tag:blogger.com,1999:blog-16594468.post3671310695074546192..comments2023-10-24T04:29:23.693-06:00Comments on Atheist Ethicist: Unhealthy Lifestyles and Universal Health CareAlonzo Fyfehttp://www.blogger.com/profile/05687777216426347054noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-16594468.post-72506369684305332942007-01-26T13:55:00.000-07:002007-01-26T13:55:00.000-07:00No my view here was specifically motivated by the ...No my view here was specifically motivated by the problems in the UK with the NHS. I asked the simple question that we have multiple parallel experiments running around the world, so lets look at them and find a metric to compare them (surely this is the job of the civil service you or I might ask, but apparently not!). This is how I discovered that Singapore has better mortality rates and other health statistics relative to per capita health costs EC, Canada, Australia and the USA - my survey was not exhaustive and in investigating why I discovered some significant difference to the NHS and USA healthcare systems, that I reported briefly here.<br /><br />I am an empiricist and I have not thought yet about welfare and income redistribution yet but I would apply the same approach, say, looking at the costs, measures of societal health (crime statistics etc.), economic success and growth and then see what seems to work the best and try to understand why.Martin Freedmanhttps://www.blogger.com/profile/16952072422175870627noreply@blogger.comtag:blogger.com,1999:blog-16594468.post-55985585125731985032007-01-26T13:03:00.000-07:002007-01-26T13:03:00.000-07:00Can I assume that you also against welfare and inc...Can I assume that you also against welfare and income redistribution plans for the same reasons?Curiosishttps://www.blogger.com/profile/14499563937438812742noreply@blogger.comtag:blogger.com,1999:blog-16594468.post-28581381049867997072007-01-26T09:30:00.000-07:002007-01-26T09:30:00.000-07:00The problem with a private healthcare market, for ...The problem with a private healthcare market, for which the USA is the exemplar, is that it is an inefficient market, even when focusing only on those who can afford to pay the insurance premiums (directly or via their job) or the fees directly. The evidence for this is the high cost of such healthcare for equivalent treatments compared to just about everywhere else on the planet (after factoring in Purchasing Power Parity or not). There are a number of economic reasons for this but what is relevant here is there are <I>three</I> types of solutions externality costs, government management/takeover of the market and government modification of the market to make it efficient. You discuss only the first two of these here.<br /><br />With regard to externality costs to make an inefficient market efficient, your arguments there are theoretically quite correct, certainly based on moral harm, even if there are a number of reasons why they are impractical in general, although not necessarily in specific, circumstances.<br /><br />The government solution, stereotypical in Europe, does lead to on average lower treatment costs than in the USA, even allowing for higher externality costs that already exist in Europe (especially in the UK, regardless of how this tax revenue is allocated). There are nonetheless many problems with it in terms of obtaining required treatment, regardless of lifestyle choices, due to (non-desire) utilitarian calculations for allocation of limited funds, leading to unequal availability of resources based on age, location, type of condition, treatment response times and other factors. <br /><br />The third solution (for which the exemplar) is the Singaporean Healthcare model. The average treatment costs are both lower than either the typical private and government healthcare models and objectively it has one of the highest levels national health when population health is normalised based on health costs. This is a mixed model, fixing the flaws inefficient private and government healthcare markets <I>internally</i> rather than externally, to achieve (near)efficiency. The key element is that all citizens pay a proportion of their income into an account that only they (and under some conditions their family members) can access and only for specific healthcare treatments. They have the option of different levels of privacy (for which they pay more) and all are entitled to treatment. Services are offered by a mixture of public nd private services. All also must pay for critical illness insurance to deal which covers exceptional illness regardless of life style choices. There is a fund for the unemployed to guarantee a minimum level for everyone. <br /><br />As a result when anyone wants any treatment they are taking it out of their own account and they do not experience the inequalities noted above with respect to traditional government healthcare systems. In addition these are incentives to limit their lifestyle choices as it is they who will be primarily paying for them - this is the internal equivalent to externality costs (which might exist in Singapore too I do not know). Now this solution is being considered for the majority of Asian countries.<br /><br />For more information see <a href="http://www.moh.gov.sg/corp/systems/index.do"> Singapore Ministry of Health</a><br /><br />So when talking about universal healthcare note there are two quite different solutions which one can miss if one assumes they are all government owned or managed.