steve

Yes, the government! So, in order to "save" money on salary, we should expend money on education? Is that your thesis

Not my thesis Steve. Simply a fact that where governments pay for the education of their doctors, doctors are paid less. And seem to accept that, probably because they are lucky enough to start their careers without crippling debt to dig out of....
I'll note also, that means that in those states, where all students compete for positions in the medical school, the ability to pay excludes none of them. This certainly ensures a more complete meritocrcy, meaning that the graduates are of the highest quality and don't include middling to poor students who managed to pay their way through school in some back water.
The US can't move to this system over night. But, it might make incremental steps in this direction in order to help alleviate the crippling cost of medicine.

I'm all for cutting federal spending when it is in excess. I think that there are many examples of this in the US health care system. But I'm confused on how this all relates to Solyndra and Steve's charge that Obama is not spending the taxpayer's money (or more accurately his children's money) well. Ricky are you saying that Solyndra is okay because the US government wastes more money on health care? Or is there some other reason that we are talking about health care again?

Who says these are the appropriate costs?

And there is the problem with central planning, in a nutshell.

There is no way for a government agency to determine what that "appropriate" costs are because they operate outside of the market. The government bases it's decisions on politics, favors, and getting votes, rather than the most efficient use of resources.

Who says these are the appropriate costs? The doctors who accept the payment. How do you know if you aren't paying them enough? They won't do the job. Which is more and more doctors are refusing medicare patients. The reimbursement is not appropriate, in their opinion.

Ray

Or is tehre some otehr reason we are talking about health care again?

I beleive Freeman introduced Health care into this...

I don't know that Obams will be successful in solving our problems with an obstructionist Congress. I am hopeful at some point that we will have patriots in Congress who will insist on doing what is good for the country. At this point, Repuvlicans are saying no to taxes and they want to dismantle our safety net. Of course, they will deny that they want to do that, but they refuse to do anything to solve the health care problem so that Medicare costs are going to go out of control and the economic policies that are pushing wealth to the top (combined with a refusal to raise taxes) is making paying for social security difficult. Once there is fairness and we still cannot pay for social security then, ok, we will have to cut benefits. At some point, yes, everyone has to sacrifice. But not until we restore some fairness to our system

If the delivery of an efficient economy and an efficient govenrment is the underlying issue - then health care is central. Solyndra does seem to be a spectacular failure. However the idea of early stage intervention in the development of industry sectors is entirely defenmsible. Both through the successes in foreign countries and the examples of American successes.
I've never defended the specifics of Solyndra, however. Only the fact that despite Solyndra's example theere is atrack record of policy like this making enormous contributions to industrial strategies.

Freeman's point about health care is apt becasue it is one of the three lagest govenrment expenditures and is an area where free marketers, through their defence of the status quo or only slightly altered staus, have essential surrendered to one of or both of...
relentless cost inflation
less than universal coverage.

Bitching about the small potatoes of a failure like Solyndra is fair. But using it as THE example to discredit an entirely successful strategy isn't...
AND put in the perspective of solving the truly major problems besetting the American economy and governance, its a side show.

theo

And there is the problem with central planning, in a nutshell.
There is no way for a government agency to determine what that "appropriate" costs are because they operate outside of the market. The government bases it's decisions on politics, favors, and getting votes, rather than the most efficient use of resources.
Who says these are the appropriate costs? The doctors who accept the payment. How do you know if you aren't paying them enough? They won't do the job. Which is more and more doctors are refusing medicare patients. The reimbursement is not appropriate, in their opinion

I agree about central planning. However I don't think that the collaborative efforts in many countries that put all stakeholders into the negotiation for a fees schedule is really central planning. You're labelling what the Germans do in their industrial sector (where they cooperativeely manage labour costs, and polcies) with a communist system where a professional manager decrees things...
The German industrial labour sector is very successful.Communism, not so much.

Further, the system as it is, doesn't work. You can point to the theory of free markets controlling costs all you want, but unless you are blind and deaf you have to realize that the US medical inflation outstrips the world, and every other sector of the US economy besides.
So what you've got isn't working.
It might work if the market was flexible. But for that to happen there would have to be a willingness by society to simply not provide service to patients in dire need without means.... But while society is unwillingly to let those in dire need simply die at the curb of the hospital, you've eliminated the leverage that a free market requires for pricing to be effected. And that lever is demand flux)
You can't provide universal coverage and access and expect a free market to function properly.
Once this is realized then the options of delivering cost efficiency become clearer. Most other nations have eventually gone down that road, and even though health care is a problem for everyone it doesn't over whelm the way the American system does. (17% of GDP versus 9% to 12%)

Ricky somewhat incoherently wrote:

Freeman's point about health care is apt becasue it is one of the three lagest govenrment expenditures and is an area where free marketers, through their defence of the status quo or only slightly altered staus, have essential surrendered to one of or both of...
relentless cost inflation
less than universal coverage.

