Brian Caplan has been reading up on North Korea, which sounds like hell on earth. He finds it hard to grasp that those who got out of the North still hanker for their homeland and thinks socialised medicine (so anything less than a free market in healthcare) is the reason. But he draws, as I think libertarians almost always do, inferences for state intervention from the most grotesque distortions of economic activity that simply cannot hold in less extreme cases. He is also probably misguided in thinking it was just the healthcare system that they hankered for.
Who doesn't hanker for home? Many Brits can't stand the NHS and we constantly moan about dirty hospitals, waiting lists and the like. And I doubt when ex-pat Brits think about home that the NHS is the main thing on their mind. You think about friends, places etc when you think of home. Free healthcare at the point of use is nice, but that's about it.
But there is little reason why socialised healthcare doesn't work given other than this unrepresentative example, and Caplan doesn't pull any examples from Western Europe, funnily enough. As Paul Krugman points out though, mocking such proponents of a free market in healthcare, over here we do actually also have decent standards of healthcare (arguably better than they have in the US).
For me it's typical. Libertarians try to find the most grotesque distortion of something and say "look how terrible it is!", "we shouldn't have that!", etc. What they should instead do is argue why a free market is better for healthcare. They should try and explain why the imperfect information issues (hard to understand procedures, high cost of mistaken choice) are not that important that they need some intervention, and why the insurance problems (adverse selection meaning that premiums for all are higher, moral hazard meaning that there is over-consumption) which essentially make a free market in health insurance impossible aren't so important (and more than just "market solutions" for the latter problem). Maybe they already do; I'd be delighted to be pointed in the direction of some of these cases.
Christians who happen to fall into this camp of proposing to cut the state back savagely from all involvement in the economy ought to be thinking particularly carefully about these issues since they are precisely social justice issues. The kinds of people that suffer from what happens to health insurance premiums tend to be those most ill (who actually would not be insurable since their probability of claiming is near certain) and those least well off. Often such Christians say charity will do the business and we should let charitable giving fill the gap. The problem is that it won't fill the gap because of our sinful hearts - we free ride, and we don't give as much as we should. In economic theory terms there are positive externalities to a good healthy population, and this means the market (including charitable methods) will underprovide.
No comments:
Post a Comment