berman@psuvax1.UUCP (Piotr Berman) (09/04/85)
Warning: may be boring. [concerning low costs of privite charities vs. high cost of the government] > >People who make it hard to be helped get dumped > >on the government. In Libertaria, people who make it hard to be > >helped, schizophrenics being the most notable case (and there are > >MILLIONS of them around, some of whom I know), still would be turned > >away by private agencies. > >Remember, the criteria for success for > >private agencies tends to be the number of bodies they end up helping. > >Any body that makes life hard on them would reduce the "success" rate. > > ................. Right now, those people do NOT have a choice regarding > (say) welfare. People who would put such things in the hands of the state > deny it to them. > Is it a shame that AIDS funding is too low? Give them a few bucks. > There are two issues conveniently omitted. 1. Help (charity, wellfare) considered here concerns people who are in this way or another incapacitated. Thus not only cash benefits are needed, but also WORK: guidance, therapy etc. Charities have voluntiers. However, I do not expect the number of voluntiers to increase drastically under any system. In fact, the capabilities of charities are often limited by the number of voluntiers, thus they distribute only as much help as they can do it cheaply. 2. There are various needs which are not particularly popular. The system proposed would determine the size of help available according to current fads. Today baby seals are popular, tomorrow starving Africans. If your case was not popularized yet (or popularized 4 years ago and now forgotten), you can rot. AIDS is a good example, since the victims were quite unpopular for quite a while. > >>Of course, if you REALLY think that people a libertarian society would > >>be less generous, you should bear in mind that you are saying that > >>people tend to give less than a fifth voluntarily than they do under > >>coercion, and that the poor have not been denied reasonable jobs > >>by such things as minimum wage laws and licensure. Not a tenable > >>position. You're also assuming that a large number of people will > >>need charity -- remember Daniel Mck.'s very well-defended discussion > >>of unemployment in libertaria. The argument of McKiernan is that in the absence of minimal wage, wellfare and licencing everybody would find employement (or starve and cease to be unemployed anymore, I presume). Then we have another argument that everyone should pay himself for health insurance (if he wishes one) plus save for his old age (or, equivalently, support his folks). The problem is that I do not see how with current minimal wage ($6700 yearly) one can afford it. My family insurance costs more than $2000 a year. Now, necessary savings, shelter (shack?), clothes and food. OK, possibly I could afford enough of liver, milk and bread for three people. Oops, I forgot school for my son! Also, I forgot that my wage will be smaller than minimal! (the implicit invocation of this arithmetic was labelled "invoking fictional Dickensian horrors"). > > > >Again, there are millions of schizophrenics who don't have to live in > >institutions. I don't remember Daniel's discussion. And I really > >think people in a libertarian society would be as generous as other > >people with similar after-tax incomes today. That sounds reasonable > >to me. And I don't think most people I know are very generous. > > Go just a step further. Supply AND demand, remember? In our society, > the Supply of money is limited by taxation. Demand for private funding > is ALSO limited -- the government is assumed to be "doing something" > (and it is, mostly inefficiently) and is put in charge of anything > regarded as a public health emergency. In a libertarian society, > the SUPPLY of money is greater (your after-tax income is raised to > match your pre-tax income) and the DEMAND for those funds from > private charities is larger. Why? Because the private charities have > not been subsidized. They have stronger cases that the funds are > needed, and needed locally. They also can do their part more efficiently. > Market forces indeed. More schizofrenics, obviously, will cause more people to care about schizophrenics. Why? Because in the economics course they teach that demand increases supply. What about another economical law - supply generates demand. More charitable contributions - more schizofrenics (another way of cutting unemployement in Libertaria). > >>Another example? Certainly. Kidney machines are rationed and > >>subsidized by the government. There has been relatively little research > >>on improving these machines because the whole thing is pretty closely > >>regulated, there have also been pretty severe limits placed on access to > >>those machines. For details, see Reason Magazine, August 1984. > > > >Boy, you're in a mess on this one. Government pays for kidney