jrodefeld posted:

Your argument that is is merely superior technology that accounts for the rising cost of healthcare does not wash. This is not true in any other sector of the economy where dramatically increasing levels of technology have actually lowered costs.

Why are computers not drastically more expensive than they were thirty years ago given how much more powerful and sophisticated they are today?

Healthcare has transformed in many ways over the past half century but improved technology usually results in labor saving for the same procedures and routines. We can compare apples to apples and when we do we see that heart surgery in 1960 and heart surgery in 2015 are drastically different in cost, with the inflated cost outstripping the CPI over the past half century.

SedanChair posted:

Did this fool just credit libertarians for decriminalization in the Netherlands?

jrodefeld posted:

Your argument that is is merely superior technology that accounts for the rising cost of healthcare does not wash. This is not true in any other sector of the economy where dramatically increasing levels of technology have actually lowered costs.

Why are computers not drastically more expensive than they were thirty years ago given how much more powerful and sophisticated they are today?

Healthcare has transformed in many ways over the past half century but improved technology usually results in labor saving for the same procedures and routines. We can compare apples to apples and when we do we see that heart surgery in 1960 and heart surgery in 2015 are drastically different in cost, with the inflated cost outstripping the CPI over the past half century.

The other angle to this is that if you examine the sector of healthcare where State interference is less, like Lasik eye surgery, cosmetic dentistry and surgery, we see falling prices due to price competition. Insurance don't cover these procedures and the State doesn't pay for them either. Yet prices have continually fallen in Lasik eye surgery even though the technology has continued to improve.

We can similarly see that where price competition is introduced into conventional medicine, as with the Oklahoma Surgery Center that advertises its prices for common procedures, prices fall far below the cost at other hospitals that rely on State funding and insurance payments.

jrodefeld posted:

Your argument that is is merely superior technology that accounts for the rising cost of healthcare does not wash. This is not true in any other sector of the economy where dramatically increasing levels of technology have actually lowered costs.

Why are computers not drastically more expensive than they were thirty years ago given how much more powerful and sophisticated they are today?

jrodefeld posted:

Healthcare has transformed in many ways over the past half century but improved technology usually results in labor saving for the same procedures and routines. We can compare apples to apples and when we do we see that heart surgery in 1960 and heart surgery in 2015 are drastically different in cost, with the inflated cost outstripping the CPI over the past half century.

jrodefeld posted:

The other angle to this is that if you examine the sector of healthcare where State interference is less, like Lasik eye surgery, cosmetic dentistry and surgery, we see falling prices due to price competition. Insurance don't cover these procedures and the State doesn't pay for them either. Yet prices have continually fallen in Lasik eye surgery even though the technology has continued to improve.

jrodefeld posted:

We can similarly see that where price competition is introduced into conventional medicine, as with the Oklahoma Surgery Center that advertises its prices for common procedures, prices fall far below the cost at other hospitals that rely on State funding and insurance payments.

jrodefeld posted:

Comparing healthcare costs in the United States to a place like Canada is not an apt comparison if your goal is to prove that since healthcare costs are lower in Canada that somehow means that State intervention doesn't cause excessive price inflation. Canada's healthcare costs are likely to be inflated beyond what would exist in a market economy.

jrodefeld posted:

There are too many moving parts in a complex economy and with central banking and fiscal policy of the governments of different nations to make precisely productive comparisons.

jrodefeld posted:

The best comparison is the one I have made where you compare, ceteris paribus, the costs of healthcare where there is no government involvement in the same economy to where there is heavy government involvement. Or to compare costs of healthcare from before the State got involved and insurance companies took on an outsized role in paying medical expenses to after these interventions took place.

If we do that, all evidence points to the fact that State intervention and third party payer schemes raise the cost of medical care way beyond the general inflation rate in the broader economy.

jrodefeld posted:

Your argument that is is merely superior technology that accounts for the rising cost of healthcare does not wash. This is not true in any other sector of the economy where dramatically increasing levels of technology have actually lowered costs.

quote:

Why are computers not drastically more expensive than they were thirty years ago given how much more powerful and sophisticated they are today?

quote:

Healthcare has transformed in many ways over the past half century but improved technology usually results in labor saving for the same procedures and routines. We can compare apples to apples and when we do we see that heart surgery in 1960 and heart surgery in 2015 are drastically different in cost, with the inflated cost outstripping the CPI over the past half century.

quote:

The other angle to this is that if you examine the sector of healthcare where State interference is less, like Lasik eye surgery, cosmetic dentistry and surgery, we see falling prices due to price competition. Insurance don't cover these procedures and the State doesn't pay for them either. Yet prices have continually fallen in Lasik eye surgery even though the technology has continued to improve.

quote:

We can similarly see that where price competition is introduced into conventional medicine, as with the Oklahoma Surgery Center that advertises its prices for common procedures, prices fall far below the cost at other hospitals that rely on State funding and insurance payments.

quote:

Comparing healthcare costs in the United States to a place like Canada is not an apt comparison if your goal is to prove that since healthcare costs are lower in Canada that somehow means that State intervention doesn't cause excessive price inflation. Canada's healthcare costs are likely to be inflated beyond what would exist in a market economy.

There are too many moving parts in a complex economy and with central banking and fiscal policy of the governments of different nations to make precisely productive comparisons.

The best comparison is the one I have made where you compare, ceteris paribus, the costs of healthcare where there is no government involvement in the same economy to where there is heavy government involvement. Or to compare costs of healthcare from before the State got involved and insurance companies took on an outsized role in paying medical expenses to after these interventions took place.

