In the United States, health care is mostly seen as a private good. A private good has two main aspects. The first, and most obvious, is that the good is private—the benefit is seen as being primarily (or even exclusively) to the individual. Put roughly, it is a good for you, but not for me (or the rest of us). Second, the good is thus typically seen as being the responsibility of the beneficiary. Put roughly, you should pay for that good, not me (or the rest of us). Of course, a private good might have some broader benefit. There are many things that are clearly private goods. For example, my running shoes are a clear private good—they benefit me, and I should be the one to buy them. In terms of a possible broader benefit, my being healthy means that I do not miss work, and this benefits my employer and students. But this is not enough to make them a public good. There are also clear public goods.
Obviously enough, a public good is supposed to benefit the many and is typically seen as being the responsibility of society. Put roughly, it is a good for us and we should pay for it collectively. A public good need not benefit everyone—almost every good is not of interest or use to at least some people. For example, public transport is not of benefit to a person who never uses it and gets around on their bike or by walking. There is, as one would expect, considerable debate over what goods (if any) should be public. Public versus private health care is certainly a matter that generates considerable controversy.
With the main exception of the United States, most wealthy countries have chosen public health care. The United States does, of course, offer some public health care in the form of Medicare and Medicaid—but people need to qualify for both. Most people who are working rely on private health care. One reason for this is that a narrative has been crafted to cast health care as a private good—or at least better as a private good than a public good. In terms of being a private good, the general idea is that each of us is responsible for our own health care—we must earn the money to pay for insurance and treatment. With the exceptions of Medicare and Medicaid, we are on our own. The idea is that my health is a good for me, but not for you—hence I should bear the cost.
There are also the arguments that the current private health care is better than public health care. This can be countered by pointing to the number of people who go bankrupt due to medical expenses, who cannot afford and hence do not get basic care, and those who turn to GoFundMe and similar sites to pay their medical bills. It is, I must admit, true that we do have the best health care that money can buy—if you have the money to buy it. I will set aside this debate to focus on the main issue: whether health care is best seen as a public or private good. One way to approach this matter is to consider paradigm cases of public goods.
Consider, if you will, an alternative America in which defense, police, fire and the legal system were regarded as private goods analogous to how health care is seen as a private good. In this alternative America, citizens would need to purchase military, police and legal insurance or face high costs for purchasing basic military, police, fire and legal services. In the case of military and police coverage, a citizen would be provided with various degrees of military protection for their person and property. Without such coverage, a citizen would need to pay high costs to secure such services as defense against foreign enemies and police investigations into crimes committed against them. Those lacking the ability to pay might be able to qualify for some basic services via such government programs as Militaryaid and Policecare. Those unable to qualify for such programs and unable to afford the services would be on their own—they would need to rely on self-defense, a good garden hose and vigilante justice to address threats and crimes against them. This would be fair and just—after all, having the military protect me does not benefit you, nor does having the police investigate the theft of my truck benefit you. Only having the military protect you benefits you. Only having the police investigate the theft of your truck benefits you. So, by the logic of health care as a private good, police and military services are also private goods. The same would also apply to aspects of the legal system. Being able to defend my property or other rights in a legal system does not benefit you, it just benefits me.
There would be, of course, certain police, military and legal activities that would occur because they would be a good for these institutions and the state. The police would certainly enforce laws that generated revenue for them and the state; but if the law served only your private good, then you would need to pay for its enforcement. Such institutions would naturally be lean and efficient, operating in accord with strict market forces as God intended.
In this world, the results would be analogous to health care in the real world. People would be locked into jobs to keep their police, military, fire and legal benefits. People in need would turn to GoFundMe to pay for such things as the murder investigation of their spouse or keeping Canadian invaders off their land. Many people would be victimized, injured or killed because they lacked basic coverage. But such is the way of private goods.
