Classical Liberalism in America
So, for many readers of my work there’s a sense that I am wishy-washy on a number of issues (though hopefully they also notice where I am consistent: against the war on drugs, for non-interventionism, gay rights, immigration, civil liberties, etc). In my humblest of opinions there are certain tangible truths and certain areas of dispute where the issues become quite a bit more murky. There are also times when the truth and the realm of possibility are not always aligned. So I write a lot about how to reconcile these things (if only to placate myself), and I try to strike a balance.
This puts me somewhere between contemporary liberalism and contemporary libertarianism, with a distinct left-leaning, broadly liberal philosophy and lots of room to shift my ideas around within that broader framework of thought. So, yeah, wishy-washy when it comes to things like healthcare reform, education, and the size of government because even if I think the more anarchistic ideas are best, the political landscape always stymies my enthusiasm.
With something like healthcare, we could probably save money if we moved to single-payer – certainly Canada is able to save money that way. But on another level, I’d really prefer to see the healthcare industry opened up to actual market forces because there’s always the risk that we’ll run into cost and access issues (not to mention quality issues) if we just pile a single-payer system on top of the system we have. At some point I just default to a position of experimentation and doubt.
Maybe this is the role of classical liberalism in America – to strike a balance somewhere in the wild between the progressive and libertarian camps.
Update: RTod notes: “I liked this post until the last line. I’d have preferred if you had ended with something like “maybe this is the job of self-aware people.””
I take his point. I guess I try to give labels to ideas even when, perhaps, they are inadequate.
Soon you’ll be talking about the veil of ignorance that should inform our decisions on how big the social safety net should be….Report
You only look wishy washy if you assume everyone has to fit neatly into one of three or four predetermined boxes. I liked this post until the last line. I’d have preferred if you had ended with something like “maybe this is the job of self-aware people.”Report
Good point.Report
I try to give labels to ideas even when, perhaps, they are inadequate.
When which are inadequate — the labels or the ideas? I think “inadequate” is a pretty good label for a lot of ideas. 🙂Report
Both maybe.Report
Great post!Report
Thanks!Report
Maybe this has been covered at another time and in an other place, but I would be interested in your views of immigration versus illegal immigration. Many, myself included, believe we are enriched by immigrants and should encourage more of the world’s best and brightest to come here and stay. And I should add, those with a strong work ethic who want to better themselves even if they are not PhD’s.
But when there are laws governing immigration, just as there are laws governing vast numbers of things, is it good to encourage violation of those laws rather than working to change the law? What if violation of the law gives rise to criminal enterprise that spills over into larger society? Prohibition certainly helped expand organized crime in America. Thoughts?Report
Of course, part of the issue is that there really isn’t a strong classical liberal party or movement in the United States. Yes, there is such things as the Libertarian Party, but I tend to think to much of libertarianism is living in a dreamworld where government doesn’t exist, instead of dealing of the world as it is and how best to use public resources.
I believe there are a lot more folks like you, Erik, but there really isn’t anything for you at least in the United States. I’ve said before, but in other nations like the UK or Germany there are parties and movements that tend to cater to you (and to some extent, me).Report
In some sense, the parliamentary systems facilitate their existences, don’t they?Report
But on another level, I’d really prefer to see the healthcare industry opened up to actual market forces because there’s always the risk that we’ll run into cost and access issues (not to mention quality issues) if we just pile a single-payer system on top of the system we have.
Yes, but the situation is so bad at this point that there’s nearly no conceivable way that single-payer can make things worse in the short term. Especially as single-payer would immediately knock something like 30% of the costs out of the system solely due to paperwork reduction and insurance company profit.
Even if costs then start climbing faster, it will take years before we even reach the point we are currently with costs, and even longer until we reach the point we would have been at had we done nothing. I have to randomly guess ‘five years’ until then.
So we might as well go there now, and _then_ worry about controlling costs. It only makes sense to worry about future costs of single payer if we’re operating under the assumption that we can only do one thing, ever, and that whatever system we set up can’t be tweaked once we see how it’s working.Report
Oh, and with regard to ‘access’…that’s a total red herring. We will have as many doctors and hospitals under the new system, and can treat exactly as many people. The exact same amount of medical care would exist. If we have shortages then, it would only be because we have shortages _now_.