If we do that, all evidence points to the fact that State intervention and third party payer schemes raise the cost of medical care way beyond the general inflation rate in the broader economy.

jrodefeld posted:

Please take a moment to read Mises's "The Anti-Capitalist Mentality" and really ask yourself whose philosophy has actually caused the greatest rising living standards and increased well being for society as a whole. The notion that Marxists and advocates of State power are on the side of the average person is tragically misguided. These people simultaneously enjoy living standards and luxuries afforded only through private production and division of labor while railing against the system that has provided them, all while ignoring the blatant irony.

jrodefeld posted:

Do you honestly feel like absolute material equality is a virtuous, desirable or feasible goal? And you propose we achieve it through the State, which is the most blatantly anti-egalitarian institution ever created? This is a bankrupt ideology.

Caros posted:

The Oklahoma Surgery Center is capable of doing what it does because it is an elective Surgery Center that is capable of taking a small amount healthy patients who pay significant amounts of cash up front for procedures, something that isn't true of your typical hospital that performs the same procedures. They have no administrative staff, and their prices increase dramatically when insurance is involved.

Moreover, the actual prices between local hospitals and the surgery center are far closer than you suggest. The oft quoted $33,000 vs $5800 fee is only applicable when you are looking at the hospital's master charge sheet. No one, not even someone actually paying out of pocket pays the charge sheet price, which is typically inflated solely so that the hospital can barter with insurance companies, which is of course a problem of having multiple insurers instead of single payer.

So yeah, you can have a successful surgery center when it is run by ideological libertarians who cherry pick their patients and avoid most overhead. Its the same system used to make charter schools look good. If it was as good as you suggest, it wouldn't be nearly unique.

VitalSigns posted:

Well now that you're answering questions, how about telling me how ISIL is managing to wage a somewhat successful war of conquest without a pre-existing tax base or market for its debt?

Because it kinda looks to me like proof that in the absence of a strong state able to exercise control of territory, it turns out it actually is very profitable to get a bunch of guys together, extort tribute from towns and villages, and seize oil wells for crude to sell on the black market, but idk, I'm open to the idea that ISIL came through a Slide from Caliphate Earth.

jrodefeld posted:

Please take a moment to read Mises's "The Anti-Capitalist Mentality" and really ask yourself whose philosophy has actually caused the greatest rising living standards and increased well being for society as a whole. The notion that Marxists and advocates of State power are on the side of the average person is tragically misguided. These people simultaneously enjoy living standards and luxuries afforded only through private production and division of labor while railing against the system that has provided them, all while ignoring the blatant irony.

Do you honestly feel like absolute material equality is a virtuous, desirable or feasible goal? And you propose we achieve it through the State, which is the most blatantly anti-egalitarian institution ever created? This is a bankrupt ideology.

People in the market who attain wealth through voluntary transactions deserve what they attain. They are free and indeed I would consider it a virtue, if they used their wealth to help others through charity and humanitarian pursuits. But we mustn't forget that it is the market economy that compels others to provide value to consumers in the pursuit of improving their own well being.

Envy is called the "green eyed monster" for a reason. It is a tragically destructive tendency of man. We should never think ill of a man because he has more than we do. We should think ill of him if he used coercion and theft to achieve his status in life.

Plenty of rich cronies have achieved their wealth through illegitimate means as I have stressed over and over. Again, it is the force, the coercion and the theft that makes these people deserving of our ire, not their superior wealth or social status.

jrodefeld posted:

And no, voluntarily hiring workers is NOT theft of their labor for any Marxists who are reading this. I've explained why a thousand times. If I was speaking to an audience, my voice would be hoarse by repeating myself so many times.

I voluntary contract is not, by definition, theft unless that contract is signed under duress. But the presence of threats or intimidation would mean that the contract is not voluntary. That is a different subject.

I support the market and the division of labor instead of State intervention primarily BECAUSE I care about the masses of the people. It is the average person who needs the benefits of mass production, not the very wealthy.

Cemetry Gator posted:

Oh, PS - gently caress you Jrodefeld. We already had this conversation.

Read this post you rear end in a top hat and see that all the points you just brought up were already brought up by you and discussed.

And here's Caros' post on the OSC.


And I'm being abusive because you're being dense and refusing to listen to what we have to say.

jrodefeld posted:

No chance. If an anarchist society was attacked by a bunch of criminals like on 9/11, the most likely outcome is that privately financed mercenaries would go get Bin Laden and his co conspirators and kill them or bring them here for a trial.

jrodefeld posted:

Please take a moment to read Mises's "The Anti-Capitalist Mentality" and really ask yourself whose philosophy has actually caused the greatest rising living standards and increased well being for society as a whole. The notion that Marxists and advocates of State power are on the side of the average person is tragically misguided. These people simultaneously enjoy living standards and luxuries afforded only through private production and division of labor while railing against the system that has provided them, all while ignoring the blatant irony.

quote:

Envy is called the "green eyed monster" for a reason. It is a tragically destructive tendency of man. We should never think ill of a man because he has more than we do. We should think ill of him if he used coercion and theft to achieve his status in life.

quote:

And no, voluntarily hiring workers is NOT theft of their labor for any Marxists who are reading this. I've explained why a thousand times. If I was speaking to an audience, my voice would be hoarse by repeating myself so many times.

