David R. Henderson  

John Dingell's Mask Slips

Incentives vs. Intentions... Jonah Goldberg on the Tea Part...

On March 22, on a radio talk show, Detroit-area Congressman John Dingell stated that it would take a long time to get the regulations together to implement Obamacare because, in his words, "it takes a long time to do the necessary administrative steps that have to be taken to put the legislation together to control the people." You can listen to it here. It's at about the 35-to-45 second point.

That reminds me of what I wrote about an even more extreme government-controlled system, the one the Canadian government adopted a few years before I left Canada. Here's what I wrote in The Joy of Freedom: An Economist's Odyssey in 2001:

It's hard to say that the Canadian government guarantees health care, at least in the usual sense of the word "guarantee." In fact, what the government really guarantees is that if you get health care, you won't be allowed to pay for it, and it is this guarantee that makes you have to wait to get it. The government also guarantees something else: If health care providers try to set up their own clinics and charge willing patients for medical care, the government will shut them down. When I tell this to advocates of the Canadian-style health care system, some are often unwilling to part with their belief in socialized medicine. I find this strange because I believe them when they say that their motive for advocating socialized medicine is to have everyone covered. Yet, many advocates of socialized medicine seem to prefer that everyone be forced into a rationing system rather than have the government provide some basic minimum and let patients and providers who want to opt out of the system do so. So, what started out as a belief in a right to health care ended up as a belief in preventing people from getting health care. Thus my conclusion that it's not about rights at all, but about power.

HT to Mark Carbonaro.

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COMMENTS (15 to date)
Patrick R. Sullivan writes:
...an even more extreme government-controlled system, the one the Canadian government adopted a few years before I left Canada.

I believe that was 1984? As far as I can tell it took almost 40 years and four major pieces of legislation before it became illegal for a citizen to pay a physician to provide medical care in Canada.

I'd say the current health care reform law is just the camel's nose under the tent.

Mommsen writes:

Wasn't there recently a court case in Canada that rolled some of this back?

David writes:

Folks, he's talking about staff of the organizations -- public and private -- who will carry this whole thing out. Don't make such a big deal out of the "control the people" comment. I work for gov't, and I know where this is aimed.

William Barghest writes:

Why does most of the public not view the state usurpation of their rights to engage in commerce for medical services as an infringement of their rights, but rather as a morally necessary extension of rights? I feel that libertarians must have a pursuasive account of why this happens (other than saying they are ignorant) if they want to convince anyone.

Kevin writes:

I would have liked to hear at least another 30 or 60 seconds of audio to see if he clarified what people he wants to control.

Liam writes:

What is most interesting on your Canadian point, David, is that when they removed "Extra Billing" it created an industry just across the border. Previously patients who required tests such as an MRI or CT scans and wished to pay for them could do so even though the doctor’s visit was covered. This made the wait times much shorter for the people who could not afford the tests and had to be added to the waiting list. Now the only option available is to drive across the border and have a private clinic do the test in the US. Just minutes across the border are many clinics that cater primarily to Canadians. They even advertise in Canadian publications.

What was maddening at the time was that even I supported doing away with Extra Billing since it was presented as rich people being able to jump the queue because they paid their doctor extra money. (I know better now)

Canadians, in general, are all about being fair in most things. For example, if you are ever waiting in line and someone tries to jump ahead of you, the entire line will jump to your defense. It's even considered bad form not to let in a car trying to merge into your lane, prompting horns and fingers from all directions.

I have always maintained that should I run for public office my main goal would be to bring back Extra Billing. And leave NATO. And withdraw from NAFTA. And make David the Minister of Finance.

David R. Henderson writes:

Thanks, Liam and Patrick. I hadn't known, until you and Patrick Sullivan mentioned it, that the restriction on extra billing came so late in the game. Thanks also, Patrick, for clarifying. I left Canada in 1972.
Liam, I like all your proposals except for withdrawing from NAFTA. How come you don't like NAFTA? How about ending the restrictions on free speech and the gun registry? :-)

Gary Rogers writes:

This is one of the best descriptions I have read describing my own greatest fear of healthcare reform. The government can do almost anything it wants but when it sees its job as preventing citizens from getting desired healthcare in the name of fairness, they have crossed a dangerous line.

Incidentally, here is my own commentary on the legislation:


Liam writes:

Actually David, I love the “idea” of NAFTA. However when it's convenient the US chooses to ignore it such as the Softwood Lumber dispute. In that fiasco NAFTA and the WTO sided with Canada and the US just said, "tough beans". That was $8 billion Canada never recovered.