So unless the problem is that access won’t ‘rationed’ correctly (Aka, access is no longer controlled based on how much money someone has.), there’s no ‘access’ issue at all. Frankly, it’s _this_ system that has ‘access’ problems…I would much rather have doctors rationing care based on doctory things, or the government rationing it based on standardized rules, than have insurance companies rationing it based on how much money patients give them.Report
I would prefer a two-tiered approach – major market reforms underscored by a single-payer option.Report
That’s Japanese health care right there: total freedom plus the government subsidizes everything 70%. Our system is shockingly ineffective in comparison.Report
Japan’s health care system may not be sustainable either. These schemes are all pretty young. A rare WaPo 2009 article—rare in that it discloses counterfactuals to the accepted wisdom that anything would be better than the current US system:
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/06/AR2009090601630.html?hpid=topnews
” Japan has a system that costs half as much and often achieves better medical outcomes than its American counterpart. It does so by banning insurance company profits, limiting doctor fees and accepting shortcomings in care that many well-insured Americans would find intolerable.”
“But many health-care economists say Japan’s low-cost system is probably not sustainable without significant change. Japan already has the world’s oldest population; by 2050, 40 percent will be 65 or older. The disease mix is becoming more expensive to treat, as rates of cancer, stroke and Alzheimer’s disease steadily increase. Demand for medical care will triple in the next 25 years, according to a recent analysis by McKinsey & Co., a consulting firm.”
“Japan has a stagnant economy, with a shortage of young people that hobbles prospects for growth and strangles the capacity of the debt-strapped government to increase health-care spending. Without reform, costs are projected to double, reaching current U.S. levels in a decade, according to the Organization for Economic Cooperation and Development (OECD).”
…
“As a result, most Japanese doctors make far less money than their U.S. counterparts. Administrative costs are four times lower than they are in the United States, in part because insurance companies do not set rates for treatment or deny claims. By law, they cannot make profits or advertise to attract low-risk, high-profit clients.”
“There are shortages of obstetricians, anesthesiologists and emergency room specialists because of relatively low pay, long hours and high stress at many hospitals, doctors and health-care analysts said. Emergency room service is often spotty, as ER beds in many hospitals are limited and diagnostic expertise is sometimes lacking. In a highly publicized but not unprecedented incident, a pregnant woman complaining of a severe headache was refused admission last year to seven Tokyo hospitals. She died of an undiagnosed brain hemorrhage after giving birth.”
“Toshihiko Oba had spent most of his medical career in hospitals. As an ear, nose and throat specialist, he worked 80-hour weeks for 13 years, with an annual salary of $100,000. The average salary for a hospital-based doctor in Japan is about $150,000, according to the Ministry of Health.
“The money was not so good and you have lots of responsibility and pressure,” said Oba, 47.
Five years ago, he made a career change common for Japanese doctors at the pinnacle of their careers. He left the hospital and opened a private clinic, and now treats mainly colds and allergies.
In his office in Tokyo’s upscale Ginza district, Oba works from 9:30 a.m. to 7 p.m., five days a week. He said he works fast, typically treating 150 patients a day, usually for about three minutes each.”
[TVD: Wal-Mart is doing the same thing of late.]
“Japan’s health-care system mixes socialism with individual responsibility and market forces. The government pays one-quarter of the total health-care bill, and employers and workers pay the rest through mandatory insurance.”
“The health-care system, though, does not deserve all the credit for the relatively robust health of the Japanese. Diet and lifestyle are generally healthier than they are in the United States. There is less violent crime, fewer car accidents and much less obesity. Only about 3 percent of Japanese are obese, compared with more than 30 percent of Americans, according to the OECD.
“There is compulsory obesity screening for 70 percent of the population. If people are found to be too fat around the waist, they are required to receive counseling on exercise and diet.”
[TVD: Oh yeah, that last one is really gonna fly in the land of the free and the home of the Whopper.]Report
“Oh yeah, that last one is really gonna fly in the land of the free and the home of the Whopper.”
Considering the Herculean struggle just to not have Coca Cola readily available in public school cafeterias, I’d have to agree with you.
Still, two anecdotes: The first from Japan: while pregnant (twice) my wife could walk to her obstetrician if I was at work. She had appointments every week and three doctors on hand when it was time for the baby to come out: her regular obstetrician, a surgeon, and an anesthesiologist. All this cost us a couple thousand dollars altogether.