I voluntary contract is not, by definition, theft unless that contract is signed under duress. But the presence of threats or intimidation would mean that the contract is not voluntary. That is a different subject.

jrodefeld posted:

jrodefeld posted:

Supposing the United States was a libertarian, State-less society. Do you suppose anyone would choose to wage war in Iraq or Afghanistan if they had to privately finance it? No chance. If an anarchist society was attacked by a bunch of criminals like on 9/11, the most likely outcome is that privately financed mercenaries would go get Bin Laden and his co conspirators and kill them or bring them here for a trial. No ground invasion of a sovereign nation or anything like that. Quick, pinpoint accuracy. The cost of an ongoing conflict will be of great concern to the private financiers of a defensive conflict, so the emphasis would be to defend the society with the least cost and the shortest possible time.

Etalommi posted:

Jrod, on the whole costs of the tech thing, you are even more dead wrong than the others have already pointed out. The most direct comparison possible is not computers -> personal computers, but room sized computers used by institutions then and now. These have gotten massively more powerful, but also massively more expensive. Have you seen the price on a state-of-the-art super computer, or even a data warehouse?

jrodefeld posted:

You have misunderstood my comments about war. I had never meant to say that war is impossible without a State or central banking. And I was not speaking about small scale terrorism or gang "war"-fare. This is plain criminality, not really an organized industrial war effort.

jrodefeld posted:

What I was trying to say is that if and when you have a productive, modern market economy such as we have in the United States and other first world nations, then war, specifically war against other nations, is made much less likely without a means of externalizing the costs of that conflict.

jrodefeld posted:

Supposing the United States was a libertarian, State-less society. Do you suppose anyone would choose to wage war in Iraq or Afghanistan if they had to privately finance it?

jrodefeld posted:

Private individuals would solve everything

VitalSigns posted:

Oh yay, instead of a bad president starting a war every 10 or 20 years and killing a few thousand Americans, we get the entire world divided up among ISIL or yakuza style gangs, each of whom kill that many before breakfast. What a great world you're painting here, sign me the gently caress up!

jrodefeld posted:

No I said that decriminalization of drugs is a core libertarian reform that we have been advocating for a long time. But, as mentioned, this is also an issue where leftists agree so I won't continue to count it as an exclusively "libertarian" reform or idea.

jrodefeld posted:

Your argument that is is merely superior technology that accounts for the rising cost of healthcare does not wash. This is not true in any other sector of the economy where dramatically increasing levels of technology have actually lowered costs.

quote:

Why are computers not drastically more expensive than they were thirty years ago given how much more powerful and sophisticated they are today?

quote:

The other angle to this is that if you examine the sector of healthcare where State interference is less, like Lasik eye surgery, cosmetic dentistry and surgery, we see falling prices due to price competition. Insurance don't cover these procedures and the State doesn't pay for them either. Yet prices have continually fallen in Lasik eye surgery even though the technology has continued to improve.

quote:

Comparing healthcare costs in the United States to a place like Canada is not an apt comparison if your goal is to prove that since healthcare costs are lower in Canada that somehow means that State intervention doesn't cause excessive price inflation. Canada's healthcare costs are likely to be inflated beyond what would exist in a market economy.

quote:

The best comparison is the one I have made where you compare, ceteris paribus, the costs of healthcare where there is no government involvement in the same economy to where there is heavy government involvement. Or to compare costs of healthcare from before the State got involved and insurance companies took on an outsized role in paying medical expenses to after these interventions took place.

quote:

If we do that, all evidence points to the fact that State intervention and third party payer schemes raise the cost of medical care way beyond the general inflation rate in the broader economy.

jrodefeld posted:

You have misunderstood my comments about war. I had never meant to say that war is impossible without a State or central banking. And I was not speaking about small scale terrorism or gang "war"-fare. This is plain criminality, not really an organized industrial war effort.

What I was trying to say is that if and when you have a productive, modern market economy such as we have in the United States and other first world nations, then war, specifically war against other nations, is made much less likely without a means of externalizing the costs of that conflict.

Supposing the United States was a libertarian, State-less society. Do you suppose anyone would choose to wage war in Iraq or Afghanistan if they had to privately finance it? No chance. If an anarchist society was attacked by a bunch of criminals like on 9/11, the most likely outcome is that privately financed mercenaries would go get Bin Laden and his co conspirators and kill them or bring them here for a trial. No ground invasion of a sovereign nation or anything like that. Quick, pinpoint accuracy. The cost of an ongoing conflict will be of great concern to the private financiers of a defensive conflict, so the emphasis would be to defend the society with the least cost and the shortest possible time.

Similarly, civil war between defense agencies or private arbitrators would be exceedingly unlikely because such a conflict is extremely unlikely to be worth the cost and businesses are interested in making profits. Civil war against another firm just so you can have one less competitor in the market, and knowing that another competitor could just spring up tomorrow, not to mention the ill will and anger that such an act would generate among the general population who they rely on as clients.

I was speaking of incentives. The facts are clear that large scale and prolonged wars are far more likely when leaders can resort to monetizing war debts and outsource the costs to taxpayers and citizen soldiers who are killed in the conflict.

Yes there are certain situations whereby a costly conquest could be profitable for a private group. But such examples, especially in the modern era, are exceedingly rare and far less likely than politicians and State contractors who almost ALWAYS stand to profit from taking nation-states to war.

