21 May 2014

With Single Payer, We Can All Get VA-Quality Health Care!

Health Legislation 82 Comments

A mainstream summary of the timeline on the developing Veterans Affairs scandal:

The Obama administration is facing a serious scandal in which government officials are alleged to have falsified data to hide how long veterans were waiting to see doctors at VA hospitals…Here is a timeline of events leading up to the current situation, which President Obama on Wednesday called “intolerable” and “disgraceful.”

• Early 2012: Dr. Katherine Mitchell, a Veterans Affairs emergency-room physician, warns Sharon Helman, incoming director of the Phoenix VA Health Care System, that the Phoenix ER is overwhelmed and dangerous. Mitchell now alleges she was told within days by senior administrators that she had deficient communication skills and was transferred out of the ER.

• Later in 2012: The U.S. Department of Veterans Affairs orders implementation of electronic wait-time tracking and makes improved patient access a top priority…

• July 2013: In an e-mail exchange among employees at the Carl T. Hayden VA Medical Center in Phoenix, an employee questions whether administrators are improperly touting their Wildly Important Goals program. “I think it’s unfair to call any of this a success when veterans are waiting six weeks on an electronic waiting list before they’re called to schedule their first PCP (primary-care provider) appointment,” program analyst Damian Reese complains.

• October 2013: Dr. Sam Foote, a doctor of internal medicine at the Phoenix VA, files a complaint with the VA Office of Inspector General alleging purported successes in reducing wait times stem from manipulation of data, and that vets are dying while awaiting appointments for medical care.

• December 2013: Foote retires, assuming the role of whistle-blower by meeting with Arizona Republic reporter Dennis Wagner. He details allegations that patients have died while awaiting care at the Phoenix VA and that wait times have been falsified.

• April 9: Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans’ Affairs, says during a hearing that dozens of VA hospital patients in Phoenix may have died while awaiting medical care. He says staff investigators have evidence that the Phoenix VA Health Care System keeps two sets of records to conceal prolonged waits for appointments.

• May 2: Mitchell goes public with her allegations about mismanagement of the Phoenix VA system and her concerns about wait times, noting that she and a co-worker moved to protect some documents as evidence.

This seems to be a pretty obvious observation, but I haven’t seen many people making it: As the “shocking” revelations unfold about this scandal, keep in mind that this combination of incompetence, callousness, waste, and deception are deployed when government officials take care of the people who go kill for the government, and who provide the ultimate mechanism for keeping it in power. How do you think these government officials will treat sick people who, say, have spent their lives criticizing the U.S. government?

82 Responses to “With Single Payer, We Can All Get VA-Quality Health Care!”

  1. Major-Freedom says:

    Given the fact that Obama is a pathological liar, I will take his protests of this being a “disgrace” with half a grain of salt. Political posturing.

    • Keshav Srinivasan says:

      What makes you think he’s a pathological liar? I’d say he has a relatively good track record on Politfact:

      • Bob Murphy says:

        “I like a guy who only lies 27% of the time!” — Keshav

        • Keshav Srinivasan says:

          Well, making false statements doesn’t necessarily mean lying – it would need to be intentional. And I did say relatively good, i.e. relative to other politicians and opinion-makers.

          • Bob Murphy says:

            OK the false vs. lie distinction is a good one, but the other one I think just shows the decadence of politics.

            • Keshav Srinivasan says:

              Yes, I readily accept that I’m grading on a curve here, because discussants in political discourse unfortunately utter quite a lot of falsehoods. In any case, I honestly do believe that although Obama has no doubt made numerous false statements, he hasn’t actually lied that much.

              • Keshav Srinivasan says:

                In his official capacity, that is. He may tell all sorts of lies in his personal life.

              • Major-Freedom says:


                I honestly do believe in Hayek’s point about the worst getting to the top in a political environment.

                Lying is a requisite, because honesty gives power, it doesn’t take it.

                By any reasonable standard, Obama must have known that the false statements he uttered were in fact false. This is because most of the things you claim he was merely wrong about, were his own promises of future actions. It is awkward to interpret someone as being “wrong” about what they themselves do soon after promising they would do something else. Especially when they do so over and over. It is far more reasonable to assume the person is lying, and not merely wrong.

              • Dyspeptic says:

                “Obama has no doubt made numerous false statements, he hasn’t actually lied that much.”

