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David Balan's Opening Statement

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David Balan asked me to post his opening statement for tomorrow's Separation of Health and State Debate.  Enjoy!  I'll post mine at midnight tonight.


Thanks to Bryan for agreeing to this debate, and for letting me post my opening statement on his blog. A few words on my background. I'm an economist here in Washington DC, and a fair bit of what I do involves health economics. While it's no great secret who I work for, in settings like this I avoid identifying my employer just to make it extra super clear that I am speaking only for myself. I got to know Bryan and some of the other GMU Economics folks a few years ago when I gave a seminar out there, and since then we have had a good many extremely interesting and highly spirited (GMU people are very into "spirited") chats about health care and many other things. We don't agree on much, but we have fun and we learn a lot (or at least I do), and hopefully that will continue here.

Let me start with a bit of throat clearing. First (and this should go without saying, but I'll say it anyway), this is not a "debate" in the sense of two people using rhetorical tricks to try to score points off of each other. Bryan and I disagree on a lot (that's why we're "debating"), but the goal here is to explore our disagreements and to see how much truth we can uncover in the process. Don't be shocked if you hear us agreeing on something, or if one of us concedes a point to the other. In fact, I think part of what will make this interesting will be to think about how it is that we have quite a lot in common (both in terms of actual propositions that we would both support and in terms of our intellectual styles), and yet we reach very different conclusions. Second, this debate is not about the merits of any specific health care plan or system. While I am still stumbling around in a joyous delirium over the U.S. health care reform that passed the other day, this debate is not about the merits of that reform or about how it compares to alternatives. My purpose here is to argue only that there are strong moral and economic grounds for significant government involvement in health care. The exact nature of that involvement is beyond the scope of this debate.

 With that out of the way, let's get started. The proposition that is being debated is "Significant governmental involvement in health care is both economically sensible and morally just." The "economically sensible" part and the "morally just" part are inter-related, but at the cost of a bit of over-simplification I'll treat them separately, starting with the "morally just" part.

Suppose that everyone in society had exactly the same health status, and everyone needed a certain amount of health care to avoid debilitating illness or death. Also suppose that health care is sufficiently expensive that the poorer people in society cannot afford it, by some reasonable meaning of the word "afford," through not-too-much fault of their own. (I'll ignore the question of how fault is determined and just talk somewhat vaguely about the "deserving" poor, however you think that should be defined). What should happen? Should the government intervene and require the rich to subsidize health care for the deserving poor? Your answer to that question should be the same as your answer to the question of what should happen with regard to any other essential thing that deserving poor people cannot afford. That answer will depend on many factors, including how expensive health care is and how beneficial it is; how concerned you are that public provision, and the taxes required to pay for it, will damage work incentives; how averse you are to governmental action in general; and many other factors. But let's assume for argument's sake that there are some circumstances under which, all things considered, you would favor some significant governmental redistribution towards the deserving poor. (I'll talk a bit below about where it leaves us if you're not prepared to assume this.)

How do things change when you introduce the fact that not everyone has the same health status, and some people need much more health care than others? This brings us into the world of risk and hence the world of insurance. We routinely buy insurance against major losses such as our houses burning down because we're better off paying a small insurance premium in all states of the world than we are paying nothing when our house doesn't burn down but losing everything when it does. The same idea holds for insurance against catastrophically bad health outcomes. Each of us has some probability of getting seriously sick and needing health care that is much more expensive than we can afford. It makes sense to buy insurance against that eventuality just like it makes sense to buy insurance against our houses burning down. The problem is that you can't buy health insurance when you're already sick, just like you can't buy fire insurance when your house is already burning. So when should you buy health insurance? Well, presumably you should buy it before you get sick, just like you should buy fire insurance before your house catches fire. The problem is that all houses start out not burning, whereas some people start out sick or with a propensity to become sick. A for-profit insurance company will not insure an already-sick person for the same reason that a for-profit insurance company will not insure a house that is already on fire. Absent government intervention, there is simply no way that you can insure yourself against being born sick, or of becoming sick early enough in life that you cannot have been reasonably expected to have bought insurance against becoming sick (here I'm leaving aside the very real possibility that you buy insurance but the insurer finds a way not to pay if you become sick). This brings us right back to the scenario we described above where everyone's health status is the same. In that world, the right thing to do depends on your attitude about what to do when people are born poor. But being born sick is just another version of being born poor: it means that you have expensive needs that you cannot afford to satisfy on your own. (By the way, do you know where I got this point from? Bryan Caplan!) If you thought it was appropriate to insure against the one, you should be in favor of insuring against the other.