Also NAFTA has that nasty little clause (the proportionality clause) stating that Canada must continue to supply the same proportion year after year. So we can’t reduce it in order to sell it at a higher price to someone else or even use it ourselves. And when it starts to run out…… well you can see where that will go.

Doesn't sound very free to me.

And the gun registry?!? I use that as an excuse of how things could be worse. For example, my son must go to summer school this summer since he did not hand in some of his assignments and I told my wife, “Well at least he didn’t come up with the gun registry.”

Yet there are little freedoms that Canada took away that I didn’t even realize until I moved to the Czech Republic and got them back. (But now I live in Singapore so I have forfeited some of them again) For instance, in Canada, you can’t drink a beer on your front lawn. That’s drinking in Public and subject to a fine. Why drinking in public is wrong has never been fully explained.

Also you can't smoke in your car if there is a child passenger. I got around that one by letting them drive. (Kidding)

Hunter writes:

For the record I would like to stop calling it government run or government controled health care. We should call it politician run health care just to make things clearer.

Ano writes:

So, what started out as a belief in a right to health care ended up as a belief in preventing people from getting health care. Thus my conclusion that it's not about rights at all, but about power.

To the ear of a liberal (like me) this misses the point so badly that it shows that you don't have a good mental model for why liberals want to do what they want to do.

There are three separate things to evaluate here:
(1) Whether the liberal goal (socialize the risk of being very sick and requiring expensive health care) is worthwhile.
(2) Whether the public policy measures taken to attempt to achieve that goal (Medicare, the NHS, Obamacare) are succesful.
(3) The consequences of the public policy measures other than (2).

All three must be evaluated to decide if a policy is a good one. Yet all you have told us in this post is that you really, really hate (3). You go on to say that (3) must actually be the goal of liberals! This is outrageous.

You can write whatever you want, of course, but if you want to engage liberals in a reasoned debate, I can tell you what, from my own perspective at least, will be more successful:
- Arguments about (1): whether the goal is worthwhile
- Arguments about (2): whether this is the best way to accomplish the goal. But there's more: please say what you would rather do to accomplish the goal.
- Arguments that (3) is so bad, it outweighs any value from (1) and (2).

Mommsen writes:

Ahhh, (2) and (3) are the same thing. In other words, whether Medicare, etc. can be considered successful depends on its consequences.

By way of example, let's look at Medicare; by its own original standard of success Medicare has not been successful; it was supposed to end the concern the elderly had in the 1960s over rising medical costs; it did nothing like that. Medical costs skyrocketed as a result of Medicare's various efforts to centrally plan medical care for the elderly, infirm, etc. Of course since the 1960s Medicare's goal posts have been changed significantly.

Is the liberal goal worthwhile? By way of answering of it I would argue that like any product line health care has at least three aspects to it: (1) quality/innovation; (2) cost; and (3) distribution. Liberals want to have lower costs and greater distribution while keeping quality/innovation; that's an impossible task. And once you sacrifice quality/innovation, that's means the future of this particular product line is less bright than it would have been. That means more preventable deaths down the line. So, no, it is not a worthwhile goal IMHO. You cannot socialize medicine and expect it to be at the same time innovative medicine; or at least innovative as it could be.

Dom. De. writes:

Doesn't everyone know "NOTHING IS FREE UNLESS YOU EARN IT" !!!!!!! DOM. DE.

PrometheeFeu writes:

All that you are showing is that the Canadian system which is based on rationing leads to rationing. That is a fair attack on the Canadian system, but that's it. A state-mandated non-profit insurance provider as an example does not need to ration. All it needs to do is provide competitive price and services to all customers preventing insurance companies from abusing the complexity of its contracts. (which effectively looks like an information asymmetry)

In reality, between adverse selection, moral hazard, market concentration and other information asymmetries, the market for healthcare (especially health insurance) is about as far as can be from the ideal of the market we construct in economics. The economic argument in favor of government non-intervention in healthcare is IMO not viable.

dullgeek writes:

Do you really think that most of the people who supported this did so because they wanted power? I suspect that there's a bootlegger and baptist type thing going on.

On the one hand there are the bootleggers who really do want power. But what they're peddling to the baptists is different. The baptists have a technocratic belief that the world works better when some smart person is in charge.

The Hayekian idea that, at the scale of a nation, no one is smart enough to be in charge is IMHO very counter-intuitive. And it's why the bootleggers can get away with what they do.

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