Getting past the fact that Ricky's browser seems to introduce spelling errors when he cuts and pastes my words, and the fact that he cannot write English, I don't see why US health care represents a failure of free markets. The US health care system is the antithesis of a free market system. It is heavily regulated and about 1/2 of the expenditures are government made. Throw in the fact that private expenditures are often influenced by their tax deductibility (income and employment), the US health care system it a demonstration of the failures of poor government legislation, poor government regulation, and the dangers of crony capitalism.

The fact that Obama spent a year "fixing it" (and in some ways made it worse) is an indictment of him and the Democrats.

ray
.

The US health care system is the antithesis of a free market system

really? Cause its seemingly preferred to "socialized medicine". And isn't that the antithesis of free market?

However the US system got into its current state, and whatever you choose to call it, it's a muddled mix that those greatly benefitting from it (Insurance companies, Medical service suppliers, pharma) defend as "free market". All those regulations came about in order to try and improve a system that wasn't meeting the needs of the citizenry at the time they were enacted. . That they've fallen short and could use a major over haul, and probably a fundamental change, is an issue that if resolved could have more effect on the economy and society in general than a million solyndras. (Which was Freemans point)

However the US system got into its current state, and whatever you choose to call it, it's a muddled mix that those greatly benefitting from it (Insurance companies, Medical service suppliers, pharma) defend as "free market".

Of course that's how they defend it. Are they going to defend it as crony capitalism? It's like when the invasion or Iraq was defended as "spreading democracy in the middle east". Did you expect them to defend it as "securing oil rights for American oil companies?"

It seems to me if you're going to blame the government for being the cause of high health
costs without commensurate health care benefits, then you should be able to explain how other western countries are able to deliver health care at a cheaper cost to everyone while at the same time doing better than we do with regard to the overall health of their people (life expectancy, infant mortality, etc.) I understand why health insurance companies and pharmaceutical companies would blame the government for high health care costs, but given that other countries with socialized medicane do a better job of delivering health care I don't understand why anyone would think that government is the major culprit here.

Oh, I know we have the best health care in the world and rich people come to see our specialists...and yet other countries spend less on health care, everyone is covered, and their people are heathier. Yet, we refuse to learn from them and continue our present system.

freeman2 wrote:It seems to me if you're going to blame the government for being the cause of high health
costs without commensurate health care benefits, then you should be able to explain how other western countries are able to deliver health care at a cheaper cost to everyone

Because they run them as significant deficits.

freeman2 wrote:Iwhile at the same time doing better than we do with regard to the overall health of their people (life expectancy, infant mortality, etc.)

Because they don't actually. They use different methods to calculate those figures. For example, in the U.S. we consider any birth where the baby breathes a live birth for infant mortality figures. Much of Europe will only consider it a live birth if the baby survives X number of hours and weighed X lbs at birth. If you recalculate using the same methodologies, the U.S. numbers jump to the top of the list.

Ray Jay wrote:I'm all for cutting federal spending when it is in excess. I think that there are many examples of this in the US health care system. But I'm confused on how this all relates to Solyndra and Steve's charge that Obama is not spending the taxpayer's money (or more accurately his children's money) well. Ricky are you saying that Solyndra is okay because the US government wastes more money on health care? Or is there some other reason that we are talking about health care again?

It's because he thinks it's a winning issue--proof that collective spending is more efficient than the marketplace.

Notice how he can't even connect the dots:

rickyp wrote:Not my thesis Steve. Simply a fact that where governments pay for the education of their doctors, doctors are paid less. And seem to accept that, probably because they are lucky enough to start their careers without crippling debt to dig out of....

Well, yes, it is your thesis. Why do they take less money? Because they are immersed in a socialist system where they don't have to consider the cost of education, never get to dream of getting rich, and can practice whatever sort of medicine the government allows.

You can't separate the State paying for education from the State paying less for doctors. The State is intimately involved in the whole process. They control it.

I'll note also, that means that in those states, where all students compete for positions in the medical school, the ability to pay excludes none of them. This certainly ensures a more complete meritocrcy, meaning that the graduates are of the highest quality and don't include middling to poor students who managed to pay their way through school in some back water.

Socialism leads to meritocracy?

Sure.

Doctor Fate wrote:

I'll note also, that means that in those states, where all students compete for positions in the medical school, the ability to pay excludes none of them. This certainly ensures a more complete meritocrcy, meaning that the graduates are of the highest quality and don't include middling to poor students who managed to pay their way through school in some back water.

Socialism leads to meritocracy?

Sure.

I don't think you read what Ricky wrote. Or perhaps didn't understand it very well. Equality of opportunity (gving people a chance to compete on ability, rather than have moneyed interests distort the field) is not necessarily socialism, but it is certainly more meritocratic.