There's a great deal more that could be said here, but that's the essence of my moral case for governmental involvement in health care. For those (important) health expenses that are reasonably predictable, there should be a public guarantee of provision for the poor just like there should be for a public guarantee of a minimum standard of food or shelter. For those health expenses that are not predictable, there should be universal insurance because anyone who ends up getting sick is like someone who was retroactively born poor, and it's impossible to buy insurance against that, just like it's impossible to buy insurance against actually being born poor.

But what if you don't, as a matter of principle, buy the idea that it's ever appropriate for the government to use its coercive power to compel the rich to support the poor? Some take that position on general libertarian grounds, which I disagree with but which are beyond the scope of this debate. But there is another objection to the idea of governmental support for the poor that I do want to address here, because I think it has considerable merit. People who are born poor in rich countries like the U.S. are much richer than poor people in poor countries. Furthermore, those rich-country people who really are poor in an absolute sense (such as people who are born with serious illnesses), are much more expensive to help than are poor people in poor countries. It can be fairly argued that to the extent that rich people are morally required to spend resources on helping the poor, it should be the much poorer and cheaper-to-help foreign poor. While I am not the complete non-nationalist that Bryan is, I am sympathetic to this argument. I follow it in my personal charitable behavior; almost all of my charity goes to extremely poor foreigners. But I don't regard that as much of an issue for this debate. If it was remotely feasible that instead of guaranteeing health care for poor Americans we would spend a similar amount of public resources in helping very poor foreigners, I would be inclined to go a long way in that direction. But it's just not relevant for practical politics.

Now let's turn from the "morally justified" part to the "economically sensible" part. I have argued that there is moral merit in providing for the health needs of the deserving poor. But that only works if such provision would confer some reasonable return on investment: there is presumably no moral obligation for a society to bankrupt itself in order to provide expensive care that does the poor almost no good. So is health care for the poor a reasonably good bargain? I think that it is. While there is a distressingly large amount of evidence that much of modern health care, particularly in the U.S., has little or no health benefit (the policy implications of this fact are a whole 'nother story), I don't think there is much doubt that certain kinds of health care are highly valuable, and that having access to them significantly improves the length and quality of one's life. Is it too expensive? Well, all of the wealthy countries of the world, and some less wealthy countries, have been able to provide it at what appears to be tolerable cost, in that it is not bankrupting their societies (those same societies have also, to a greater or lesser degree, ameliorated other kinds of poverty, also at no overwhelming social cost). This does not prove that it's a good bargain, but it at least proves that it's not a catastrophically bad one. And even if you think that it's a pretty bad one, you could make governmental provision of health care less generous (say by means-testing benefits) without violating any of the principles of my argument.

Up to now the discussion has centered on the moral obligation to provide health care for the poor, and the "economically sensible" considerations were limited to whether this moral obligation can be satisfied at tolerable economic cost. But there are a bunch of other, more conventionally "economic" reasons for government involvement in health care, of which I'll list just a few. First, healthy people are more productive. Second, there are significant externalities and spillovers related to health: we're all better off when our fellow citizens are healthier. Third, there is a strong case for governmental involvement in medical research and development. Private firms only have an incentive to do research that will lead to patentable innovations; they have no incentive to test whether an apple a day really does keep the doctor away. Fourth, there is a case for governmental regulation to ensure that health care is safe and effective (no selling poisonous snake oil), and that health insurers actually pay up when you get sick. You could argue that the market will take care of this by itself through reputation effects, but look around!! Fifth, there are some instances where the government is simply more trustworthy than private firms, and that trust allows economically efficient things to happen that otherwise wouldn't happen. For example, it seems pretty clear that in the coming years people (not just poor people) are going to need to be induced to limit the health services that they consume; we just can't provide everything to everybody all the time. The problem is, it's hard to get people to agree to limits when the ones doing the limiting are unregulated private insurers who have an incentive to cut whatever care they can get away with cutting, rather than cutting care that is of low value. But if it is the government doing the limiting (either directly or through regulation of private insurance), and this limiting is being done through a rational process that people trust, then it has a chance of happening. I could go on. 

