Wednesday, July 29, 2009

Fantasy Worlds

Bill Maher writes about health care in American culture. It's a target-rich environment, but I'll just touch on his central thesis:

How about this for a New Rule: Not everything in America has to make a profit. It used to be that there were some services and institutions so vital to our nation that they were exempt from market pressures. Some things we just didn't do for money. The United States always defined capitalism, but it didn't used to define us. But now it's becoming all that we are.

Um, no. There never was such a time.

The whole enterprise of the "reformers" is to change human nature so that we work for social interest instead of self interest. It will only work if we can create a "New Rule" that alters how humans do and always have been motivated. And because their efforts can only succeed if humans can become angels, they will only make things worse.

Side note: although Maher believes that not everything has to make a profit, apparently the comedy business does. Here are pictures of his Beverly Hills mansion.

HT: Miss Cellania


Jeff the Baptist said...

Agreed, that time never existed or at least like Maher thinks it did. You had great public philanthropists like Carnegie, but they were generally industrialists and businessmen spreading the wealth out of their largess. Not the kind of guy Maher is likely to idolize.

Really the best bet is not to try to change human nature, which is doomed to failure, but to try to make align the social interest with self interest as much as possible. Prior to the Great Depression a lot of the political progressives based their economic theory around doing that. Unfortunately Maher's politics make no real attempt to do this.

Bro. Dave said...

I disagree. There was a time in our nation when people sacrificed a lot for this country. Take WWII for one example. Men and women volunteered by the thousands to go to fight in a war in Europe to make the world safe. The post-WWII America was all about making our country great. Charitable organizations and churches were at their peak. That generation wanted to make life better for others, for their children. Having been given so much, however, the following generations grew to "expect" certain things to be given to them, craving the biggest, fastest and most expensive of everything, borrowing instead of saving. So today it's "all about me".

truevyne said...

How come the NY Times doesn't ask me where I entertain? Huh, huh?

John said...

Bro. Dave, command economies can achieve great results for short durations because they can take advantage of a popular sentiment and/or use outright force to weld people into common action. Both the U.S. and the Soviet Union during World War II are fine examples of this. But these economies only work in the short term because people are inherently selfish and will not accept self-sacrifice indefinitely as a matter of national policy. This is why the Soviet Union ultimately failed where the US succeeded. The US dropped most of the dictatorial features of World War II life (e.g. draft, price controls, rationing), whereas the Soviet government continued to rule over every aspect of citizens' lives. It became economically ineffective because people did not want to devote their entire lives to a cause, even what the state said was a noble one.

Maher wants doctors, medical researchers, and pharmaceutical company employees to devote their lives to a noble cause. It will not work because ultimately, these people will want to make money and address their own personal wants instead of living lives of service.

Perhaps you'll find a few people who do want to live a live of service. But you'll scare away a lot of smart, capable people who want to make money, and now will no longer be developing new wonder drugs, marvels of medical technology, or surgical techniques. Because there's no profit motive, people motivated by profit will not participate. This means fewer doctors, fewer biotech innovations, fewer new pharmaceuticals.

BruceA said...

Yes, exactly.

OK, we really do need health care reform in this country: We need to make it more affordable for people to get quality insurance coverage, even if their employer doesn't provide it, or if they are self-employed, or if they have a chronic illness and are unable to work.

And in my experience, Maher is right about Catholic hospitals providing better care than corporate, for-profit medical centers.

BUT, Maher is very mistaken if he thinks the high cost of medical care in the U.S. is due solely to the growth of for-profit medicine.

The skyrocketing cost of higher education saddles today's physicians with hundreds of thousands of dollars of debt by the time they finish medical school. Then they have to pay ever higher fees for malpractice insurance. Even if a doctor wanted to work solely. On top of that, about half of all patients are covered by Medicare or Medicaid (people eligible for these programs have, on the average, more medical needs than the rest of the population) which pay a small fraction of the standard charge for a medical procedure.

Even if a physician wanted to work solely for the public good, he or she would have to charge much higher rates than physicians of a generation ago just to put food on the table.

bob said...

The for profit mentality is the reason people are living longer and better.

Longer and better however are not cheap, new drugs mri machines cat scans all very expensive.

As an example where I work from time to time we will get an order for an mri machine not the whole thing just the frame work. It will generally take us about a month working two shift to machine these parts. These parts when finished weigh approx. 128,000 pounds, steel is expensive. Doctors and hospitals aren't greedy their just working with very expensive tools.

BruceA said...

And the cost of the machines is only part of it. Now that doctors have the machines, they must use them enough to catch that one patient out of 100 who actually has something that only the machine can catch. So 99 people get an extra medical test that they really didn't need, and that adds to the expense of health care. But if the doctor didn't order those 100 tests, the one patient would file a malpractice lawsuit.

It's a no-win situation for health care providers. We do need health care reform in this country, but not at the expense of those who actually provide the care.

doodlebugmom said...

There was a day when companies woud make profits, and no one can belittle a person for trying to make a buck.

Its the "record profits" that I find offensive, greed, people making unbelievable amounts of money off the backs of the poor working schmuck