Is Equal Health Care Impossible?

Tyler Cowen is taking heat at the Daily Kos, at Jubilee and from Matt Yglesias, but is defended by Josh Barro for this statement:

Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor…We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

I would put it differently:

  1. There is no known rationing system (in which individual behaviors can affect the outcome) which will produce an equal allocation of basic goods.
  2. In general, price rationing with subsidies (e.g., Food Stamps) produces more egalitarian outcomes than non-price rationing (e.g., education and health care).
  3. Countries that have pursued the goal of equal health care access through non price allocation for many decades (e.g., Canada, Britain, new Zealand — to pick a few English speaking examples) have no more equality — and perhaps even less — than countries that aren’t even trying (e.g., the United States).

These are some of the themes of my new book, Priceless.

Comments (10)

Trackback URL | Comments RSS Feed

  1. Harold says:

    Agreed. Barro sounds pretty harsh…

  2. Joe S. says:

    I’ve read your book and I like it.

  3. Hoads says:

    Liberals go apoplectic when their bluff is called out in public. They tie themselves in knots trying to maintain the illusion that socialized healthcare systems are better and more egalitarian than ours. Meanwhile, the chatter behind the scenes is talk of the unsustainability of healthcare costs in all healthcare systems. Their national conversations are no different than ours.

    I’m always curious in this golden age of globalism and high tech social media how is it we are still so separated from our global neighbors. Where are the first person interviews, reality shows, Facebook pages, translated youtubes etc. of the chronically ill, disabled, hospitalized, disease stricken, trauma victims, etc. in these socialist utopias to tell us just how wonderful their healthcare system is?

  4. Otis says:

    Excellent post. To bad policy makers can’t see how the gargantuan effort made in many western countries (and now in the U.S.) to attain egalitarian outcomes on health care has done little to achieve those outcomes.

  5. Ambrose Lee says:

    Cowen needs a PR person.

  6. Alex says:

    There are certainly better ways to say what he did.

  7. Studebaker says:

    Tyler Cowen has hit upon a subject about which people have an irrational views. People accept that being rich means you can purchase more goods and services than someone who is poor. People generally are fine with that. However, irrationally, they don’t believe the poor should experience health outcomes that are worse than the rich. This might be achievable if the poor had healthy lifestyles habits comparable to the rich — but they don’t. Or, might be achievable if medical care could really mitigate poor health habits — but it cannot. Health outcomes will never be equal until lifestyles are comparable. This is something that can be taught, but forcing in on people is coercive – as is using taxes to pursue equal outcomes in health.

  8. david says:

    The price system, as advocated by Adam Smith, only works when neither buyers nor sellers are exceptionally powerful. For him, that would have meant severe restrictions on intellectual property that drives up the cost of medicine and, yes, that “power” would include purchasing power on the part of patients.

    Price rationing wasn’t originally advocated because it would lead to equal distribution. Price rationing leads to efficiency when there is equality to begin with.

    Cowen doesn’t need a PR person; he needs a philosophy professor.

  9. Kerri W. says:

    Wow! That is quite a statement from Mr. Cowen. Although I do agree that so many of the current stated “solutions” to the health care crisis do , in fact, take money from the poor and middle class (much like our current lotteries that we have in my state of Tennessee-but that is a whole other issue)through higher taxing, I cannot agree that the poor sometimes die simply because they are poor as a principle! I find that extremly harsh. Yes, sometimes those who are not “financially challenged” will seek healthcare more often than the poor since they can afford co-pays and the like, but visit my local hopsital’s ER on any given day and you will see a wide variety of individuals throughout different economic classes being seen and treated. Those without insurance are not being turned away-at least not here, and the hospital will not recieve any payment from these visits. I belive in capitalism whole heartedly. My hospital, although not-for-profit, is still a business, and a business must at least break even in order to survive. As a registered nurse, it is my job to care for my patients the same regardless of their insurance or lack there-of, and I do my job well-I honestly never look at the “face sheet” of a chart for that purpose-I simply don’t care. However, I still want to be paid for my services, just like any one of us who has a job. I say all of this I guess to simply say that there is not one easy solution to this crisis, but I do not think that President Obama’s plan is the correct one-I desire less government, not more! I do agree with Mr. Goodman that we should look at other countries such as Canada and ask ourselves if this is really beneficial to ALL??

  10. david says:

    Kerri–patients don’t get turned away from ER’s because of a law that says they can’t (i.e., more government)

    Poor people do indeed “die simply because they are poor.” ER’s are only required to provide stabilizing services if you can’t pay. Need anything else–such as to cure what’s CAUSING you to be unstable, or chemo, or transplants–but you can’t afford it? You’re SOL.