The second from America: my younger daughter broke out in a fever followed by a rash. I call the pediatrics clinic that my family has been patronizing since I my older brother was an infant: could be roseola (harmless), German measles (no case in the U.S. in some years but common in Asia = definite public health risk), or measles (again, fairly common in Asia, Boston outbreak occurred in February = CDC firestorm). Oh, wait a second, you just came to the United States? You’re refugees from Japan? You say you have Masshealth, but your daughter’s name is not on our computer. I’m sorry, sir, we can’t see you daughter, and I don’t feel comfortable even giving you advice.
Of course, other anecdotes abound. In my experience, American health care is absolutely abysmal. This says nothing about medical care or biotech, which, despite all the assertions to the contrary, are only loosely dependent on the health care market.Report
Mr. Carr, I assume [hope!] your daughter’s story has a happy-enough ending. These anecdotes seldom include the end, just the initial bureaucratic boondoggle. Our emergency rooms are required by law to treat people, and we have county health systems that are never discussed in these debates, as though they don’t exist.
My main reservations about tales of better health care in other countries is a) I’ve heard horror stories as well b) these systems may not be sustainable, the point of the linked WaPo article. This universal health care thing is only a half-century old.
And I’ll add a c) that the US is different and diverse demographically [Asian American health outcomes are roughly the same as in their home countries] and d) we have a lot of violence, accidents and obesity which squirrel the stats. [We calculate infant mortality differently as well; it’s almost impossible to get clean stats on it.]
And hell, we might as well add an e) that American doctors aren’t going to work 80 hours a week for a mere $100K. Well mebbe they will in future, as we socialize medicine and the current generations of doctors die or quit. Or both. ;-}Report
A nearby clinic agreed to see her no questions asked. I’m not saying we should have the Japanese system, but there are elements of it that we should incorporate into ours. Also, I realize that there are downsides to socialized medicine. But from my subjective point of view, the Japanese system (and that of Canada and that of New Zealand where I have also lived) is definitely superior. I realize that emergency rooms are required to treat everyone who shows up, but, to share another anecdote, the last time I came home for Christmas, I realized I forgot my asthma medicine. After several hours on the phone, it became clear that the only way for me to pick up a rescue inhaler would be to go to the emergency room, wait around for hours since getting an inhaler is not a priority, pay something like 300 dollars for the visit and another 200 for the inhaler. I decided to tough it out and ignore the doctor’s prescription for the two weeks I was home. In Japan, there are multi-purpose clinics on every block. I walk into any one, wait thirty minutes, tell the doctor i have asthma and have been taking medicine for it since I was twelve, pay four bucks, and walk out and across the street to my apartment.Report
And this is all despite not being a Japanese citizen.Report
Mr. Carr: The ER was there; your health was not in actual danger. I hear your point, but such inconveniences do not demand radically overhauling our system, in my view.
I’ve also discussed this with acquaintances from other countries; we agree theirs are better to be mildly ill in. It gets more complicated when you’re gravely ill, as I’m sure you know–NICE in the UK, etc.
Further, the main objection here is that these other systems have hit their own walls of sustainability and/or their applicability to the US for various reasons touched on above.Report
I’m not saying that people in the U.S. don’t get access to great medical care. What I’m talking about is absurd waste. Who needs to be paying 500 dollars for a medication that’s generic and in common use? Whose pockets is that money lining? As for the applicability argument, that’s just wild speculation, isn’t it?Report
There are drugs that cost a lot of money and there are generics, but I’ve not heard of a generic that costs $500?Report
The 500 would be for the trip to the emergency room that getting said drug apparently necessitates.Report
Ahhh, gotcha.Report
Is it time for you to do another post on healthcare reform? Seems you have an opinion and others want to weigh in. I did a guest here some time ago on the topic, pre Obamacare (sorry I can’t remember the correct name) and am not lobbying for an encore, but this topic is topical.Report
I don’t think you’re wishy-washy, but I do think your political ethic remains largely unformed. A lot of what goes on here could be filed under the category of “battling for the soul of Erik Kain”.Report
Narrowed it down to somewhere between Ayn Rand and Hugo Chavez. 😉Report
I’m trying to think of a funny way to insert Hitler in there, and it’s not working.Report
One of them is a power-obsessed megalomaniac. The other two don’t speak English.Report