                So the man touted as the most intelligent and knowledgeable President in history by his acolytes, media sycophants and academic admirers turns out to be just an ignoramus then?

                Your claim that he doesn’t lie but merely mangles the facts is undermined by two observations. The first is that you are relying on Politifact as an honest, competent and non partisan fact checker, an assertion which I reject as dubious and unproven.

                Your second error is ignoring the fact that when he utters a public falsehood it usually “just happens” to give him a political advantage. Do you really think that is coincidental?

              • Matt M (Dude Where's My Freedom)) says:

                “Your second error is ignoring the fact that when he utters a public falsehood it usually “just happens” to give him a political advantage. Do you really think that is coincidental?”

                Great point. He never just happens to error on the conservative side of things, does he?

                Just like how the CBO never *over* estimates the cost of a government program…

          • Keshav Srinivasan says:

            I think McCormaack is distorting what Harry Reid said. Nowhere did Reid say that Obamacare was designed to fail. He just says that he believes that we ought to have single-payer, and that that’s the only system that will completely solve America’s health care problems. It’s not a secret at all that lots of liberals would have preferred single-payer, and view Obamacare as an imperfect alternative. But that has nothing to do with setting it up to fail.

          • Keshav Srinivasan says:

            Howard Dean is just saying that he thinks that small businesses are likely to dump their employees onto the exchanges. But first of all he doesn’t think this was an intentional effect of the law, and second of all he presumably doesn’t think that the same will be true of large businesses (there is the employer mandate after all). And In any case, going to the exchanges would still be buying insurance in the private marketplace, not single-payer.

            • guest says:

              Government forcing you to fork over your money for insurance is not a private marketplace.

            • guest says:

              But first of all he doesn’t think this was an intentional effect of the law …

              Obama, in the “Just the beginning …” video, alludes to the fact that it was an intentional effect of the “law” (Constitutionally, it’s not a law):

              … I don’t think we’re going to be able to eliminate employer coverage, immediately. There’s going to be, potentially, some transition process …

            • Dyspeptic says:

              Keshav, Is your real name Jay Carney by any chance?

              “going to the exchanges would still be buying insurance in the private marketplace, not single-payer.”

              Your statement is muddled and misleading. The exchanges are certainly not exactly like Government Monopoly Healthcare, or “single payer” as you euphemistically refer to it. But they absolutely do not constitute a private or free marketplace either.

              In a real privately owned free market businesses compete and survive based on consumer satisfaction and all transactions are voluntary. In an actual free and privately owned marketplace there are no subsidies or government enforced mandates to purchase.

              Obamacare created a government designed, government administered, government regulated, government subsidized and pervasively coercive “market” for health insurance. Your implication that this is somehow a free market because insurance companies are still privately owned for profit agents is absolutely false.

              Obamacare is a perfect example of Crony Capitalism in all of it’s greed, inefficiency and corruption. It has nothing to do with free markets or economic liberty.

              • Keshav Srinivasan says:

                I didn’t make any claim that Obamacsre constituted a laissez-faire free market system. (Obviously Obamacare constitutes a move to the left relative to what was there before, and that wasn’t a laissez-faire free market system).

                All I claimed is that the health insurance bought on the exchange. Lots of industries are private, although they’re heavily regulated. I wasn’t making any claims of an unregulated free market, just a claim that this isn’t single payer.

          • Keshav Srinivasan says:

            I think you posted the wrong link.

            • guest says:

              The site automatically switches you to a new video after you’re done with one of them.

              Sorry about that:


              • guest says:

                Seems like a good place to stop posting links, anyway.

                All useful, but maybe overkill at this point.

          • Keshav Srinivasan says:

            He said “death panels” as a joke. He’s said this line numerous times:
            He’s using “death panels” as a humorous short-hand for policies that he does favor, but which are not part of Obamacare and which he does not think actually amount to death panels.

            • guest says:

              Obama adviser admits: ‘We need death panels’

              A top Democrat strategist and donor who served as President Obama’s lead auto-industry adviser recently conceded that the rationing of heath services under Obamacare is “inevitable.”

              Steven Rattner advocated that such rationing should target elderly patients, while stating, “We need death panels.”

              Rattner was the so-called “car czar,” the lead auto adviser to the Treasury Department under Obama.

              Beyond Obamacare [by Steven Rattner]

              We need death panels.