My bottom line is this. Guaranteeing health care for the deserving poor and guaranteeing catastrophic health insurance for everyone is morally required provided that health care provides significant benefits and can be provided at a tolerable social cost. These conditions are easily satisfied in contemporary prosperous societies. There are also a number of other practical reasons, not directly related to moral obligations to the unfortunate, for various kinds of governmental involvement. This is a very minimalistic framework: there could be a great deal of variation of opinion about optimal policy even among people who buy into it. Since Bryan is going to be arguing for no governmental intervention at all, I look forward to hearing which part(s) of the framework he rejects. Let the games begin! (Oh, another thing Bryan and I do together is play nerdy games.)


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COMMENTS (16 to date)
Steve S writes:

David,

I wish I could come to the debate. It looks like a good time will be had by all. I hope its posted online eventually.

The first sentence of your last paragraph is intriguing. Are you arguing for universal catastrophic insurance? Everything else about your post says no? I am pretty certain that, among a range of competing policy options, that Bryan, Arnold and most of the GMU cloud would love to have seen a universal catastrophic health care. I'd even like Marty Feldstein's idea for an income rated annual voucher system or mandatory and subsidized (via mean's test) HSA's. I think that many of the policy goals you espoused could have been realized in a vastly more sensible way than this dramatic expansion of government power. All sensible people believe that health care reform is needed. Just not the health care reform we are getting.

Steve

ThomasL writes:

It begins well-stated piece, but it never presents a cogent argument.

It uses a few lines to gloss over all the important controversies and otherwise indulges in moral feelgoodism.

For a couple of examples:

"I'll ignore the question of how fault is determined..."

Most convenient to do, but hardly fair in context of reforming a whole health care system. Perhaps the author is introducing a brand new idea for a brand new system, but otherwise no discussion in popular circulation is about a new system specifically addressing the needs only of those born with disabilities or illnesses.

This appeal to an emotion necessitates throwing out the "undeserving" from the equation explicitly, and all the people who are not born with illness implicitly. Rightly so, because if you allow people to get sick later in life someone must ask the questions. If you are treated for cancer, did you smoke? Liver failure, did you drink too much? Diabetes, are you overweight?

The likelihood of people thinking you justified in coercing support for treatment will change depending on the answers to those questions. Many people wouldn't think it fair that a well-to-do man, who exercises daily, never smoked and eats modestly would pay for the health care of an overweight diabetic that smokes two packs a day and drinks a six pack of beer every evening.

Turn that around to be a baby with leukemia and almost everyone will want him to pay, and call him evil if he doesn't. A triumph of Singerian ethics...

In the real world, there are more overweight diabetics than there are children with leukemia, but they don't make interesting examples, so it is much easier if "[we]'ll just ignore the question of how fault is determined..."


Another point that leaps out:


"If it was remotely feasible that instead of guaranteeing health care for poor Americans we would spend a similar amount of public resources in helping very poor foreigners, I would be inclined to go a long way in that direction. But it's just not relevant for practical politics."


That is an amazing argument within the section on _moral_ justification. Is that how morals are fixed? Political practicality? In "similar amounts"? How similar? What if we could only guarantee one-quarter the amount but it did twice as much good? Is it more moral to give four times the _amount_ or twice the _effect_? You say "spend... a similar amount" so it certainly sounds like the level of spending is the primary issue. I suppose you've noticed some charitable deficiency exists in your fellow citizens, but that you happen to know just the right amount of spending to root it out. All to their own good... since the effect on the recipient is obviously of less importance than the level of spending by the benefactor I must assume the primary goal is, in fact, the extraction of spending.

PJens writes:

Bryan, please bury this guy with facts.

I would start by dismantling his "bottom line" of: Guaranteeing health care for the deserving poor and guaranteeing catastrophic health insurance for everyone is morally required provided that health care provides significant benefits and can be provided at a tolerable social cost.

Medicare was set up to do just that for senior citizens, and low and behold, that program is not working as advertised, and the costs are not tolerable nor sustainable. Evidence to support this is the shortfall of services to "deserving poor" requiring dental treatment under Medicare, and the huge looming funding deficit to Medicare. What makes him think this new program will work?

The other fact is that people are currently treated for any and all medical conditions. BHO traveled to Cleveland to talk about a lady with cancer who did not have insurance and was afraid of loosing her house. She could not be in attendance because she was being treated for her cancer in a state of the art hospital who came out and said she qualified for a current program, and they would not be going after her house.

The argument that we as a nation have not been doing our moral duty to the poor is a false one.

We have (had?) the best medicine and treat everybody regardless of ability to pay. It is the payment system that is screwed up.

