he just said that society benefits "as well as the individual".
This is an important distinction, because I think a big part of the disagreement here is how big a gap you'd need to see to call something a "public good" and accept some degree of government regulation.
In my intro economics textbook, on the section about externalities, the authors used the typical example of pollution as a negative externality. For a positive one, they wrote (paraphrasing) "economists have long recognized that certain professions, such as science and engineering, produce benefits to society that greatly exceed the immediate rewards that the practitioners are able to recoup..."
So it really is a question of degree. The people who did the original research that led to the creation of the internet or decoding the genome have contributed vastly more to the general wealth than people who lobby for the extension of copyrights that were set to expire (who probably profit personally but destroy wealth), but I bet they earned a lot less. I'm not opposed to a government that provides incentives through grants to the researchers.
Unless you're an extremist, the principles are the same, it's just where you draw the line. I'd call myself a moderate fiscal conservative - in general, I'd prefer market solutions, but I'm not a small government zealot. P
One quick thing about public health care - I got an interesting perspective from a physician who worked in an emergency room. He said that people who are broke and have no health care still get their health care paid for by the taxpayer. They just wait until problems become so awful that they have to crowd the emergency room, where treatment is at its most expensive. They're on the hook for the money, but you can't get blood out of a turnip, so the hospital is never reimbursed, and private emergency rooms transfer the patient to the county (taxpayer supported) hospital asap. Unless you're prepared to deny people with extremely bad health conditions access to the emergency room, you, as the taxpayer, are going to pay for the "emergency room public health clinic". So would you rather pay early, when it's cheap, or later, when it's extremely expensive?
- CWuestefeld 17y agothe hospital is never reimbursed, and private emergency rooms transfer the patient to the county This is not the case. Hospitals (including private ones) get some reimbursement from Medicare for bad debt cases. My wife manages the department responsible for this reimbursement at a local hospital, and we've had endless discussions about this. And in a conversation with their CFO over a friendly ping-pong game, I was told that contrary to public wisdom, the ER is actually profitable -- and this is an urban hospital with a high "disproportionate share" of bad debt.
- geebee 17y agoI should clarify this - I meant that the hospital is never reimbursed by the patient. Medicare generally pays only a fraction of the bill, though the bill is often inflated in anticipation of this fractional payment (from medicare or HMOs), so the numbers aren't straightforward. Either way, the taxpayer is on the hook. If some ERs are profitable in spite of a high percentage of bad debt, this just means that the taxpayer is carrying an even higher debt burden.
- CWuestefeld 17y agoThat's mostly correct, except that there are three classes of payers: Medicare/Medicaid, cash patients, and insurance. They form three separate supports that must together cover the expense. In practice, Medicare/Medicaid form a near monopsony -- they're the 800lb gorillas, and can demand capitulation to their reimbursement rates. On the opposite side, cash patients are few, and many of those are expected to be bad debts, and so contribute little. Thus, the pressure release must be through private insurance payments. And that's why your insurance rates are increasing. This is also why many experts fear that Obamacare's plans will squeeze private insurance out of the business, despite the "public option" being putatively off the table. If regulations hold government reimbursement down to a fraction of real cost, private insurance is forced to take up the slack. That necessitates raising rates, and thus forces customers out of private plans. But they're required to be insured, so they must move into a government-controlled plan. Edit: awkward phrasing in 1st para
- geebee 17y agoA proper and accurate accounting is important. We should know how much of the cost of treating patients who don't pay is covered by the hospital, the private insurance companies, the taxpayer, etc. In terms of the argument about the "public good", though, I think the original point is unaffected. You wrote that private insurance "is forced to" take up the slack. Who is forcing them to treat these patients? Medical ethics does to some extent, there is what is called an "imperative to rescue". But there's also the long arm of the law - an ER that refuses to treat a critically ill patient may face criminal charges and other sanctions. Private hospitals definitely do transfer these patients to county if they can possibly get away with it, but at times they must treat and receive medicare reimbursement that doesn't cover the cost. So we actually have a public health care plan. Right now, our public health care plan is a patchwork of regulations that encourages people with no money and no insurance to use the ER for primary care, resulting in a burden on taxpayers, private insurance, and private hospitals. A lot of people, myself included, believe that this has resulted in an extremely expensive and ineffective system of quasi-public health care. This is why I would support some form of organized public health insurance, in spite of the fact that I tend to lean toward market solutions and small government as a general principle.