              Well, maybe not death panels, exactly, but unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget.

              • Keshav Srinivasan says:

                Yes, Rattner was using “death panels” in the same joking fashion as Krugman. Neither Krugman nor Rattner believe that the policies that they’re advocating actually amount to death panels. And these policies are not actually part of Obamacare just something that they want enacted in future.

            • Andrew' says:

              No, Keshav, you are wrong.

              Not to be argumentative.

              • Keshav Srinivasan says:

                You disagree that Krugman used “death panels” as a joke? Then why does he say “not really death panels, of course” in his post?

              • guest says:

                Government end-of-life health care rationing = “death panels”.

                That’s what is meant by the term.

              • Anonymous says:

                First of all, Krugman is just proposing that the Medicare limits how much money it spends on end-of-life care, he’s not saying that we should stop people from purchasing more end-of-life care (or supplementary insurance) if they can afford it. So he’s not really proposing death panels.

                But in any case, the question isn’t whether the policy he supports actually amounts to death panels, but whether Krugman is “admitting” that he’s in favor of death panels. And he emphatically does not think that limiting how much money Medicare spends amounts to death panels.

                And I should emphasize again that Krugman is discussing a policy proposal that he favors, not something that’s in Obamacare. So it should be noted that this comment by Krugman does not alter the veracity of the claim of Obamacare death panels by Sarah Palin and others.

              • Keshav Srinivasan says:

                First of all, Krugman was just proposing that Medicare limits how much end-of-life care it pays for, he doesn’t want to ban people from purchasing more end-of-life care on the private market (or supplemental insurance) if they can afford it. So he’s not advocating death panels.

                But in any case the question isn’t whether Krugman’s preferred policy amounts to death panels, but rather whether he is “admitting” that he favors death panels. And he emphatically does not believe that limiting what Medicare pays for amounts to death panels.

                And let me emphasize again that Krugman is describing a policy proposal that he favors, not something that’s already in Obamacare. So it should be noted that any claims that Krugman’s quote vindicates what Sarah Palin and others said about death panels in the healthcare law are doubly wrong. (Because first of all what he’s “admitting” to is not death panels, and second of all he’s not talking about what the law is already, but about what he’s proposing in future.)

              • guest says:

                I was hesitant to share this because I can’t independently verify the following quote, but here’s Mother Jones admitting that Howard Dean admits there are death panels in Obamacare:

                Democrats Jump on the ‘Death Panel’ Bandwagon

                The Democratic death panel fear-mongering follows an editorial that former Democratic National Committee chair Howard Dean wrote in the Wall Street Journal in July. He called for a repeal of the cost-cutting board because, he wrote, it would have the effect of rationing care by making it hard for doctors to make money from Medicare.

                The link to the Howard Dean WSJ article is SUPPOSEDLY here:

                The Affordable Care Act’s Rate-Setting Won’t Work

                It’s a legitimate WSJ article, and the author is Howard Dean – but it’s subscription-only.

                Mother Jones isn’t Right-Wing or Palin-Wing, but I’m still going out on a limb, here.

              • guest says:

                * I reserve the right to pull quotes out of my ass.

              • Keshav Srinivasan says:

                Here is Howard Dean’s Op-Ed in PDF format:
                Dean is simply misinformed when he says that IPAB is capable of “determining which procedures and drugs will be covered”.

                The law prohibits IPAB from engaging in any such things: any proposal that IPAB makes “shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1395i–2, 1395i–2a, or 1395r of this title, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria.” http://www.law.cornell.edu/uscode/text/42/1395kkk

              • guest says:

                So … reducing tax-victims’ wealth without insurance requiring rationing?

                As I said: It’s designed to fail.

                Insurance requires rationing; And although people can pay for health care on the otherwise free market, health care costs will rise NOT due to the greed of free market health care providers, but because the government will guarantee income to those insurance companies who are part of the government-mandated exchanges by taxing people.

                Peaceful free market voluntary health care providers, not being able to compete with those competitors who’s business has been artificially stimulated by the crony insurance system set up by the government, will have to raise their prices.

                It’s the same situation with education costs.

          • Keshav Srinivasan says:

            Peter Orszag didn’t say anything about rationing. In fact IPAB is prohibited from rationing, as I linked to earlier. All he’s saying is that he hopes that IPAB will help achieve the goal of having Medicare pay for quality of care rather than volume of care. It’s not about restricting what healthcare seniors are allowed to buy from doctors.

