OFF: consumer economics (was: Hawkwind MP3's)

[M Holmes]

nickmedford at HOTMAIL.COM writes:

> >>Whereas in our socialised medical system, they die queueing for
> >>operations at zero price. If the price is too low then demand exceeds
> >>supply and some of it goes unsatisfied.
> >
> >
> >Are you suggesting that if people in the UK had to pay for (say) coronary
> >artery bypass grafts, then fewer British people would require them?
> >
> >If you're not suggesting that, what does your above paragraph mean?
>
> OK, I'm being unnecessarily obtuse, so I'll clarify.

It seemed a perfectly clear question to me.

> I assume you mean that
> if money was changing hands, then the service would improve, waiting list
> times would decrease, etc.

Provided the pricing meant that extra supply could be provided at less
than the price charged in order that investors could gain a normal
return on capital. I'd also expect people to eat fewer pies, drink less
beer, or walk a little more often if they knew they'd get hit for the
costs of their own healthcare (or that they'd exercise because insurers
cut them a deal for spending registered time at the gym as happens in
the US).

> and thus demand would no longer exceed supply.
> But these kinds of assumptions about supply and demand may not be as
> readily applicable to healthcare as to buying a loaf of bread, to use your
> other example.

It could be argued thusly. However my partner is an oncologist and so
I'm more regularly treated to arguments pertaining to the economics of
healthcare than I am to those concerning the music business and thus I'm
more confident of my ground here. Nobody who's taken seriously in
argument on the subject doubts that due to the price being lower than
the market one, that demand must be queued by time rather than price.
Indeed the majority of medics would kill (feh) to have the government
simply admit this and move on to discussing how to decide which queues
get priority (as has happened in some states in the US such as, I
believe, Oregon).

> When you buy a loaf of bread, you can be pretty sure you're getting the
> same as the next person who's also buying bread. But two people going for a
> similar operation are not in the same situation: firstly their underlying
> medical problems will not be identical, although they may be similar. They
> may receive quite different standards of surgery and aftercare. They may
> respond in very different ways to the anaesthetic, the surgery itself, and
> any other aspects of the treatment. One may develop fatal complications
> while the other does not. And so on.

I've no argument with that and if it affected pricing then so be it.
That's rather a side issue to debating free at the point of sale versus
more free market models.

> In short, I'm extremely wary of theories of health economics where medical
> interventions are conceptualised as being like consumer goods on a
> supermarket shelf.

How about treating health advice and intervention in the same way as
stockbroker advice and car mechanic intervention? The free market is
already adapted to non-commoditised goods and services and to markets in
which predictive value is uncertain.

> For what it's worth, I believe it would be possible to run a better health
> service without having to pour further billions into it- but only if some
> bold moves were made first. The biggest cause of overspend in many NHS
> trusts is money spent on agency nurses, because there aren't enough regular
> nurses to staff the wards. If regular nurses' pay was doubled, I suspect
> this would result in massive savings in the long run.

There are so many screwups in the NHS that we could start from just
about anywhere. I've heard recently of operations being cancelled
because a couple of beds were occupied medium term by two old folks
leaving surgery for lung cancer. Their homes were damp and they couldn't
be released back to them for fear of fungal infection. Social services
took three months to get another council house or damp treatment and so
many operations were cancelled through leack of recovery beds.

It's just our version of Soviet factories producing thousands of size 8
left shoes because it was easier to meet a 5 year plan by producing all
the same model of shoe(*) If you want something done efficiently, don't
do it under a socialist model.

FoFP

* Assuming of course that this wasn't apocryphal (though it says enough
about communism that there's even room for doubt) but you get what I mean.