Mornacale posted:

Since you're actually answering questions about healthcare, I am not going to debate you about libertarianism's inherent racism. But I want to just give you an idea to mull over. When asked if racial discrimination is morally wrong, the first thrusts of your response are 1) justifying the idea of not preventing it, and 2) nitpicking about how it's okay sometimes. This suggests to the reader that you are more concerned with not being called racist than with actually ending racism. I would ask you to really seriously think about what caused you to address the question in this way.

e: Just for clarity, I am not trying to drive you to the conclusion "I, jrod, secretly hate all black people" because I am honestly willing to believe you that you want the best for others.

jrodefeld posted:

Could not the exact same argument be made against the ACLU or other left-wing free speech groups who support the rights of bigots to publish hate speech? No one accuses ACLU lawyers of being secret racists when they come to the defense of people who make reprehensible statements. Their goal as an organization is in the defense of the Bill of Rights and any restriction on these rights, even for popular measures such as stifling hate speech, creates a chilling effect and precedent for the censorship or suppression of less controversial speech and eventually all speech becomes threatened.

jrodefeld posted:

Could not the exact same argument be made against the ACLU or other left-wing free speech groups who support the rights of bigots to publish hate speech? No one accuses ACLU lawyers of being secret racists when they come to the defense of people who make reprehensible statements. Their goal as an organization is in the defense of the Bill of Rights and any restriction on these rights, even for popular measures such as stifling hate speech, creates a chilling effect and precedent for the censorship or suppression of less controversial speech and eventually all speech becomes threatened.

quote:

It is the same with the libertarian. You question our commitment to "anti racism" because we defend the right of the private property owner to discriminate on who he can invite onto his property or who he can dis-invite. The right to freedom of association and the right to be free from coercion against your person or property is the principle that libertarians are trying to defend.

quote:

Similar to ACLU defenses of the right to free speech of bigots, the libertarian opposes the use of aggression against private property owners even for bigots because we know that the betrayal of this principle of private property as an expression of self ownership will inevitably create precedent for further rights violations until the private property owner is being inundated from all sides with demands and conditions on how he must use his property, how he must not, and who he can and must associate with on his private property through the establishment of strict racial quotas for hiring practices, and leaving him vulnerable to lawsuits and all manner of expensive and time consuming litigation.p/quote]

So... the slippery slope argument. Jeeze, if you tell us we have to let blacks into our restaurants the next thing you know we'll have to stop storing those oily rags next to the stove! Those things you suggest are not 'inevitable' outcomes, or even necessarily bad outcomes. And unlike the ACLU's defense of free speech, the right to discriminate based on race is not one that our society believes should be more or less inviolate.

[quote]Of course this principle of private property is of urgent importance to the black community as well. The black entrepreneur should have the understood right to use his or her property in the manner they see fit. They don't need to be the victim of systemic assaults on private property any more than white folks or Asians or Hispanics.

QuarkJets posted:

The ACLU simultaneously supports free speech while fighting against people who seek to commit bigoted actions. For instance, the ACLU would happily provide representation to an African American who was banned from a restaurant on the basis of skin color. Libertarians would not do the same.

jrodefeld posted:

Could not the exact same argument be made against the ACLU or other left-wing free speech groups who support the rights of bigots to publish hate speech? No one accuses ACLU lawyers of being secret racists when they come to the defense of people who make reprehensible statements.

jrodefeld posted:

I too would appreciate more libertarians on this site, if only so that a discussion like this could be more comprehensive and not a thirty to one sort of pile on.

I maintain that this is really not a very good way to discuss these issues. There are a million different issues and every little diversion sidetracks discussions, complaints are levied that I didn't respond to specific posts and topics are switched before others are fully fleshed out.

I have one more thing to say about Hoppe and the racism charge against him. I will offer a concession of sorts. I was not too familiar with the Property and Freedom Society that he runs. I've looked into exactly who people like Jared Taylor and Richard Lynn are and I don't agree with any of that "racial realism" crap. I reject it completely.

I only judge what I read personally from Hoppe and, whatever his personal beliefs, his articulation of libertarian theory and Austrian economics are consistent with what every other notable libertarian intellectual has said for half a century or more, most of whom who have never uttered any un-PC statements. I've long known about Hoppe's social conservatism and his disdain for "left libertarians".

With this new evidence, I can say that there is a high likelihood that Hoppe personally believes in some of this "racial realism" stuff, or that there are racial differences in intelligence or whatever the continuum is on this line of controversial thinking.

And I can say that I profoundly disagree. I never actually meant to take time defending anyone else, but rather to defend myself and my own views. I'm not going to defend Hoppe against charges of racism or anyone else for that matter.


I don't mind people who dabble into controversial subjects and even those who hold controversial positions on race and genetic differences. Race is a subject where a full and open discussion is not possible for fear of being labeled "racist" or being silenced by the PC police. With that said, I think that some libertarians open courting of certain controversial figures are making a big mistake.

Here is some history. Murray Rothbard personally aligned himself with the New Left in the 1960s and his writings at the time reflected this alliance. He joined left coalitions in opposing the Vietnam War and he hated the Cold War militarism and propaganda of Bill Buckley and The Weekly Standard, who reciprocated that hatred. As we know in the 1970s he was instrumental in the founding of the Libertarian Party and libertarians became a third political choice, neither left nor right. This is where I feel Rothbard should have stayed, at least strategically.

What happened next is well known. The Koch Brothers became more and more influential and wanted to mold the libertarian movement and control it. They wanted to "sanitize" it and remove its teeth, remaking it into an inside-the-beltway, "respectable" and in many ways dumbed down movement that would be welcomed or at least tolerated by the D.C. opinion molders.