ThomasL writes:

The shorter version of my objection to this statement is that the author starts with a philosophical argument, open to a host of practical objections which we are asked to ignore for the sake of simplicity. Fine, we shall do so.

Soon, a philosophical objection is raised and the immediate riposte is that the objection is not practical, and should therefore be dismissed.

So now we have, in barely six paragraphs, a theory which one is barred from countering on any basis whatsoever, practical or philosophical.

This does offer that special flavor of socialist argumentation in a concentrated, essential form, but I'm not persuaded.

Joey Donuts writes:

This debate looks like fun.

One thing missing in the arguments presented here is the question of supply. What does the supply function look like? What responsibilities does the government have for providing rules that let potential suppliers actually compete with each other for customers. In an earlier post Bryan mentioned offering a person an option to go abroad for treatment and sharing any savings with the person. i hope the debaters take some time in this debate to discuss supply issues and the governments role.

ChrisW writes:

Mr. Balan, thank you for a level and rational argument. Even if I disagree, it beats the heck out of the pathos-dripping messes that I encounter elsewhere.

I'd like to point out that the market failures you allude to in your economic analysis are erroneous. While it's true that there are many abuses today (e.g., "You could argue that the market will take care of this by itself through reputation effects, but look around!!"), this can largely be blamed on the distortions the government has already caused in the market.

The fact is today that health insurance is largely tied to ones employment, and so the costs and benefits of health insurance must be viewed as a package with the rest of one's employment situation. That is, maybe my insurance company is bad, but my pay is good, I get lots of vacation, etc., so on the balance I like the overall situation.

And the thing is, it's the government that caused health insurance to be packaged up with employment, from back in the WWII era when there were controls on pay. Since it's the government creating these distortions, it seems crazy to dig a deeper hole, taking us further yet from the natural behavior of the market. If they've broken it so far, there's no reason to think they'll be able to make it any better.

mark writes:

I enjoyed this; there are parts I like a lot and I am not going to be as acerbic as others where I differ. I will just mention two aspects that I think are analytically weak.

First, the "born sick" = "born poor" argument is weak. Neither "sick" nor "poor" is a fixed point or even fixed parameter concept. There are wide variations of "sick" and "poor". It is plausible that one could be born sick and overcome it, with or without social aid, and the same goes for being born poor. And there are circumstances where neither can be overcome. So the concepts are too vague to be treated as identities. In addition, neither one, standing alone, is a steady state. Life isn't just "sick and needs help" / "healthy and doesn't" or "rich, can afford to give / poor needs help". It's more nuanced and dynamic. Think of the basic triaging formula, which breaks everyone up into three categories and the complexity becomes more apparent. That is one flaw in the argument. It is easier to argue at that high level of generality but not insightful on reflection.

Second, it is largely devoid of quantification and cost benefit analysis. When David says things like "healthy people are more productive" it jumps out: how much more productivity do you get for the money you spend? Someone can be a little bit sick or hurt and yet be more productive than a healthy person. Think of the link between depression and creativity. Or, in athletics, Michael Jordan's legendary under-the-weather performace in the NBA championship finals against the Utah Jazz. There are a lot of people who are not productive even when healthy: retirees, slackers, think of the unions that have "job banks" for instance. Clearly, the rise in health costs has exceeded the rise in productivity for decades. So I think these kind of generalizations are weak and prove nothing.

ChrisW writes:

Sorry for making a second post, but I've been thinking more about the moral side as well.

I don't think I can buy the moral argument, at least not without a lot more development.

First of all, babies aren't magically born. They are the product of parents who, explicitly or implicitly, have accepted the risks and necessary investments inherent in having a child. I'd expect that this should obligate parents to expend their own funds on any care the child needs, even if that's large.

Consider my own case. I have Crohn's disease, which is a poorly understood malady, but genetics is thought to play a role. I've elected not to have kids, in part to avoid passing on these bad genes. Had a decided differently, is it right for me to pass the costs of that decision on to the rest of society?

Second, the question is far more complex than "should we help sick people or not?". Many sick people (babies or otherwise) cannot be helped regardless of what is invested. Others might be saved, but only at tremendous expense.

It goes without saying that we can't help those who are beyond help, but what responsibility do we have to make the effort?

For those who can only be helped with heroic measures, how do we perform the calculus to determine whether we should invest in the treatment of the patient? I don't think we can make the general moral statement that we should help, without first knowing if we're going to be following some sort of utilitarian philosophy of greatest good for the greatest number, or if there's some other means of determining.