          • Keshav Srinivasan says:

            Yes, I readily concede that Obama flip-flopped on the Cadillac tax. The same can be said of his position on the individual mandate. Basically Barack Obama changed his views on a lot of details of what healthcare reform should look like after he got elected and sat down with a lot of health policy wonks; he discussed the evolution in his thinking in the 2010 healthcare summit. But yes, it’s fair to criticize him for attacking McCain and Hillary for positions that he later concluded were actually good ideas.

            • Bob Murphy says:

              Keshav wrote:

              But yes, it’s fair to criticize him for attacking McCain and Hillary for positions that he later concluded were actually good ideas.

              My goodness Keshav, you are really in the tank for Obama.

              The issue isn’t that he changed his mind. The issue is that in the 12/23/09 interview, he said he was “on record” for wanting to tax so-called Cadillac plans. Nothing about, “You know, I used to be totally against that, and campaigned strongly against it, and demonized McCain for supporting it…but in the last year I’ve totally changed my position.”

              That is incredibly dishonest, and it’s amazing that you are interpreting that video clip as an example of a guy updating his Bayesian priors in light of new information.

              • Keshav Srinivasan says:

                Bob, yes, Obama absolutely should have acknowledged his flip-flop in that NPR interview, rather than just acting as if it was his position all along. I don’t think he was intentionally hiding the flip-flop in that interview; he was asked whether he thought a Cadloiac tax would be in the final bill, and he was essentially trying to say, “I think it will be in the bill, because I’m at least on record as favoring it so Congressional Democrats are likely to include it.”

                In his defense, he has acknowledged this and other flip-flops on the details of healthcare policy in other venues, but that’s no excuse for failing to do so here.

              • Keshav Srinivasan says:

                By the way, here’s the full NPR interview if anyone’s interested:
                He elaborates on why he thinks we can have a Cadillac tax without hurting ordinary workers:
                “Well, I think that’s a pretty good benchmark, and the cost of a plan for members of Congress, which are pretty good health care plans, is about $15,000 a year. Right now this fee on Cadillac plans doesn’t kick in until $23,000 under the Senate bill. So I think that we can structure something that protects ordinary workers, makes sure that they are getting a great health care plan, but also makes sure that they are not overpaying in a situation where they’re just giving money to health insurance companies that instead could actually be going into their pockets in the form of higher salaries.”

      • Matt M. (Dude Where's My Freedom) says:

        Politifact is known to be quite biased in favor of the left. They bend over backwards to make Obama’s lies not seem like lies.

        • Keshav Srinivasan says:

          Well, I do agree that Politifact has a (slight) liberal bias, but I think examining and analyzing Obama’s statements would lead an impartial observer to conclude that he makes probably less false statements than a lot of other politicians and opinion makers.

          In any case, saying that he’s lied is a much stronger claim than saying that he was merely wrong about something. What, in your mind, are the biggest lies he’s told?

          • Scott D says:

            “If you like your health care plan…”

          • Dyspeptic says:

            “examining and analyzing Obama’s statements would lead an impartial observer to conclude that he makes probably less false statements than a lot of other politicians and opinion makers.”

            You get today’s Jay Carney award. Congratulations Keshav!

          • Fully Accredited Impartial Observer says:

            No, you are wrong. After exhaustive research and navel gazing I have come to the professional conclusion that Obama is to veracity what Roseanne Barr is to feminine pulchritude.

      • Andrew' says:

        How do you know he is “good” according to politifact?

        His true or mostly true was 46%, so I looked up GWB and his was 50% but only on n=4.

        Politifact doesn’t show Obama is good absolutely or relatively.

        • Tel says:

          If true vs false answers evaluate to 50% then a coin does the same job. This implies zero information content, and that’s about what I would expect, from both Bush and Obama.

          If a politician is wrong significantly more than 50% of the time, you can get useful information by presuming the opposite… but that’s getting into NYT territory.

      • Mule Rider says:

        A “relatively good track record”? Sorry, even by that source, 54% of what he says is a half-truth or worse. No thanks, I’ll pass.

        By the way, I’d wager it’s even higher than that. For all the issues I have with the man, he is a gifted orator and has strategically phrased and couched many of his comments in just enough vagaries and qualifiers so as to avoid being considered outright “lies” when they were still very much clear demonstrations of dishonesty.