In general, such things as police, military, legal and fire services are seen as public goods because they are regarded as meeting the state’s minimal obligation of protecting its citizens. There is also the fact that such goods require large expenditures to operate, thus requiring collective funding—which warrants providing a collective good. The same can be applied to health care—just as the state should protect its citizens from ISIS, fire and crime, it should also protect its citizens from COVID-19 and cancer. After all, you are dead whether you are killed by an ISIS bomb, a criminal’s bullet or COVID-19.
Police, military and other such services are also seen as public goods because they do (mostly) benefit everyone—even though the specific applications obviously benefit specific people. The same also applies to much of health care. For example, infectious illnesses spread and containing them is a public good. As another example, sick and injured people contribute less to the economy, so treating them benefits the public by getting them back into serving their core functions in capitalism: working and spending. As such, health care should be seen as analogous to the public goods of the military, police, fire, and legal system. There are, of course, obvious exceptions in which medical procedures are entirely private goods (like face lifts) but these exceptions do not disprove the general principle.
This is a much more reasoned essay, though again it misses the important smaller distinctions in an attempt to contrast the big ones.
It is generally agreed that at least some areas of healthcre should be public goods, like vaccination for kids that protects public health, and that others like facelifts should be private goods.
The question is not: should healthcare be a public or private good? but what elements of healthcare should be split between public and private options, across what diseases and what demographics? And the discussion should involve a careful weighing of costs and benefits.
I get the feeling that neither one of you know what you are talking about.
Fair point. We are not using the term correctly. We shouuld change the term.
What is the correct term for a good or service provided by the community for individual benefit?
Charity? Assuming the providing of the good or service being done by the community is voluntary. If said good or service is being extracted from the community for individual benefit is being extracted in an involuntary manner, it gets more complicated than that as each actors motivations become suspect. Though socialism is somewhere in that mix…IYKWIM
See Mike, this is how it’s done. I raised a valid concern about one person’s reasoning or use of language and they (well half of they) addressed it.
Now Michael, “Hands up, don’t shoot”, fact or fiction?
By the way, I’ll just leave this here for our small group:
I think this, or one of the other trials, is the best hope for an exit to what will otherwise be a disaster on the level of a world war. We NEED to have a practical counter for the small percentage of serious cases. Vaccines are at best 18 months away, We can’t keep the world shut down for 18 months – people who are not on the government dime need jobs, and even civil servants need food and other necessities provided by people who make and distribute and finance them.
If there is a treatment that will reduce the 14% to 3%, and the 1% to <0.1%, especially a well-known and easily available treatment like quinine, we can get back to work, expedite the herd immunity process without sacrificing millions, and this could be a disaster averted.
I just hope that a) this works, and b) we don't immediately forget the lessons.
My question is, why this level of response for this level of pathology? This is an unprecedented response. Governor Cuomo’s speeches sound exactly Trump’s. The irrationality and panic is probably worse than the virus.
None of the numbers match the response when compared other pandemics.
What do you think the numbers are? The general belief is that 80% of the world will be infected in the next 18 months without vaccines.
In the USA, that’s 260 million.
Of those, 14%-20% will be hospitalised for an average of two weeks. Call it 40-50 million. The US has capacity for a million beds (and despite Mike’s assertions without numbers, that’s a better ratio than almost any other country) but those are needed for run-rate cases. Say there is a 25% slack, then there are 250,000 beds to serve ~45 * 2 = 90 million bed-weeks of demand, assuming the demand is evenly spread, which it won’t be. That works if you spread it out over 360 weeks = 5 years. That is do-able with universal lockdowns to spread the load – but universal lockdowns will also be destructive and deadly in other ways.
Further assume a 1% death rate overall, that’s 2.6 million, about equal to the regular USA annual death count. But if we say that the rate goes up from 5% among serious/critical cases to 15% among that cohort because of a lack of supportive care because there are facilities and trained staff are not available, that’s more like a death toll of 8 million.