Kevin writes:

I was enjoying this (except for the double standard on morals and practical concerns) until the second to last paragraph. It was so bad I literally thought it was a joke. Items 1 and 2 beg the question. Item 3 is makes no sense at all (wouldn't the apple producers do it, and wouldn't the orange producers seek contradictory evidence if it existed?) 4 presumes the status quo isn't due to government participation. And I had to reread 5 to be sure I wasn't missing something - I am in disbelief that this is made as a serious argument and laughed out loud when I first read it.

Colin K writes:

1. If we provide 2,000 calories per day worth of food to every person under the poverty line, then it is a certainty that none of them are going to starve.

2. Those people subsisting on rice, beans, and 5lb blocks of process cheese may resent the monotony of their diet, but very few people would argue that it is our communal responsibility to ensure that everyone has access to meals by chefs trained in molecular gastronomy, or even ones that know the difference between broiling, braising, pan-frying.

3. In terms of equality, what people really want is equality of outcomes, but health outcomes are notoriously unequal, even controlling for lifestyle and socioeconomic factors. We can only try to provide equal access.

4. It is almost impossible to define an objectively fair measure of equal access to medical treatment in the way that we can define a 2,000 calorie/day diet as objective assurance that someone will not suffer from starvation.

5. Subsistence-level food and clothing were, within living memory, a major expense even for the middle class of the US, and as they remain for much of the third world.

6. To the extent that we take food and clothing for granted in the US, and that the younger generations of Chinese have never experienced a true famine, it is because of productivity growth rather than redistribution.

7. Productivity growth in industries tends to be correlated with reduction of government involvement: I was born in the 70s, when long-distance phone calls and airline travel were still considered expensive indulgences in my upper-middle class household.

8. The $250,000 we spend extending the life of an 85-year-old by 6 months is not lost when she dies; in the process we may refine knowledge that is later used to grant an 8-year-old another 70 years. To the extent that old people get most of the diseases, we cannot scale back on treating them without losing a lot of opportunities to get better at saving young people who haven't had their allotted measure of years.

Dr. Balan is concerned with what is seen: the fear that one will be bankrupted by medical costs, or that one will die for lack of treatment that a wealthy person could afford.

I am concerned by contrast with what is unseen: that our healthcare system today remains wildly inefficient (in large part due to regulation-driven incentive structures) and incapable of curing or alleviating a broad range of grievous ailments, even for someone as rich as Bill Gates.

If my morality means that one person dies today to save 1,000 over the next twenty years, I can sleep far easier with that than Dr. Balan's remedies, which would trade 1,000 lives tomorrow for one today.

Caleb writes:

"I follow it in my personal charitable behavior; almost all of my charity goes to extremely poor foreigners. But I don't regard that as much of an issue for this debate. If it was remotely feasible that instead of guaranteeing health care for poor Americans we would spend a similar amount of public resources in helping very poor foreigners, I would be inclined to go a long way in that direction. But it's just not relevant for practical politics."

This is a pretty obvious cop out. Those of us who think that the moral impetus for aiding the less fortunate begins and ends with with the individual assume that which you so cavalierly discard. Namely: it is the statist political process itself which hampers charitable resources from reaching the most desirable recipients.

The political resource allocating process is inherently fraught with self-interested, selfishly motivated actors. The more resources which pass through the public sector, the greater the incentives for certain political factions to capture the regulatory and distributive parts of the system and bend it for their own aims.

You say that it simply isn't practical or feasible to redistribute our wealth toward those who you readily admit are more deserving. This doesn't bother you? At all? For me, it is point #1 in a long list of why morally driven social wealth redistribution is too important for government to touch.

Peter writes:

With respect, in my view the moral case has been side-stepped. The case is not the form of transfers but the reasons why transfers should be made at all, even to the deserving poor.

If there is a war and invasion we are all at risk of catastrophe, but we are not all fit to man the guns. In fact, only people of a certain age and physical ability are fit to fight. Have I just made a moral case for conscription?

REL writes:

As a physician, I'm surprised by the double-standard used here. Only a very small percentage of people are born very sick, plus chronically ill plus survivable and able to live normal lives if finances are no issue--well under 1%, I'd guess. Yet a relatively large fraction of people are born destined to grow up short or ugly--we can define this as we like but conservatively consider the lowest 10% on each metric. Being short and being ugly have dramatic negative economic impacts on people's lives and negative impacts as well on their happiness. Why is there no ethical mandate to make these people whole--they have no more say in being born short or ugly than others do in being born sick.