Murray Rothbard was infuriated by Ed Kochs 1980 run as the Libertarian Party nominee when he called libertarianism "low tax liberalism" and watered down the core tenets of the belief system. Soon he was fired from the Cato institute and his vocal criticisms of the Kochs made them lifelong enemies.

Rothbard, along with Lew Rockwell, went on to found the Ludwig von MIses Institute as a competing, far more intellectually vigorous and principled libertarian think tank organization. The Koch funded enterprises continued to try to make inroads into the mainstream through Cato and Reason magazine and they made continual overtures to the left and the D.C. crowd.

They basically purged Rothbard from their educational efforts, though students still read him his work wasn't provided or recommended. The same, to a lesser extent, is true of Mises. They preferred people read the more mainstream Hayek and Milton Friedman.

What happened next was unfortunate and a case of bad strategy all around. Rothbard and some elements and the Mises Institute sought new alliances to advance their more radical anti-State views. As a counter reaction to the supposed "left-libertarianism" of Cato, Reason and other Koch funded entities, they created new alliances most notably with the paleo conservatives. This, just as was Rothbard's alliance with the New Left in the 1960s, was one of convenience and strategy. People like Pat Buchanan, who was a genuine paleo-conservative, were not libertarians but hated the State enough and were similarly disaffected from the Republican Party as Murray was to the Koch enterprises.

What this alliance brought on was a bunch of baggage. These paleo-conservatives tented to hold a substantial degree of racial resentment that was not shared by libertarians. It was even proposed at the low point in libertarian popularity (right after the presidency of Ronald Reagan) that a deliberate strategy of "outreach to the rednecks" (and that exact phrase was used) should be pursued. This paleo-conservative alliance in addition to this strategy of seeking the support of anyone who held anger towards the State is the primary reason for the infamous "Ron Paul Newsletters" that have caused so much trouble for him over his political career.

Libertarians didn't believe any of that stuff that was printed in those newsletters, it was a cynical and stupid attempt to generate anti-State sentiment in angry white trash. Thankfully this tactic was abandoned by the mid 1990s as the institute came into its own.

This counter reaction to the Koch enterprises pushed the MIses Institute crowd to align more with paleo-conservatives over the years.

Let me explain something about many libertarians. We are primarily concerned with the principles of individual liberty, private property and non aggression, sound money and decentralism. As a small movement we tend to align ourselves in political coalitions with people we disagree with frequently, provided there is agreement on the central tenets that we believe in.

Some libertarians don't care whether someone personally holds an irrational racial prejudice in their heads so long as they believe in the non-aggression principle and private property rights, meaning that they would never initiate violence against someone no matter what they might think about them.

Jared Taylor and Richard Lynn are NOT libertarians. I would wager not even 1% of libertarians agree with them on their racial views.

Hans Hermann Hoppe is the one intellectual who never backed down from that early paleo-conservative strategy but doubled down on it. He has routinely harshly criticized left libertarians for a whole number of reasons, a few legitimate and many that are not legitimate. He seems to think that libertarians need to align heavily with radical conservatism. Even many at the MIses Institute have criticized him for these views.

Yet and still, as an economist and political theorist, I find him very good and I will continue to read him on issues that I agree and continue to strongly reject his social ideas and proposed strategy. I continue to find his writings on Argumentation Ethics and many of his criticisms of Democracy to be very interesting and compelling.

He authored one of the most influential (to me) articles/speeches I have heard. He critiqued and contrasted Marxist and Libertarian Class Analysis and I think made a compelling cases for what Marx gets right and what he gets wrong. It is indeed a libertarian class analysis and a different distinction between the exploited masses and the exploiters that needs to be expressed. As a comparison between radical leftist Marxism and radical libertarianism, I don't think it has any equal.

Muscle Tracer posted:

Hahahaha

Off the top of my head, other industries that have had their costs increased by technology include food preservation, transportation, telecommunications.

Back in the old days, all I needed to do to preserve food was rub salt on it, or smoke it! Nowadays, though, I have to not only buy a refrigerator, but also the electricity to run it! PRICES SKYROCKET!!

The time was, I got around on my own two good ol' feet, for FREE. Nowadays you can hardly buy a bicycle for $200, much less getting around in a car for thousands of dollars, or by plane for hundreds of dollars per trip!! LITERALLY INFINITE PRICE INFLATION!!!

My grandpa could send a message across the world by just strolling down to the local telegraph office and paying a nickel to send 140 characters to his sweetheart in Cincinnati. But now? I've gotta have this dumb iPhone, and make monthly payments to Verizon—or worse yet, use an expensive computing doodad to access that newfangled Internet thing!!

What do these three examples, and healthcare, have in common? What do they have that other industries made cheaper by technology lack? Things that were once impossible are now possible. When technology makes a procedure easier, the cost is likely to decrease, but when a new and better process is developed—not an improvement, but a replacement—prices tend to rise!!!!

jrodefeld posted:

Yes this is self evident. But that doesn't explain the healthcare phenomenon.

jrodefeld posted:

Yes this is self evident. But that doesn't explain the healthcare phenomenon. I mentioned that we can compare an apples to apples comparison like heart surgery in 1960 and heart surgery today and see price inflation far higher than the CPI. This isn't explained because heart surgeries are so much more sophisticated now. They still require a skilled surgeon, a bunch of assistant, a few hours in a hospital room and several days to recover before heading home. Yet the costs have increased quite substantially, much more than could be anticipated by comparing general price inflation in the broader economy.

jrodefeld posted:

Yes this is self evident. But that doesn't explain the healthcare phenomenon. I mentioned that we can compare an apples to apples comparison like heart surgery in 1960 and heart surgery today and see price inflation far higher than the CPI. This isn't explained because heart surgeries are so much more sophisticated now. They still require a skilled surgeon, a bunch of assistant, a few hours in a hospital room and several days to recover before heading home. Yet the costs have increased quite substantially, much more than could be anticipated by comparing general price inflation in the broader economy.