maintenance > >because most kidney disease sufferers can't afford dialysis. So the > >government created the market for kidney machines in the first place, > >by making current technology affordable. > > > > Tsk! When you go to the doctor, how much of the bill do you pay? > I generally pay $1, because I have health insurance. Was the insurance > federally subsidized? Nope, not as far as I can tell (modulo, of course, > the ever-present tax arguments by which it may be argued that anything > is subsidized). My understanding is that I'm paying for things like > dialysis, should I need them, by pooling my risk of needing such things > with other people. Need dialysis be expensive? As I noted before, the insurance is expensive. My insurance (according to my employer) costs more than $2000 and I still pay the first $400 for visits, plus unlimited for medicines. Since more than 10% of GNP are medical services, it seems to be right. No wonder, at leat 25% of population cannot pay for they insurance. > [from a libertarian magazine] > Dutch physician Willem Kolff, the inventor of the dialysis > machine in the 1940s, told me he was shocked to learn of the > high cost dialysis machinery being used on an experimental basis > in the United States when he immigrated here in 1950. Intent on > altering this situation, Dr. Kolff continuously pushed to reduce > costs. By 1968 he had modified Maytag washing machines into > dialysis machines at a fraction of the cost of machines then in > use. The same year, he sent 21 people home with machines and > two months worth of supplies for a total cost of $360 per > patient. > > Or consider how the system stifles equipment innovations. > Kidney-machine inventor Dr. Kolff has now developed a portable > dialysis machine that would enable patients to travel, work more > easily, and generally lead more productive, normal lives. But > Kolff told me that he is unable to get any American > manufacturers interested in making the machine. > > The problem is uncertain demand. Prototypes have been made for > $6000 each -- the same cost as American machines used in > dialysis centers when purchased in volume. Although Kolff's > machine could provide dialysis patients with more-satisfying > lifestyles, neither nephrologists, equipment makers, nor > facility operators have much incentive to introduce their > patients to the machines, since it is not clear how they would > fit in to ESRD reimbursement provisions. So Kolff has gone to a > Japanese manufacturer to supply him with prototypes. > [Reason Magazine, August 1984] I suspect that there is as much reason in Reason Magazine as there is truth in Plain Truth (a fundamentalist monthly, which makes feats like explaining the election results in Australia with quotes from the Scripture). The numbers presented here do not add up. First, Kolff makes a dialysis machines Maytag washers and sends patients home with machines and two months worth of supplies for a total cost of $360 per patient. I would like to see Maytag washing machines that cheap (and what about supplies, were they ordinary detergents?). Then portable machine (portable washing machine?) that would cost less than $6k. If they would be that cheap, there would be enough of wealthy patients who would like to have them. That would create sufficient market. It is standard that the inventor is very optimistic about his design. If this optimism is not shared by profit oriented manufacturers, the chances are that they were right. Another flower of reason from Reason Magazine. > "But Popeo, the son of a working-class family, was offended by his cases > at Interior. Handed the responsibility for enforcing health and safety > regulations often capricious and petty in nature, he found that his > opponents in court were often struggling entrepreneurs. The last straw, > Popeo related in a recent interview, was when he found himself seeking a > court injunction to 'close down a one-man mine operation because the > owner didn't have a two-way radio to talk to himself, or a stretcher to carry > himself out of the mine if injured.'". [Reason Magazine, Sept., 1985, pp 48]. So the proposal is to make it legal to operate an underground mine without any safety measures? What if it would be two-men mine? Are you proposing to abolish all safety regulations? Is the cheaper coal worth additional deaths? Possibly, work related accidents would help to eliminate unemployement in Libertaria. Again about dialysis. Suppose we cut the government funding. > And would thousands die? One doesn't hear about it in the case of > hemophiliacs: > > The effect of these portrayals [dramatic appeals to the US > congress about kidney failure] should not be minimized. There > are, after all, other catastrophic disabilities that affect as > many people and cost as much to treat as kidney failure but > don't lure as much government money. Richard Rettig, professor > of social