Tracy W writes:

Fourth, there is a case for governmental regulation to ensure that health care is safe and effective (no selling poisonous snake oil)

Can you please list the governments in the real world that have ensured that health care is safe and effective? I have just been reading The Checklist Manifesto by Atul Gawande, and he talks about the rate of preventable errors in surgery around the world and striving to reduce that. He discussed safety problems in rich countries like the USA, the UK and poor countries like India. And his suggested solution in this book is not government regulation, but instead turning the medical profession into one more like air pilots in terms of adding discipline to their procedures.

There is ample evidence that homeopathy is ineffective, both from double-blind experiments and from our fundamental understanding of chemistry. How many real world governments have banned homeopathy? What do you think about the risks of regulatory capture, when it comes to real world governments?

Fifth, there are some instances where the government is simply more trustworthy than private firms, and that trust allows economically efficient things to happen that otherwise wouldn't happen. ... But if it is the government doing the limiting (either directly or through regulation of private insurance), and this limiting is being done through a rational process that people trust, then it has a chance of happening.

And there is a chance that tomorrow some scientist will unveil a perpetual energy machine. If the best you can say is that "there is a chance" then your argument needs some major work to improve it. I am not an American, I am a NZer, and I know the difficulties the NZ government faces in limiting health care to politically-organised groups. For example, the NZ government tried to refuse to fund Herceptin for more than 9 weeks, a drug that slightly increases the life expectancy of people with HER2 positive breast cancer, if women wanted it longer they had to pay for it themselves (this did not stop them getting treatment under the public system for the rest of their care, NZ is not the UK). But then the breast cancer activitists got involved, and started protesting, and eventually the government backed down. See http://www.breastcancernetwork.org.nz/pages/herceptin.html
Of course limiting healthcare to non-politically organised groups is doable, for example a continued problem with the NZ system is getting glue ear treatments for poor kids, as poor hearing really affects educational outcomes, but this doesn't garner the headlines that say hip surgery for the elderly does.

So while I agree with you that there's a chance that a government would be able to limit healthcare spending where firms wouldn't, this strikes me as as bad a basis for policy-making as if you were to say we should build our energy system around perpetual energy machines.

I could go on.

Please don't. I would much rather that you went back and put your existing arguments on firmer foundations.

Tracy W writes:

And just picking up on another part of your argument:

I don't think there is much doubt that certain kinds of health care are highly valuable, and that having access to them significantly improves the length and quality of one's life. Is it too expensive? Well, all of the wealthy countries of the world, and some less wealthy countries, have been able to provide it at what appears to be tolerable cost, in that it is not bankrupting their societies ...

As far as I am aware, in all countries that there's healthcare system, there is still an inverse gradient between income and health outcomes - ie poor people tend to have worse health. There's a lively debate over the slope of these gradients, and some suggestion that they aren't that different from those prevailing in the USA, see for example the papers at :
http://www.nber.org/papers/w13495 - compares income gradient in the USA to England (part of a longer debate)
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=993187 - Canadian debate over income gradient
http://mpra.ub.uni-muenchen.de/13959/ - Australia gradient
http://eprints.ucl.ac.uk/2653/ - suggests steeper gradient in the USA, one for David Balan's view.
http://www.hc-sc.gc.ca/sr-sr/finance/hprp-prpms/results-resultats/2005-ross-eng.php - Canada again
http://jech.bmj.com/content/63/7/569.abstract - oral health in UK, Finland, Germany and Australia, finds targetted programes for poor increased inequality.

So, well, are all these non-US wealthy countries providing access to these certain kinds of healthcare that are highly valuable? Or are they providing access to a whole bunch of forms of healthcare, some of which probably aren't valuable at all? Eg antibiotics for viral infections, and some of which are probably non-valuable (eg surgical operations that are ineffective and increase the risk of death from the risks of any surgery)?

Basically, I think you are implicitly arguing based on a perfect-government model, you think that if a government sets a policy to do something, the thing is as good as done. This is as likely to lead to bad policy advice as a perfect-markets model.

Swimmy writes:

Bryan, Tracy has a good point with homeopathy law. You might even bust out Robin's argument that ineffective medicine is part of the optimal stock of medicine, or Klein's that there is no market failure to justify the ban-until-approved practice of the FDA.

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