Unless you think that medical ability comes from your folks having the money to put you through med-school?

danivon wrote:

Doctor Fate wrote:

I'll note also, that means that in those states, where all students compete for positions in the medical school, the ability to pay excludes none of them. This certainly ensures a more complete meritocrcy, meaning that the graduates are of the highest quality and don't include middling to poor students who managed to pay their way through school in some back water.

Socialism leads to meritocracy?

Sure.

I don't think you read what Ricky wrote. Or perhaps didn't understand it very well. Equality of opportunity (gving people a chance to compete on ability, rather than have moneyed interests distort the field) is not necessarily socialism, but it is certainly more meritocratic.

Unless you think that medical ability comes from your folks having the money to put you through med-school?

No, but that is not what he is talking about. Maybe you didn't read what he wrote. What countries pay less to doctors because they put them through school?

Beyond that, you can't even justify the bald claim that it is a more "meritocratic" system. What of those whose education is paid for and who never go into medicine? Drop out of school? Are marginal doctors? What of those whose parents pay their way and become great doctors? Or those who take lesser positions (non-specialists) simply out of a desire to serve their communities?

There would be a lot of work involved to even begin to make the case. However, I really appreciate you (once again) jumping to Ricky's defense. Someone needs to.

freeman2 wrote:

It seems to me if you're going to blame the government for being the cause of high health
costs without commensurate health care benefits, then you should be able to explain how other western countries are able to deliver health care at a cheaper cost to everyone

archduke responded

Because they run them as significant deficits.

If the socialist systems are paying for these deficits from the general tax base, why does this matter?
If you're saying that they add to general deficits okay. But comparing the deficits of the US - I'm not sure this is a distintion with much difference. Particularly because indigent patients showing up in emergency wards and state hospitals are treated at the behest of tax payers OR through over payment by other patients...
Other OECD countries provide health care for between 9 and 12% of GDP. The US spends 17%.
Whether or not the nations are running surpluses generally, and places like Norway and Sweden are doing okay in comparsion, the general cost efficientcy and cost effectiveness are the salient points,



freeman2 wrote:

Iwhile at the same time doing better than we do with regard to the overall health of their people (life expectancy, infant mortality, etc.)

archduke answered

Because they don't actually. They use different methods to calculate those figures. For example, in the U.S. we consider any birth where the baby breathes a live birth for infant mortality figures. Much of Europe will only consider it a live birth if the baby survives X number of hours and weighed X lbs at birth. If you recalculate using the same methodologies, the U.S. numbers jump to the top of the list.

Lets say every time you get down in the weeds and examine the subtle differences (the few hours difference in the definitions of live birth for instance), the US improves its relative performance... does the end result still justify an expenditure of 5 to 7 points of GDP more than the compared nation?

Thats the central problem that Freeman points towards. Generally there is a defence of the health care system as free market. Even though it isn't. And that defence is lead generally by the stake holders within the industry who benefit most from the status quo.
And that defence usually leads to battles over counter factual minutae like the definition of a live birth. But is generally obfuscation and doesn't lead to the kind of honest assesments that can lead to the incremental improvements that can increase effectiveness or efficiency.
I don't think its at all possible for the US to turn around the cost effectiveness or efficiency of its health care system over night, in a significant way. But, it is important to first admit that whats in place isn't really working that well, and that begins by surrendering the notion that the system needs defending.
It needs improving. And whats offered from republicans right now, "lets get rid of oabama care", is simplistic nonsense.
The recent changes to health care aren't particularly effective or efficient. But they at least move in a direction that sugests incremental chnage can be accomplished. And the changes to "universality" and portability will be major improvements for a lot of people.
I also note that Obama allowed Medicare to negotiate with Pharmeceutical suppliers, and that is resulting in billions of dollars in savings. (I'm repeating a claim here that I have yet to find substantiation for, the savings that is not the executive order, ....but I'll look).

steve

What countries pay less to doctors because they put them through school?

Try reading the study again. The US, even when purchasing power of the dollar is factored for, pays doctors more than any other nation.
The authors then note : most of those other nations pay all or part of the cost of the education of their doctors.
http://economix.blogs.nytimes.com/2009/ ... ries-make/

A pure meritocracy simple means that the best students compete for the positions based upon their scholastic records. When the students aren't disqualified because they can't afford tuition or books etc., all students compete on an equal footing.
I'm not sure why you have trouble comprehending this.... The fact that students who do pay their way can be excellent doctors is a non-sequitar.
They gained their education in part becasue they were the best of the pool of students competing for positions who were able to afford the education. The more expensive the education the smaller the pool of students who will be able to compete.
The more competition there is, the better the final product. And when you remove affordability as a factor the competition pool becomes largest.
(Its really the basic reason the Finnish education system is better... More competition for positions in teaching schools... )