sciences at the Illinois Institute of Technology, > notes that the taxpayers are not footing the bill, for example, > to treat hemophiliacs, whose numbers exceed those with kidney > failure. The central symptom of hemophilia is serious bleeding, > and Rettig figures that a quarter of all hemophiliacs "require > continuous replacement of fresh whole blood, plasma, and > clotting concentrates," a therapy at least as expensive as > dialysis. > So what happens to uninsured hemofiliacs? Presumably, thousands die. But this issue is not disscussed in the quote (from Reason Magazine?). The real problem however is that we cannot support all terapies which are technologically available. Thus only the cheaper are selected (cheaper does not mean cheap). Will we be able to support hemophiliacs, there will be another group. Does it mean that saving lives is not recommended in any case. > >And besides, government's not a bad market, either, if it operates a > >proper bidding process. > > That is a pretty big "if", O mighty evaluator of markets. In the > particular case of ESRD aid, the government offers a fixed fee for dialysis, > regardless of what costs were. The result? It's very profitable indeed to > run dialysis outfits, and new technology is not evaluated properly because of > the uncertainty of how the government will treat it. > > In fact, I've answered this last statement of yours as if you'd said > "the government doesn't do too badly at the market, either, if it operates > a proper bidding process." To answer what you actually wrote (which > I believe to be a mis-phrasing) the government is an AWFUL market -- one > of the reasons why it's hard find anyone who still believes in the government > setting all prices. The problem is that a government doesn't have available > the information to set prices correctly, which results in > incorrect prices, which results in misproduction. > Very socialist economies tend to set their prices to reflect politics, not > engineering reality, which is one reason why they have to make it illegal > (for example) to feed bread to cattle (the price of bread is lower than > that of the corresponding amount of grain). > > >Then the lowest price competitors get to sell > >to government, and if there's competition, prices will go down. > > This would be true enough, but what has happened in this case is that > the government offers a fixed price, so there is no pressure to > charge the government less, so prices stay just where they are. > This ties in nicely with the recent discussion in net.politics of the > increasingly more complex specifications for airplanes -- the government > has indeed put things out for bid, but the specs often limit competition, as > do political requirements (I'm told that the Soviet rifle has much better > performance when dirty than does the American, but do can you see > the American government buying, say, knock-offs of that design?) > Rifle example shows that government may work better or worse. Sometimes it does it pretty bad. However, there is no way one can introduce market principles everywhere. As rifle example shows, Soviet military tends to have lower costs. According to the market reasoning (unblemished by petty political requirements), we should hire the Soviet Red Army for our defence, with tremendous savings. In a pure market system everything is a commodity. Health is a commodity, personal safety is a commodity, elementary education is a commodity, freedom of speech is a commodity. Granted, wealth should have its rewards. Having wealth, I may afford superior health care, good protection, my voice is better heard. But how large should be the penalties for lacking wealth? Third-world-like medicine? Substandard education? What else? What would be the force keeping the fabric of society together? > >>>I agree with Piotr. I'd rather believe in people than believe in > >>>libertaria anytime. > >>> > >> > >>That's quite a statment for someone who seems to be advocating the > >>welfare state..... Do you believe in people, or do you believe in > >>people with the right chains on them? > > > >In the absence of decent moral education, I believe in people with the > >right chains on them. > > > >Tony Wuersch > >{amd,amdcad}!cae780!ubvax!tonyw > >/* End of text from inmet:net.politics.t */ > > That last sentence was so priceless that I thought I'd leave your > signature right next to it. It's so nice to know that you'd like to > give people a "decent moral education". The thought of my (hypothetical) > child getting one of which you'd approve gives me the shudders. When convenient, you prefer not to see the sarcasm. On the other hand, what is your morality? You believe in a society where the ill have nots have two choices: be pleasant to the haves (they may give me some charitable help), or die. No government intervention in this interaction. Let market forces teach the poor to be pleasant. Piotr Berman