        • Matt M (Dude Where's My Freedom)) says:

          Right, and that’s what I mean when I refer to bias. Politicians are experts in lying and getting away with it. They know how to strategically phrase things.

          What politifact does is qualify any phrase that might technically be partially true as a truth (if it comes from a Democrat), and qualify any phrase that might remotely imply anything false as a lie (if it comes from a Republican.)

    • Andrew' says:

      Obama is not a pathological liar. Those are people who lie even when it doesn’t benefit them. Obama lies as soon as it benefits him. So, I’d test him for sociopathic tendencies.

  2. Matt M. (Dude Where's My Freedom) says:

    Technically speaking, people who get health care from the VA have already separated from the military, and the VAST majority of them will never be returning to duty.

    So while your point of “If this is how they take care of their own people, how will they take care of us?” is valid, keep in mind that these people are used-up assets. The government has zero incentive to care for them other than avoiding scandals such as this one. Separated veterans who are not going to be returning to active duty are a liability, and the VA treats them as such.

    Blah blah blah, incentives matter.

    • Bob Murphy says:

      Matt M. so is that why companies don’t pay out on their pensions?

      • Matt M. (Dude Where's My Freedom) says:

        I guess that’s a fair point.

        The best I can do is point out that people hold companies to high standards, and let the government get away with anything. VA health care is presented, even to separating veterans, as a “resource” but not as something that is guaranteed. It’s pretty much universally understood that you *might* be able to access it, but it will be low quality and involve long wait times.

        In that sense, VA health care isn’t really considered a proper “obligation,” at least not by the people receiving it. It would be a lot different if the military stopped paying out its pensions, that would be openly lying about a benefit people are led to believe is rock-solid. Nobody I knew in the military considered VA health care to be anything other than “I guess you can go there if you’re broke and about to die and maybe they’ll treat you, but it’s like, the absolute last-resort”

        • Keshav Srinivasan says:

          “It’s pretty much universally understood that you *might* be able to access it, but it will be low quality and involve long wait times.” Well, there’s some indication that the VA health system has improved considerably over the years, this Pheonix scandal notwithstanding, to the point where some are saying it’s a model of quality and cost control:

          • Bob Murphy says:

            Keshav wrote:

            Well, there’s some indication that the VA health system has improved considerably over the years, this Pheonix scandal notwithstanding, to the point where some are saying it’s a model of quality and cost control:

            Keshav are you saying this Phoenix thing is a crazy anomaly that doesn’t represent the whole system, or are you saying, “Hey, it used to be a lot worse!” ?

            • Keshav Srinivasan says:

              I’m saying the former: that there are lot of people arguing that the VA is a model of cost control and quality relative to the rest of the American healthcare system. So it’s possible that the Phoneix story is an anomaly.

      • Bob Murphy says:

        Matt M. I just want to make sure you understand my point:

        I wasn’t disputing what you said; you are right, the government doesn’t care about veterans because they’re not immediately useful.

        But I was saying that this is still pretty shocking treatment, since people considering joining the military can see how they will be treated. Just like, if a private company just refused to pay contractual pension obligations, beyond the immorality and legal ramifications, that would make it harder for them to attract personnel.

        In the extreme, if the military just executed everybody who retired from service, that would presumably have a big impact on enlistments.

        So my overall point is that if this is how the government provides health care to (former) military, holy cow what do you think it will do for people who actively chafe it?

        • Matt M (Dude Where's My Freedom)) says:

          Right, and that’s an excellent point that I’m not trying to dispute. That line specifically is actually what I quoted when I shared this page with some of my friends.

          I was just trying to clarify for you and for your readers who might not know the details of VA health care that the VA does not treat active duty personnel. While you never directly stated they did, I feel like a non-careful reader might have been able to get this impression.

          Anybody who understands a single lick of economics, even on just an intuitive level, would be able to predict that the quality of care for retirees would be lower than the quality of care for currently enlisted folks. Most people receiving VA care are either retired or disabled. I think it’s possible that the government death panels would in fact provide better care to a successful IT consultant in his mid-30s who runs a libertarian blog than it would to a retired and disabled 60-year old soldier who is a chest-pounding nationalist.