Doing overall numbers like this dosn’t really make sense, because of the capacity factor over time. You need to look at a model that takes into account infection rates, facilities available, and recovery rates on a week-by-week basis.
Apart from those direct deaths, you can also add in those caused by the medical shortage. A friend of mine was due to have a serious operation next week. That has been postponed, because of the risk of infection. Will he ever get to that operation, or will he die, or have the operation only to contract the virus? I’m worried about him,
I am glad to see countries now adopting possible treatment options like chloroquine, remdesivir, lopinavir/ritonavir. That might change the numbers a lot. We can hope, But they are not currently proven.
And yes, you can pick on any and all of these assumptions and percentages. Put them in a spreadsheet. I did. You can bring the numbers down or up.
But if you are asking why governments are taking lockdown measures, what numbers do you have?
Well, looks like lopinavir/ritonavir isn’t going to be a great help. Minor improvement, shortened recovery time by a day on average in the trial. Possible that it will be more effective if administered before severe stage, but still of limited scope.
This has been going for three months. The CDC expects it to peak in 45 days in the US. If this is to reach even the H1N1 500000 deaths globally, it better hurry. China saying some areas that were infected now 14 days without a death. Globally, as of yesterday, under 10 k. The demographics at risk are much smaller in scope than H1N1 and now that they’re known, can quite easily be protected. 90 percent of deaths in Italy are 70 years old or more.
Again though, why didn’t this happen with H1N1? The only thing that made this different from SARS was that China tried to hide the initial outbreak for longer. And the media was met trying to troll a US president over SARS.
Those that are mostly likely to be out and about (young people) especially under 19 are mostly asymptomatic and will establish herd immunities in their communities rather quickly.
I just want a number. If there’s fewer than half a million deaths from this, what was the difference? The entire world follows the US media. I stand by the idea that this is the difference. Even Cuomo hinted at this.
Bottom line for me: I feel zero angst over potential death for myself because of COVID-19.
I just want a number.
We all just want a number. What we have are many, many numbers, none of which we trust, for one reason or another. If we only had A number, THE number, it would be great. But we don’t.
Nobody has A number.
This type of situation has been intensely studied and modelled and gamed by epidemiologists, but without much more data, they don’t have a number either. We just have to watch the situation day by day, and keep adjusting strategies based on the latest info.
The deep uncertainty is the problem. This could start fizzling tomorrow, or it could steepen its exponential rise. We have to make decisions without knowing.
Again though, why didn’t this happen with H1N1?
“six months into the outbreak, a total of 209,450 cases and nearly 2,200 deaths had been reported globally.” We’re three monthis into this one, if you take the long count, and Worldmeter is currently showing 276,714 cases and 11,421 deaths.
I feel zero angst over potential death for myself because of COVID-19.
Hm, that’s odd. I hadn’t even considered this a danger to me personally. Of course, as an old man with some minor conditions, I am in the high-risk group for criticality if I get it, but since I’ve retired, my lifestyle does not lead me to crowds or events where I have a high risk of contracting it. And since I never pick up whatever bug is going around, I have a sense of invincibility … which is irrational, now I think about it.
“ Such institutions would naturally be lean and efficient, operating in accord with strict market forces as God intended.”
Can anyone name anything in America the operate in accord with strict market forces, as God intended?
Or is this more theoretical bullshit? The average homeless person I dealt with in law enforcement had way more free MRIs than I ever had in total. We can argue as to if that’s a good or bad thing, but not as to if it’s actually a thing. It is.
Leftism: arguing for things you already have. Like abortion rights. And five cats.
But also, how’s soft socialist Italy doing in all this? The United States in fact, as almost always is doing great compared to almost everyone else.
Still waiting for COVID 19 to reach 1/3 of a typical seasonal flu fatality number in the US however…
There’s also a ton of overlap between private good and public good. False dichotomy.
*or false dilemma
See this chart:
Curious…does anyone here understand this chart? Do y’all understand the difference between National Defense and health care? There’s a very important distinction (or two or three).
