What does it mean to "run an efficient system"? What is the value of the next 24 hours of your life? ... of your demented mother's life? ... of your neighbor's demented mother's life? These are real moral and ethical dilemmas that people face every day. These moral issues are primal. The economic issues are secondary.

Yes, they are real moral and ethical dilemmas and I have faced them, walked thru them, and I live with them every day of my life.

I had to look my mother in the eye and say, "Do want to go home?" and she said, "Not until I am ready." to which I replied, "What if that day never comes?" She had the option and was dead 24 hrs later.

My father was not so lucky. I had to sit with him thru months of his praying for "Jesus to take me" because he knew he was losing it to Alzheimers and he could do nothing about it. Fortunately (for me) he now no longer knows he is losing it and is just my father (what is left of him)(he has not known my name in years) and I am able to enjoy him once again...

But I still pray for his release from the binds that hold him to this world, binds that I am powerless to break.

The conundrum: I can make the system pay tens of thousands of dollars per month (he has lots of insurance) to keep him alive, but I can not pay out of my own pocket for that which we would do for a dog.

Where is the sense? Where is the justice? Where is the empathy?

Where in God's name, is the human dignity?

Let me guess, business school?

There's no such thing as absolute efficiency. Just as there's no such thing as absolute red. Or absolute nice. Absolutes are for mathematics. So I used the word "efficient" as any sensible person would to mean relatively efficient. But the qualifier really shouldn't be necessary. Excuse me, it shouldn't be relatively necessary.

I see we agree that we want a more efficient system. I see we agree that France's system is more efficient than ours. I see we agree that the problem of an ineffective government is not chiseled in stone but might be changed.

Then I see you automatically precluding the possibility that government might deliver that efficiency. An assumption.

As for mathematical proof that government is necessarily less efficient than government, please, feel free to put up some links. This ought to be good.

In fact, Steve, it's that kind of sloppy thinking that makes me think we should teach more philosophy. The notion that you can define efficiency and demonstrate the inevitable inefficiency of government without reliance on unproven presuppositions is at the very least extremely dubious.

But I await a dazzling download of the sort of thing that passes for serious thinking in B-schools.

So, because our government is inferior we should shrug and move on rather than perhaps trying to improve our government?

Of course not, what I'm saying is that it is a factor that needs to be considered. If you don't and try to forge ahead anyways you might be doomed to failure.

Irrelevant. I'm often referred to as a genius. (Usually by me.) You offer no proof, just restatements of assumptions.

Google. Try it. Or look at Jean-Jaques Laffont's text Fundamentals of Public Economics.

Actually, for f*cks sake get it through your head: no system is indefinitely sustainable. You insist on making the perfect the enemy of the good.

No Michael I'm asking you to stop using misleading and false statements. Your statement that France is efficient is not factually true. They are more efficient, but still have problems mainly with cost growth rates. The same problem we have.

Everything we ever build -- ever -- is unsustainable. So the question is never "What is the perfect system?" The question is always, "What's the best we can do for now?"

Trite trivial truth noted, but irrelevant. The problem is that no country that I know has a sustainable health care system over the next couple of decades. Britain, France, Canada, Germany, and so on.

If we have a system that will melt down in say 10 years, and we are offered either the choice to let that happen or replace it with a system that will melt down in 30 years, I think we take option B.

No duh. If this is all you have to contribute then please stop, it was part of the opening post.

You're exasperated because I've asked you a very simple question that you ought to be able to answer but can't. Do you have some proof for the proposition that government is necessarily less efficient than private industry?

I'm exasperated by your ignorance and false statements. France is not efficient. And yes, I have proofs, formal mathematical proofs, but call me Shirley, I don't think you really want to see them. There are also empirical research papers on it as well, but I don't think you want them either.

One other point: there's no absolute standard of efficiency. It's relative. Less inefficient equals more efficient.

Backpedalling duly noted. And your statements were not relative, but absolute: France's system is efficient. That is an absolute statement.

This is why they should be teaching philosophy in schools.

Bwahahahaha

They aren't efficient, they are just not as inefficient as the U.S. health care system.

One other point: there's no absolute standard of efficiency. It's relative. Less inefficient equals more efficient.

This is why they should be teaching philosophy in schools.

Here's an idea, maybe France's government is less prone to rent seeking, regulatory capture and overall has better institutions. Or not. I really don't know. What I do know is that these things can prevent us from rationalizing our health care system.

So, because our government is inferior we should shrug and move on rather than perhaps trying to improve our government?

Actually, government provided outcomes are quite often referred to as "second best" outcomes.

Irrelevant. I'm often referred to as a genius. (Usually by me.) You offer no proof, just restatements of assumptions.

And for f*ck sake Michael get it through your head. France's system is not sustainable either. They aren't efficient, they are just not as inefficient as the U.S. health care system.

Actually, for f*cks sake get it through your head: no system is indefinitely sustainable. You insist on making the perfect the enemy of the good.

Everything we ever build -- ever -- is unsustainable. So the question is never "What is the perfect system?" The question is always, "What's the best we can do for now?"

If we have a system that will melt down in say 10 years, and we are offered either the choice to let that happen or replace it with a system that will melt down in 30 years, I think we take option B.

You're exasperated because I've asked you a very simple question that you ought to be able to answer but can't. Do you have some proof for the proposition that government is necessarily less efficient than private industry?

I don't think you do. So the eye rolling doesn't really do much except demonstrate the weakness of what is a quasi-religious belief.

As for the windfall aspect, it's pretty much the case that if you cut my yearly cost of anything in half that's a windfall. More money in my hand, less in someone else's hand. Windfall.

But in the end you wont get that money, it is to be spent providing health insurance for others who currently don't have health insurance.

Now, I agree with Schuler that we need to increase the supply. More doctors, lower pay.

Good luck with that. Doctors, the AMA, and others have a vested interest in keeping the supply limited. To keep from getting that lower paying thing. And don't forget nurses. We can't train all the nurses we need in this country. Good luck changing that, too.

If France's government can run an efficient system, why can't ours? Perhaps because the French do not hold hold the quasi-religious belief that government = stupid, the free market = smart?

Here's an idea, maybe France's government is less prone to rent seeking, regulatory capture and overall has better institutions. Or not. I really don't know. What I do know is that these things can prevent us from rationalizing our health care system.

Uh, for many folks who post here, that last is false. For them, the economic issues (read, taxes) are the moral issues.

And why shouldn't taxes be a moral issue? You want to take my money. I use my time and labor to earn that money. You are in effect using force to take my time and labor from me. To say it isn't a moral issue indicates that whomever holds such a view is morally blinkered.

That's you arguing your faith against a straw man. I don't have faith either way. I'm just not prepared to genuflect to the received wisdom that government is necessarily incapable of efficiency.

Actually, government provided outcomes are quite often referred to as "second best" outcomes. First best are the most efficient (as defined by pareto optimality) and are often unattainable. Even in a completely theoretical setting were you have a benevolent social dictator doing what he thinks is best for individuals you get less than optimal outcomes. Of course, at the same time, the market often cannot provide the optimal outcome either. But the idea that government is going to be "efficient" is largely a myth. The most that can be said is that in some cases government will be the best worst choice. I'd also point to the research of Elinor Ostrom that government need not always be the choice either when dealing with public goods, commons, and so forth.

And for f*ck sake Michael get it through your head. France's system is not sustainable either. They aren't efficient, they are just not as inefficient as the U.S. health care system.

Try this for God's sake.

For example if we took "France's systme + 50%" on a percentage of GDP basis we'd actually be worse off. For 2007 our health care expenditures as a percentage of GDP would go from a bit over 15% to 17.5% or so. That is a big increase. If we went with the French system + 0% we'd drop down to about 11% of GDP. A definite improvement, but again costs are growing too fast in France too.

Really, read up on this topic, your comments indicate a woeful lack of knowledge on the topic.

Apparently trusting the government to do it right is a statement of reality, at least for those in the reality-based community.

That's you arguing your faith against a straw man. I don't have faith either way. I'm just not prepared to genuflect to the received wisdom that government is necessarily incapable of efficiency. If other governments can be efficient -- as the French government appears to be -- then why can't ours?

That's a statement of faith.

Apparently trusting the government to do it right is a statement of reality, at least for those in the reality-based community.

Taxes aren't necessarily the moral issue but they are a moral issue. The false dichotomy you and some others here offer that a person can care for either people or profits but not both is utter bullshit and damn insulting, but YMMV. Now you'll probably say that this is an unfair reading of what you said, but from my perspective that is exactly how it reads.

These are real moral and ethical dilemmas that people face every day. These moral issues are primal. The economic issues are secondary.

Uh, for many folks who post here, that last is false. For them, the economic issues (read, taxes) are the moral issues.

Let me know when you decide what kind of country this is ... and what kind of animal we have become.

Knowing our political system I would much rather have insurance companies rationing than the government

.

That's a statement of faith.

If France's government can run an efficient system, why can't ours? Perhaps because the French do not hold hold the quasi-religious belief that government = stupid, the free market = smart?

Is it possible that we get the government we think inevitable?

We have two choices. One, control demand through rationing. That seems to be the way a single payer system would work. Or two, increase supply of service. How cheap would it be if we increased the number of doctors and subsidized their education? Nurses? Techs? What about subsidizing effective health technology? CT and MRI machines?

Steve,

Supply isn't an issue. There are more MRI machines in the city of Houston than in the entire country of Japan. Now admittedly Houston has perhaps the best medical centers in the world but wouldn't you say that's a bit of overkill?