          They’re so arrogant that they don’t really care about perception or popular opinion or whatever. The 30 year old will keep providing them tax revenue, and nobody listens to those crazy libertarians anyway. Meanwhile, it’s cute that the retired soldier is so pro-government, but he can no longer provide the state with any resources (in fact, he is an active drain on their resources at this point).

          I guess my larger point is, if you examine the economic incentives involved, the government would be much better off if every single disabled or retired soldier dropped dead the minute their contract expired, so long as they weren’t held responsible by the “support our troops” faction of the voting public. Now you’re right that this is ALSO true of Ford or any private company, and on a similar notion, I would expect that a retiree of Ford who has issues with receiving his check probably gets worse/slower customer service than an active employee would.

    • Tel says:

      … keep in mind that these people are used-up assets.

      I’m sure the present day military are keeping that in mind.

  3. Tel says:

    How do you think these government officials will treat sick people who, say, have spent their lives criticizing the U.S. government?

    Let’s just say the death panel (yeah, the one that doesn’t exist) will be heading out to lunch a bit early that day.

  4. John says:

    Is the VA the right analogy to a single payer system for civilians, or is Medicare? Personally, I could see arguments going both ways on that one. The VA is certainly a mess and has been for a long time. However, Medicare seems generally to pay for quality care and at lower cost than any private insurance plan. And single payer systems in other countries (every first world country has either single pay or some kind of guaranteed right to health care) do seem to be getting as good or better health results as we do. I know the crazy cost of health care in this country is definitely a problem for Medicare’s continued viability, but the system itself seems to work quite well. That of course doesn’t mean one has to be for it, like it, or think it’s a good idea.

    On death panels and the notion that really the government designed Obamacare to fail, I just think, you know, there are no death panels, in the sense of a panel deciding that your grandma won’t get treatment, although my understanding is there will be doctors looking into whether certain treatments make sense at the end of life, and I could see where that’s kind of creepy. But insurance companies already do that, and the free market (as far as I can tell) is a whole heck of a lot more likely to sentence grandma to death if she has no money to pay for treatment, which, before Medicare, she usually didn’t. As for the theory that Obama planned that Obamacare would fail so that his party could lose the Senate and his legacy would be permanently ruined, I jthink that’s spectacularly unlikely on its face. There’s enough problems with the Affordable Care Act without reaching out for the fanciful.

    • guest says:

      But insurance companies already do that, and the free market (as far as I can tell) is a whole heck of a lot more likely to sentence grandma to death if she has no money to pay for treatment, which, before Medicare, she usually didn’t.

      This is true for the free market model of health insurance. But at least the *possibility* would exist to make deals with other people (or other doctors) in order to get care somewhere else.

      Of course, in a free market, more people would be able to afford health care without insurance.

      The Relentless Process of Socializing Health Care

      Why is American health care so expensive? The federal government increases the cost of insurance by regulating insurance deductibles. Given the administrative costs of insuring routine health care, it would make more sense for consumers to pay out of pocket, instead of through insurance. Health care deductibles would enable us to economize on the administrative costs of insurance, but federal law won’t allow this. Also, DeLoach and Platania also ignore the AMA monopoly on the supply of physicians. The American Medical Association has a history of restricting entry into the medical profession. AMA control on the supply of physicians has not helped health care affordability.


      As for the theory that Obama planned that Obamacare would fail so that his party could lose the Senate …

      It’s not so that his party could lose the Senate, but rather so that people will mistakenly blame the free market for all the “free market exchanges” failures that will occur and then call on the government to “fix” yet another problem of its own making.

    • Matt M (Dude Where's My Freedom)) says:

      “However, Medicare seems generally to pay for quality care and at lower cost than any private insurance plan.”

      The “lower-cost” is heavily subsidized, and not just in the “tax dollars pay for medicare” sense, but in the “doctors willingly accept lower payments from medicare patients because they plan on making up the difference by charging exorbitant rates to private insurers” sense.

      If every person was enrolled in medicare, doctors would either quit or insist on higher rates for everyone.

      • John says:

        Hmm. Not sure about this one. Medicare has the bargaining power to bend the cost curve. If everyone had Medicare, as in other countries, American medical costs might well be in line with medical costs in other nations that have single payer. I’m also not so sure that in a totally free market medical costs would be lower than in a regulated market, but on that one I just don’t know, and will have to leave it to the economists on the right and left to fight it out, as they generally do quite eloquently on this site.