Politics is probably the worst thing on the planet. Humans default to tribes for a reason. I side with my father because he is my father. Screw politics. Met many Afghans that were happier than well-to-do woke DemocratS.
Madison’s plan was as brilliants as could be. But he could not envision the ability of technology to enable agitation 24 hours a day, from anywhere in the globe. We will result back to open tribalism because that which cannot continue, won’t.
Also, the more I think about it, screw the ancient Greeks, too.
Politics is probably the worst thing on the planet. Humans default to tribes for a reason. I side with my father because he is my father. Screw politics. Met many Afghans that were happier than well-to-do woke Democrats.
Madison’s plan was as brilliants as could be. But he could not envision the ability of technology to enable agitation 24 hours a day, from anywhere in the globe. We will defaukt back to open tribalism because that which cannot continue, won’t.
Also, the more I think about it, screw the ancient Greeks, too
I can’t think of anything more frightening than being forced to use a government doctor if I were really sick.
Michael LaBossiere says
How about not being able to afford to see a doctor? Or not being able to see a doctor at all?
To infer that X is bad because X is government is a nice bit of sarcasm, but is no better an inference than X is bad because X is private sector. It is not the sector that makes something bad, it is the badness that makes it bad.
When you’re the only person saying something, I admit it’s comforting to find an expert who finally says the same. I’m getting a sneaking suspicion this will go down as one of the greatest over-reactions in history.
Shutting down California? China meanwhile two days in a row with no more reported cases. Both SARS and MERS mutated and disappeared. Coronavirus should are prone to this. Those acting for common good act on incomplete knowledge and can make things worse.
I had read it.
Ioannidis is a hero for his great paper and his various other contributions to sanity, but this essay is a let-down. It doesn’t say anything useful. (Also, he confuses “case fatality” with “infection fatality”, which I find surprising.)
He keeps telling us what we do not know. We already know what we do not know. I see commentary already starting, pointing this out.
Yes, we can do massive damage to society and production, causing more suffering and death, with shutdowns and quarantines. We will do at least some.
What we need is information that finds that optimum point at which we do the least harm and most good.
If we are overreacting, we will see that within weeks when the expected surge of cases doesn’t materialise.
China meanwhile two days in a row with no more reported cases.
Given their recent record, I do not trust a word the officlal Chinese sources day. Not one word. But all I have is more numbers, more modelling, for example. https://www.medrxiv.org/content/10.1101/2020.03.14.20036178v1.full.pdf “In the case of China, it is estimated that more than 700.000 casesof COVID-19 actually occurred instead of the confirmed 80,932 cases as of 3/13/2020.”
I think it says many useful things. For instance;
“ Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%). It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.”
This should be emphasized. I looked back at articles published after the 2009 pandemic (swine flu). All predictions were wrong. Predictions by government scientific groups. The geometric calculations used for infection do not work. I am yet again reminded that experts often do not know as much as we hope, but are often able to dazzle with jargon.
The predictions for H1N1 vastly overstated the likely deaths. As for COVID 19, this is already happening. Though China is prone to lying, so is CNN. Frankly the Chinese death rate we see is compatible with what we see in more reliable countries.
Nothing we are seeing is matching the horror stories. After three months we should have seen 100k dead. At least. This threat has remained largely theoretical through the whole event and is a study in what post-social media years will look like, not how disease could devastate.
More articles are beginning to note that the numbers are not lining up:
At what point will we consider that this has been an overreaction? What if by the end of August the number of deaths is less than 100k globally and the disease has all but stopped spreading? 400k die every year, year in year out, globally, from the flu. I know personally of nobody that’s died from the flu.
I haven’t replied because this discussion demands more space and time than a simple comment, and I can’t seem to condense my points enough.