I don't know why you feel the need to make the obvious point that if you need a surgery for a medical condition for which no treatment existed fifty years ago, your medical care rates would be higher than if you got no treatment fifty years ago. You would live of course and not die which seems a fair trade off to me.

Of course having a life threatening or permanently debilitating illness for which no treatment was available in the past likely meant that the overall cost to your family would be massively greater than if a cure was available, no matter how inflated the cost. That is also self evident.


I don't know why you fight the notion that when consumers are completely divorced from the cost of their medical care, they don't care about costs and costs naturally are inflated higher than they otherwise would be. How exactly is this a point that you feel the need to argue with?

Let's say that tomorrow, the Federal Government took over the cell phone industry. Nationalized it completely and created a "single payer" system of cell phone service available to everyone. You would be eligible to receive the newest iPhone every year for free. The State contracted out the actual production of the phones to Apple and the service to Verizon.

Now would you expect that the cost for an iPhone would rise, fall or stay the same? Naturally Apple would charge the State a lot more because they can get away with it. iPhones might cost $7000 per phone instead of $600 or $200 with a contract that they cost for consumers today.

And since for consumers the phone is "free" why would they shop around? Why would they compare and contrast and look for alternatives?

Now suppose another scenario where the government didn't nationalize the entire cell phone market but a small pocket of companies also offered a few models and plans that people could buy for themselves. They also contracted with the State but you could purchase a phone on your own as well.

Do you suppose the price would still be inflated? Of course it would. The less a company needs the consumer to buy their products, the less likely they are to lower costs and improve quality. Why sell the consumer a phone for $600 when the State is buying up phones produced by contractors for $7000 each?

Thus heavy State intervention raises costs even for pockets of the market that remain open to those few consumers who buy their own cell phones and forgo the State offered "free" phones and wireless plans.


This is exactly analogous to what has happened in the healthcare market in the United States. The third party payment system, comprised of the State for veterans, a portion of the poor, and the elderly, and Insurance companies for nearly everyone else, raises costs because the consumer has no incentive to shop around for lower costs.

And with heavily inflated healthcare costs, what happens if an insurance company denies you care or you don't have medical insurance because you were fired from your job? Or what happens if shortages and waiting lines develop for State provided healthcare services?

In a normal market system, entrepreneurs will provide levels of healthcare service catering to every income bracket and people would just go and purchase the healthcare services that they need. In a distorted market however, costs are so inflated that most people cannot afford to pay for basic healthcare service if the insurance companies or the State don't pay for it for them.

And your options are artificially reduced since it is the State and/or the Insurance companies who will dictate to you what they cover and what they don't, which doctors you can see and which you can't see.


You frequently speak of families who go completely bankrupt because a family member gets sick. Or others who literally die because they can't pay for a relatively simple operation that could save their life. The costs are so out of control that tens of millions of Americans could never pay these medical costs even if their lives depended on it.

Now why on earth would that be in any sort of free market? Why wouldn't an opportunistic entrepreneur see the profit incentive in catering to this criminally undeserved market? Why wouldn't competing healthcare providers figure out cost cutting measures in order to offer healthcare services to lower income individuals with prices they could actually afford?

The reason is that most people, especially the working class, rely exclusively on third party payers for medical care. Most would never consider paying out of pocket for any medical service, even one they could afford. People won't even see a chiropractor if their insurance won't pay for it.

Plus the State mandated regulations and restrictions that exist in entering the market mean that it is not worth it to cater to the consumer directly. It is FAR more profitable to lobby the State, to work for large insurance agencies or pharmaceutical companies.

This is the inevitable result of that sort of system. This is such basic, economics 101 level stuff that I am shocked I even have to go over this. When price competition is removed from a market and people rely more heavily on third party payers and the State to provide funding for services, prices rise.

If you were a contractor to the government would you charge more than you would if you were serving a consumer who had to pay the costs for the product or service directly? Of course you would. Everybody would.

jrodefeld posted:

If you were a contractor to the government would you charge more than you would if you were serving a consumer who had to pay the costs for the product or service directly? Of course you would. Everybody would.

jrodefeld posted:

This is the inevitable result of that sort of system. This is such basic, economics 101 level stuff that I am shocked I even have to go over this. When price competition is removed from a market and people rely more heavily on third party payers and the State to provide funding for services, prices rise.

Who What Now posted:

The hell it does. Show this evidence and how it points towards government interference raising prices. And, unless you're suggesting that insurance companies be completely outlawed in your ideal world then the fact that they drive up prices is a point against your claims. Which, of course, is actually true, which is why you are trying to weasel the blame away from your side like the dishonest lying twerp you are.

quote:

The idea of consumer sovereignty was central to Mises's understanding of the market economy. According to this understanding, consumers shape the pattern of resource use and the assignment of resource rewards according to their preferences. The outputs being produced at any date, the methods of production being employed, and the rewards being given to the various owners of productivity are those dictated by consumers.

Market prices are described by Mises as reflecting an "equilibrium of demand and supply." It is on this basis that Mises views any government interference with market prices as a disturbance to the equilibrium that will, in general, produce results that are worse than the conditions the government wished to improve. Government intervention in the provision of medical goods and services is a perfect example.