        • Matt M (Dude Where's My Freedom)) says:

          Right. It’s possible that a lot of the current “excess” cost is going to doctors directly. The third option for doctors under the “everyone has medicare” plan is “just start accepting lower rates and less money.” Some surely would, because they just love being a doctor or whatever. But surely some marginal doctors would drop out, demand more, etc.

          In a totally free market, costs would almost certainly go down, as the “Dr. Nick”s of the world would come out of the woodwork. Mentioning a “Wal-Mart of medical care” typically makes leftists cringe, but that’s the exact sort of thing that the poor in this country need, and that is currently illegal/priced out of economic viability.

          • John says:

            I hear you on the WalMart of doctors idea. You know, that sounds like it might be right, but might also be an argument for why medical care might not be an appropriate industry for unfettered application of the free market. Sending some people to Walmart doctors might not be very different from sending them to basically no real doctors at all. I’m more familiar with lawyers than doctors, and I can say with relative confidence that a “Walmart” lawyer is probably less desirable than no lawyer.

            • Matt M (Dude Where's My Freedom)) says:

              If that were true, then people wouldn’t go to them. The poor may not be rocket scientists, but they aren’t stupid. They go to Wal-Mart because they perceive it gives them good value. Sure, “Great Value” brand pasta isn’t the most delicious or nutritious food in the world, but it’s good enough for the price. Same principle applies to medicine, law, etc.

              Now, it might be that the “Wal-Mart of lawyers” is still rather expensive compared to say, pasta, but the idea is that there needs to be a “value” option. With medical care, we don’t really have that right now. I can’t really speak for law as I don’t know much about it.

            • guest says:

              … and I can say with relative confidence that a “Walmart” lawyer is probably less desirable than no lawyer.

              This would be worth consideration when deciding between the two:

              How stare decisis Subverts the Law

          • Keshav Srinivasan says:

            How would you respond to the arguments that healthcare has some fundamental differences from other markets that makes it less amenable to free market solutions? For instance, the ones in Krugman’s blog post and the Arrow paper he links to:


            • Matt M -Dude Where's My Freedom- says:

              The only objection he makes that is truly unique to medical care is that it’s difficult to comparison shop.

              And surprise surprise, that difficulty emerges ENTIRELY from government interference and regulations, not from the market itself.

              In a free market, there is absolutely no reason to think that you wouldn’t see Bob’s Discount Medical Practice offering a “15% of all hip replacements during Memorial Day weekend” sale, while down the block Crazy Ed’s Hospital counters with “Free NFL tickets with the purchase of an appendectomy.” Maybe Dr. Smith offers a punch card where after five prostate exams, the sixth one is free.

  5. Andrew' says:

    I think the ultimate mechanism of keeping them in power is lying.

    This occurred to me back during discussions about how “Democracy is a market” as a witty retort by liberals.

    It occurred to me that if that were the case, then it would be dependent on the opposite of the lies people have become calloused to by the government officials we depend on to make our “market decisions” in a democracy.

    Thus, if the defense of government is that this democracy is a market, then who is going to prison?

    I vote for Eric Holder. I just don’t like him more than I don’t like other people.

  6. Slappy McFee says:

    Progressive talk radio yesterday. The VA scandal is an example of why we need single payor healthcare and what happens when you try to drown government in a bathtub.

    • Gamble says:

      The VA is an example of why America needs to stop instigating war…

      • Matt M (Dude Where's My Freedom)) says:

        Meh. At the risk of starting a flame-war, I’m willing to bet a large portion of VA patients are exaggerating the effect that actual combat had on their medical “conditions.”

        It is common water cooler talk in the military how to scam the VA for as much money/care as possible even when there is nothing wrong with you. Nobody sees this as immoral. “We’re all in the military so we are heroes and deserve whatever we can get.”

  7. Gamble says:

    Another bomb from Richard Nixon. Too bad Obama doubled down…


  8. Mule Rider says:

    Is it just me or does anybody else here find it kinda funny that when Bob shares blog posts that are a little more “academic,” shall we say, Lord Keynes gladly comes on here to spew his brand of sophistry and yanks the discussion off in some nebulous direction, but when Bob posts something like this highlighting the REAL WORLD failures of the state and the horribly inefficient bureaucracy that facilitates its business, he’s nowhere to be found.

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