Yes, Ioannidis repeated the abstract of the Diamond Princess study, but that is not new information – just amplifying one data point in a huge space of data points. Yes, it was an important data point a week ago. It was the first solid, verifiable indication that the IFR was likely less than 1%. It was an anchor point. But it is not new information.
I went through this process more than a decade ago with global warming. Very different timescales, of course. It took three months fo me to read myself in enough even to understand the context of the numbers – well, most of the important numbers. I started off alarmed, gradually went dismissive, and slowly gravitated back to believing that it’s an issue that deserves attention, though not the extreme proposals that are currently mainline policy in far too many countries. Unfortunately, most people don’t consider the cost/benefit of specific proposals, simplifying into pro- and anti- tribes. The same thing seems to be happening here, but unlike climate, we will know the answer before the main talking heads retire or die. Remembering the nonsense I believed at different stages of getting to grips with that issue helps me stay modest here.
Of course, as with COVID-19, the number of articles pushing one narrative or the other has no correlation to the facts.
Yes, a shutdown means people out of work, unable to pay for what they need, and every week it is prolonged makes the recovery longer and weaker, which means more suffering and death for more people.
I don’t have to make practical decisions about the specific mechanisms for preventing infections now and overwhelming health workers, causing more deaths vs. causing ongoing hardship and death through a depression. I’m glad of that. I don’t have the character for it. Nobody has the intellect for it. But the division into pro- and anti- tribes, and the publication and repetition of manifestos on either side, is inevitable. It seems to be part of the unavoidable process.
Agree with this. But what disturbs me, much like with AGW, is the degree of unthinking contempt even from accomplished scientists. Scientists should be able to argue a point, refute a point, without going all-in with moral superiority and a 100% confidence level. It riles up the mob justice attitude and it pushes those on the other side to put up their defenses and not consider the weaknesses of their own positions.
In a much, much smaller way, it’s one of the things that frustrates me here. I know I can make better arguments for Mike’s positions than Mike does. But it’s the same problem on a much wider and more consequential scale.
I think it is a mistake to crater the economy in response to the corona virus. What we should be doing is:
1) isolate people over 70
2) rapidly increase the number of hospital beds and ventilators. Put some military people in charge of this. Hotels could be quickly turned into hospitals, for example.
Put some military people in charge of this. Hotels could be quickly turned into hospitals, for example
You lost me here. Putting peace-time military people (which is overwhelmingly what we have available) in charge of much of anything is a disaster in the making. Not gonna happen but assuming you could pull together a subset of such who’ve actually been shot at in anger, well you might have something there. OTOH, they’d likely be indifferent to what all the fuss is about.
The military is quite good at logistics.
I’ll take Amazon and FedEx over the military any day. Mostly because they hired away the brighter ones.
I agree that what has been done to the economy in response to this is a mistake. We will learn from the mistakes of the individual states as long as the federal government doesn’t initiate overwhelming domestic restrictions. Let anti-fragility do it’s thing.
Also, masks. Masks help reduce the spread of the virus. Is the U.S. not capable of producing masks?
We should be taking positive steps, not cowering in our homes.
Especially not cowering in our homes with our infested children…
Medium took down that article. I read it. But the media in almost all its forms is insufferable. It was excellent.
Yet another thing that is far scarier than the virus. Even in my worst pessimism, which most people whom I know found unreasonable, I never thought things could sink this low this easily.
I’ve been making an effort to evangelize, for lack of a better word, the Diamond Princess study. God help us if they bury that as well. Very, very few people know about it in normal world.
That article has been republished at ZeroHedge, though with knee-jerk angry caveat…
Again, agree. Today Trump addressed this. Deregulation to make construction masks available to hospitals. Also, Hanes will begin making many more masks.
Ironically one of the reasons the flu is worse in the winter is because people stay inside.
I don’t watch television. Haven’t for 5 years or more. Somehow I’m still exposed to this:
And over and over in the last few months I’ve found more insight and logic on Joe Rogan than anywhere else. This is troubling:
Not what I meant to post: