The fundamental problem is that we don't pay people to die.
Let's say you're in the hospital. You're in agony and the doctor offers you something that probably won't work and if it does won't extend your life very long. Right now you are presented with two options.
1) Let the government pay a bunch of money on free stuff for you
2) Save the government some money
I mean I'm not surprised that people pick #1. Sometimes their own suffering is enough to end it but they don't think about the money even when it's hundreds of thousands of dollars.
By contrast if turning down end of life Medicare expenses left money to your descendants I think a lot of people would pick #2. But we don't offer it because its uncomfortable socially.
Oh, no, it's so much worse than that! Patients don't have the ability to refuse treatment, and people in agony are forced to go through the treatment no matter how much they wish to die. I want this spending stopped so that the hell-prisons are shut down, and I recommend you avoid the medical system once your body starts breaking down from old age.
If Mises thought only government bureaucracies had spending rules and budget limits, it just clarifies that he never worked for a private business. Under any system, there have to be limits to care. Do we trust civil servants? Politicians? Corporate executives? Hedge fund managers? Private equity? It's not obvious to me that transferring responsibility for such decisions to private businesspeople operating under incentives to increase ROI would provide better outcomes. Or cheaper ones.
"f it seems cold-blooded to put a price on another person’s life, remember that each of us puts a price tag on our own lives every time we drive to the store or cross the street."
...only an economist would think of doing anything that (explicitly) stupid.
"These detailed instructions are necessary because in a bureaucracy what has to be done and what has not to be done must be determined by such rules."
I wish Mises would explain why this is the case, and why those instructions are unnecessary outside government. Seems like the reasons he points to fail to distinguish government from private business.
Every company I ever worked for had rules about what could be spent by employees. That's a limited number of companies, but no business would allow an employee unlimited freedom to spend the company's money. Most employees have no ability to use company funds to buy anything outside of very limited expense account items.
The real question, Brian, is why private insurance companies are not more aggressively performing the role of "death panels" to weed out inefficient therapies/medications. My explanations are regulations, the lack of competition, public relations problems, and the impact of the Medicare "template." My suspicion is that, in a free market for healthcare insurance, companies would offer products with different prices and different policies on high cost, but only marginally effective, therapies/medications. What are your thoughts?
There really isn't "private insurance". If you run say a Medicare Advantage plan what you have to cover is going to be extremely regulated. Only a narrow band of treatments are optional coverage, usually the government either allows or forbids it.
A lot of what insurance companies try to do is find way to nudge bad risk onto someone else's insurance plan.
In a totally free market insurance companies would offer effective and efficient coverage for everyone that doesn't have a pre-existing condition. The people with pre-existing conditions would be unable to purchase affordable insurance. No, it's not possible to sell pre-existing condition insurance (even the most limited attempt have failed spectacularly).
That's the basic problem. People with pre-existing conditions want subsidies and people that are worried about having pre-existing conditions can't insure against the risk without accepting some degree of subsidy for those that already have them in a universal risk pool.
The fundamental problem is that we don't pay people to die.
Let's say you're in the hospital. You're in agony and the doctor offers you something that probably won't work and if it does won't extend your life very long. Right now you are presented with two options.
1) Let the government pay a bunch of money on free stuff for you
2) Save the government some money
I mean I'm not surprised that people pick #1. Sometimes their own suffering is enough to end it but they don't think about the money even when it's hundreds of thousands of dollars.
By contrast if turning down end of life Medicare expenses left money to your descendants I think a lot of people would pick #2. But we don't offer it because its uncomfortable socially.
Oh, no, it's so much worse than that! Patients don't have the ability to refuse treatment, and people in agony are forced to go through the treatment no matter how much they wish to die. I want this spending stopped so that the hell-prisons are shut down, and I recommend you avoid the medical system once your body starts breaking down from old age.
Scott Alexander wrote a post about end of life care at the hospital he works at and it is horrible. https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/
I’m well aware.
The worst situation is to spend other people's money on other people. And that's exactly how our medical system does it.
If Mises thought only government bureaucracies had spending rules and budget limits, it just clarifies that he never worked for a private business. Under any system, there have to be limits to care. Do we trust civil servants? Politicians? Corporate executives? Hedge fund managers? Private equity? It's not obvious to me that transferring responsibility for such decisions to private businesspeople operating under incentives to increase ROI would provide better outcomes. Or cheaper ones.
"f it seems cold-blooded to put a price on another person’s life, remember that each of us puts a price tag on our own lives every time we drive to the store or cross the street."
...only an economist would think of doing anything that (explicitly) stupid.
I put a price on my head when I go do the groceries or hang out at the park- what are you babbling on about?
"These detailed instructions are necessary because in a bureaucracy what has to be done and what has not to be done must be determined by such rules."
I wish Mises would explain why this is the case, and why those instructions are unnecessary outside government. Seems like the reasons he points to fail to distinguish government from private business.
Every company I ever worked for had rules about what could be spent by employees. That's a limited number of companies, but no business would allow an employee unlimited freedom to spend the company's money. Most employees have no ability to use company funds to buy anything outside of very limited expense account items.
But Shell Oil was generous compared to the Navy.
The real question, Brian, is why private insurance companies are not more aggressively performing the role of "death panels" to weed out inefficient therapies/medications. My explanations are regulations, the lack of competition, public relations problems, and the impact of the Medicare "template." My suspicion is that, in a free market for healthcare insurance, companies would offer products with different prices and different policies on high cost, but only marginally effective, therapies/medications. What are your thoughts?
There really isn't "private insurance". If you run say a Medicare Advantage plan what you have to cover is going to be extremely regulated. Only a narrow band of treatments are optional coverage, usually the government either allows or forbids it.
A lot of what insurance companies try to do is find way to nudge bad risk onto someone else's insurance plan.
In a totally free market insurance companies would offer effective and efficient coverage for everyone that doesn't have a pre-existing condition. The people with pre-existing conditions would be unable to purchase affordable insurance. No, it's not possible to sell pre-existing condition insurance (even the most limited attempt have failed spectacularly).
That's the basic problem. People with pre-existing conditions want subsidies and people that are worried about having pre-existing conditions can't insure against the risk without accepting some degree of subsidy for those that already have them in a universal risk pool.
Hillary Clinton's Task Force had decided that there would be an age limit on provision of health care, any kind of care, after a certain age.