<br /><br />Wrote more than I planned but your site is always one of the most illuminating and hopefully I am somewhat returning the favour.<br /><br />PS The pop-up version of blogger comments interacts badly with Firefox. It is much easier to use in any browser if you switch off the pop-up feature.Martin Freedmanhttps://www.blogger.com/profile/16952072422175870627noreply@blogger.comtag:blogger.com,1999:blog-16594468.post-1706912114991051862007-01-26T08:19:00.000-07:002007-01-26T08:19:00.000-07:00Externalities should be assigned to the degree tha...Externalities should be assigned to the degree that it is efficient to do so. As Joe Otten states in his comment, it does not make sense to go through $1000 of expense to assign $100 in externalities. Nor does it make sense to forego $500 in benefit because we cannot efficiently assign $100 in externalities.<br /><br />The moral case, does not change simply because we cannot find an efficient legal/political solution. We can still make the <i>moral</i> case for promoting an aversion to actions that have negative externalities, by condemning those who engage in such acts, and praising those who refrain.<br /><br />Of course, abandoning the idea of universal health care is one possible way of avoiding its subsidy of unhealthy lifestyles. This solution also has its problems. Namely, differences in wealth allow rich people to bid resources for low-value uses away from poor people who have a higher-value use for the resource but who cannot afford to bid.<br /><br />(See, <a href="http://atheistethicist.blogspot.com/2006/12/survival-vs-property.html">Survival vs. Property</a> for my discussion of this concern.)<br /><br />In this case, I think we can assign some of the costs for those externalities using the methods that I discussed - particularly the second (an 'unhealthy lifestyle tax') to help pay for universal health care and reduce the demands placed upon it.Alonzo Fyfehttps://www.blogger.com/profile/05687777216426347054noreply@blogger.comtag:blogger.com,1999:blog-16594468.post-21274765691865794392007-01-26T07:26:00.000-07:002007-01-26T07:26:00.000-07:00I think there is a whole class of behaviour that, ...I think there is a whole class of behaviour that, while causing some small harm to everybody else, are nonetheless acceptable because if they weren't acceptable the loss of freedom would be even worse.<br /><br />For example, if I buy a bigger car, then my potential for injuring other people who I may collide with will increase. (I don't buy any arguments based on the economic consequences of my buying a car - I would just buy something else with the difference anyway.)<br /><br />It seems to me that mildly health-threatening lifestyle choices within a system of universal healthcare also fall into this category. Yes, there is a moral hazard, but it is worth the tradeoff against the benefits of universal healthcare.Joe Ottenhttps://www.blogger.com/profile/18380362092159905533noreply@blogger.comtag:blogger.com,1999:blog-16594468.post-16349271351491407732007-01-25T23:13:00.000-07:002007-01-25T23:13:00.000-07:00I have some of the same concerns about universal h...I have some of the same concerns about universal health coverage. On the other hand, I think that any system that pools risk will have similar problems, though to a lesser degree. For instance, low-deductible, low co-pay insurance policies give people too little incentive to avoid expensive treatments and tests. <br /><br />Our present system, I understand, incurs something like 15-20% overhead for administrative expenses related to figuring out who pays how much for what services. It is also my understanding that the overhead associated with single payer systems is much lower. If that is the case, does that not at least mitigate some of the disadvantages?<br /><br />Finally, this is not new territory. Universal health care coverage is the prevalent system in developed countries, and they spend a smaller percentage of their GNP's on health care and have generally healthier populations. While it may not be the case that universal health care is uniquely responsible for these facts, it is enough to suggest to me that the consequences we fear from universal health care coverage are not so likely as we might expect.<br /><br />My tentative position is that we should provide universal health care coverage and to work on the potential behavioral problems you describe using the tools of education, praise and condemnation, and probably still some kind of financial incentives.Alan Lundhttps://www.blogger.com/profile/05175526514562663282noreply@blogger.comtag:blogger.com,1999:blog-16594468.post-52738588524800224882007-01-25T21:55:00.000-07:002007-01-25T21:55:00.000-07:00I couldn't agree more. You are applying the concep...I couldn't agree more. You are applying the concept of externalities to human health, which is I think, an excellent extension.<br /><br />Briefly, any cost to society or the environment incurred by actions that benefit small groups or individuals is an externality.<br /><br />There is no reason why all externalities shouldn't be assigned to those who benefit from the transaction. It is common sense, and it would be a better world.BlackSunhttps://www.blogger.com/profile/15591731325290405256noreply@blogger.com