In a previous article, I suggested that government intervention, not market failure, is responsible for today's out-of-control healthcare costs. There are a multitude of reasons why this is so, but the most important, in my opinion, is the loss of consumer sovereignty brought about by government intervention, which would not have occurred under market conditions.

"If we returned purchasing power to patients — in effect, restored consumer sovereignty — healthcare spending would decline dramatically."
Prior to the advent of Medicare and Medicaid, individuals paid for the majority of medical goods and services out of their own pocket (Figure 1) and utilized health insurance as a rational tool for mitigating financial risk posed by catastrophic events.1 During this time a real market existed for the vast majority of medical goods, and services and prices were reasonable. However, after the advent of these programs, third-party spending on routine medical services increased, and out-of-pocket spending fell dramatically. To match the coverage of these government programs, especially Medicare, the private-insurance market took a reactionary turn for the worse, which was encouraged by earlier legislation that allowed health insurance to be purchased with pretax dollars from an employer. The move to third-party payment was further accelerated by passage of the HMO Act of 1973.

Figure 1. Sources of personal health expenditures
personal health expenditures
The act gave HMOs greater access to the employer-based market, providing for the rapid expansion of managed care. Finally, as Thomas DiLorenzo has pointed out,

Layers of regulation plague every aspect of medical care and health insurance in America … each state imposes dozens of regulatory mandates on health insurers, requiring them to include coverage of everything from massage therapy to hair implants.
A colleague of mine, who practiced before and after this dramatic shift occurred, and whom I will not name due to his academic affiliation, neatly summarized how third-party payment for routine medical services has led us to the current situation we are in with regard to healthcare costs. He wrote to me:

I have lived through those times when the patient and the doctor each had a sense of responsibility regarding the patient's health. There was, in effect, a "contract" between the two that resided in the awareness that the doctor was the expert and would do the best he/she could for the patient and the patient, in return would pay for those services. There were no guarantees but an expectation of ethical behavior by both parties. Healthcare costs were reasonable and in those instances where payment was beyond the reach of a patient's resources, arrangements could be, and were usually made.

The system worked and worked well. Enter third party pay and it all went to hell in a hand-basket because it now became possible to charge whatever the system would bear.
Because of this change, medications, tests, and procedures that in many cases provide only marginal benefits are now widely used despite the fact that they may cost much more than the procedures they were intended to replace.

In a real market, many of these "breakthroughs" would simply not be viable. But because the test of viability in America's government-managed healthcare system is not consumer sovereignty, we have a situation where Medicare, Medicaid, and politicized private-insurance companies pay hundreds of dollars a month more for a drug that decreases total event rates by a few percentage points compared to whatever that drug replaced or was intended to augment.

The following is an example of a real and very popular drug that I use on a routine basis that I will call drug X. Drug X works by inhibiting blood clot formation (when a blood clot forms in a vessel in the heart, one can have a heart attack). Drug X and drug Y work together by acting on different substrates of the clot-formation process to ultimately effect the same outcome — stopping clots from forming. Drug X costs on average $141.82 per month. Drug Y costs a couple of dollars per month over the counter at your local drug store. What does the data tell us about the two?

Multiple studies have been performed to answer the question: Does drug X improve cardiovascular outcomes compared to drug Y alone after a patient has had a major cardiovascular event or a stroke? The answer, unequivocally, is yes. By how much? The answer is a few percentage points, give or take.2 Does it eliminate the risk all together? The answer, unequivocally, is no. It should also be noted that drug X in addition to drug Y confers a minor increase in the risk of having a major bleeding event. So the question is: How many people, in the appropriate clinical setting, knowing this information, would buy drug X for $140 per month? Probably not nearly as many who take it now for nothing or for a small copay. Leaving aside the issue of brand names and patents, under conditions of market competition, do you think the company who makes drug X would lower the price to entice more buyers? If they did not lower the price, or simply could not lower the price due to production costs, I would venture to guess that drug X would not be marketable outside of a small niche of patients.

Now ask yourself, is the doctor who recommends drug X the bad guy? Of course not: drug X does provide a benefit beyond drug Y itself, and furthermore, if he didn't offer it and the patient had a heart attack (which could happen despite being on drug X) the doctor could be at risk of losing his medical license. After all, drug X is part of the standard of care. Is the patient the bad guy? Of course not: if you were offered the chance to take a drug that had a defined benefit and wouldn't cost you that much, you'd be silly to reject it. Is the pharmaceutical company the bad guy? No, they have a responsibility to their shareholders to make a profit, so they should sell their product at the highest price possible.

So who's to blame? The answer: a system that has been developed by government intervention to interfere with consumer sovereignty and make every individual pay for every other individual's medical expenses so that the individual consuming the care does not bear the full price at the point of utilization. We should not conclude from this example that the run-up in healthcare costs is solely due to increased spending on pharmaceuticals, for this situation applies to everything from doctor visits to laboratory tests to diagnostic studies to minimally invasive and full surgical procedures. Very simply stated, consumers now use many medical services that they would simply reject if they had to pay for them out of pocket — and truthfully, in most cases, they would be none the worse off for rejecting them.

The RAND Health Insurance Experiment was a prospective social experiment (and to this date, the only social experiment) in which health insurance with different levels of benefit coverage was randomly assigned to individuals, and subsequent health outcomes were compared across experimental groups. The results showed that while spending increased as benefit coverage increased, health status and health outcomes did not improve. There was very little evidence to demonstrate that having a high level of benefit coverage improved population health on average.3 The RAND Health Insurance Experiment debunks the idea that patients are not capable of being prudent consumers of medical goods and services.

So what does all this tell us about solving the current problem with healthcare costs? I think the answer is relatively straightforward: if we returned purchasing power to patients — in effect, restored consumer sovereignty — healthcare spending would decline dramatically and prices for medical goods and services would reflect the true value to consumers in a competitive market.

Under free-market conditions, would there be a role for health insurance? The answer is clearly yes, but health insurance would much more closely resemble the rational/catastrophic model that developed spontaneously before the onset of serious government intervention into the healthcare industry. Can we get back to that model? Yes, in theory, but it would require that we abolish all government insurance programs, deregulate the system at the federal, state, and local levels, and get rid of all the existing tax deductions, exemptions, and subsidies for the purchase of health insurance.

The main objection to restoring consumer sovereignty as I have described is the progressive appeal to social justice. Paul Krugman tried to make the case for this in a recent editorial entitled "Patients Are Not Consumers" in the New York Times. Krugman's logically flawed and contradictory arguments can be boiled down as follows:

Healthcare is a right and the doctor-patient relationship is sacred; therefore, patients should not be viewed as consumers.
Doctors and patients cannot be trusted; therefore, a third party must intercede in the decisions made between the patient and his or her doctor, because somehow, without any personal knowledge or previous interaction whatsoever, the third party knows what the patient needs better than the other two connected parties (doctor and patient).
(If you think these two points are contradictory, you are not alone.) Krugman writes,

Here's my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as "consumers"? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn't commercial enough.

What has gone wrong with us?
I take this to be Krugman's variant of the social-justice argument — because healthcare is a right and the doctor-patient relationship is sacred, patients have a right to whatever they and their doctor agree to; they should not be forced to pick and choose.4 Of course, healthcare is not a natural right, as natural rights define what somebody else, including the government, cannot do to you. They do not oblige anyone to act on your behalf, and they do not oblige you to act on the behalf of anyone else, except to respect the fact that others have the same rights as you. If a right to healthcare were recognized, it would necessarily enslave each of us to everybody else's healthcare needs. But Krugman does not really believe healthcare is a right, as the next part of his argument reveals. He writes:

About that advisory board: We have to do something about healthcare costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can't maintain a system in which Medicare essentially pays for anything a doctor recommends. And that's especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren't saints — a strong financial incentive to engage in excessive care. …

[T]he point is that choices must be made; one way or another, government spending on healthcare must be limited.
As the above passage makes clear, to Krugman and progressives like him, healthcare is not really a right, and the doctor-patient relationship is not really all that special. Instead, healthcare is a privilege to be granted at the prerogative of the ruling class. Progressives do not reject the idea of consumer sovereignty because it is economically or ethically flawed, but rather because the act of being a consumer requires that an individual's natural rights be fully protected. The recognition of such rights represents a check on arbitrary power, and as such it is the enemy of the state and ruling elites like Krugman, who have an insatiable lust for power and control over the rest of us.

jrodefeld posted:

Of course having a life threatening or permanently debilitating illness for which no treatment was available in the past likely meant that the overall cost to your family would be massively greater than if a cure was available, no matter how inflated the cost. That is also self evident

jrodefeld posted:

Let's say that tomorrow, the Federal Government took over the cell phone industry. Nationalized it completely and created a "single payer" system of cell phone service available to everyone. You would be eligible to receive the newest iPhone every year for free. The State contracted out the actual production of the phones to Apple and the service to Verizon.

Now would you expect that the cost for an iPhone would rise, fall or stay the same? Naturally Apple would charge the State a lot more because they can get away with it. iPhones might cost $7000 per phone instead of $600 or $200 with a contract that they cost for consumers

jrodefeld posted:

I want you to take a close look at this graph:

http://mises.org/sites/default/files/styles/full_width/public/10100%20%20personal%20health%20expenditures.png?itok=GnwPFrtY

In 1960 consumers spent money out of pocket on nearly 60% of their healthcare costs while less than 20% was payed for my private insurance. By the early 1990s (the date the graph goes up to), out of pocket spending on medical care had fallen to below 20% and private insurance accounted for more than 30% of healthcare expenditures while more than 40% of healthcare expenditures were payed for by Federal, State and local governments.

Are you honestly claiming that this precipitous fall in out of pocket medical costs and the move towards third party payment for medical services didn't distort the market and make consumers less concerned with cost, thus causing prices to rise?!

Caros posted:

You're not understanding what is being said here Jrodefeld. It isn't just that technology is better, it is that entirely new fields of life saving technology have been created, and that when you lump that together, costs are far higher as a result.

Do you think more or less money overall is being spent on cell phones today than in say... 1980? Clearly it is more, Just about everyone owns a cell phone now, whereas in 1980 almost no one had a cell phone. Now what about... say.... open heart surgery? This was a proceedure that was in its infancy in the 1960's. Individual open heart transplants probably cost in the millions of dollars back then, and were more or less non-existent because the number of trained surgeons who were available to do the proceedure were miniscule. But as time went on the cost of doing the surgery lowered, while at the same time the number of surgeries shot through the roof. This means there was more money being spent on heart surgeries, even though the average cost of surgeries decreased.

In 1950 they gave you nitroglycerin for a heart attack, at the cost of a few hundred dollars in pills. Today you pay tens of thousands but have a better life expectancy. Additional costs produced better results, but it also caused overall spending on medical costs to drastically increase. This has been explained to you multiple loving times.