The story of the Obamacare exchange website snafu
Long, but well worth reading.
Excerpt:
Some blame the contractors involved for not being upfront about the potential for such fundamental difficulties, but some say the contractors did offer warnings, and especially that the contractors believed the time they were given for development was totally inadequate. It seems clear, though, that the administration was not warned to expect quite what has happened here, and was not prepared for it…
CMS officials and the large insurers thought at first that the garbled data being automatically sent to insurers must be a function of some very simple problems of format incompatibility between the government and insurer systems, but that now seems not to be the case, and the problem appears to be deeper and harder to resolve. It is a very high priority problem, because the system will not be able to function if the insurers cannot have some confidence about the data they receive. At this point, insurers are trying to work through the data manually, because the volume of enrollments is very, very low. But again, if that changes, this could quickly become impossible.
In a couple of ways, then, the severe user-interface problems at the front end of the federal exchange has actually had some advantages from CMS’s point of view, because by keeping enrollment volume low it has kept some other huge problems from becoming instantly uncontrollable.
But that low volume is mostly a very bad thing for Obamacare, of course, since the viability of the exchanges depends on a certain size and demographic mix which cannot be attained unless these problems are resolved very quickly.
There’s much, much more.
There’s an arrogance involved with people who aren’t technically capable; they tend to view tech in this very simpleminded way, like it is just a matter of hiring people who just crunch through the work in a straightforward manner, when, in fact, tech work is something of immense complexity and prone to massive failure, and something that requires extremely technical, highly-competent people to oversee. You can’t have the process overseen by policy people; the idea that you can get away with that is something that has often come up over the decades that the software industry has existed — in the early 2000 tech boom tons of tech startups got destroyed when they hired MBAs with no tech background to be the “adults in the room”, supervising the supposedly immature young techies — this resulted in widespread, repeated failures.
Today, in the tech industry, the importance of having top-level engineers crucially involved at the very top of every project is widely understood, which is why top tech talent is in super high demand even in an age where nearly everything has been outsourced to India and China. HHS clearly didn’t understand this. It’s a failure that could have easily been foreseen, and I have to say that I’m very disappointed in Todd Park for not having warned the Administration about this.
A project like this is something that absolutely should have been done differently. Of course, I am a strong proponent of Obamacare, from a policy standpoint, but it is certainly the case that conservatives have a correct view that government, especially the Federal government, is not well-suited to oversee projects like this. Hopefully this will be a lesson for the future: large IT projects cannot be taken for granted. You have to have long lead times and lots of testing. You have to put top-level tech talent in charge of sprawling, complex tech projects, not government policy wonks.
Mitsu:
My very strong guess is that the Obama administration would not have changed their decision to put policy people in charge, even had they been warned sufficiently.
The reason is that putting policy people (i.e. political policy people) in charge is one of the hallmarks of the Obama administration, to a degree greater than previous administrations on either side.
It’s something I’ve noticed over and over with Obama: the appointment of mediocrities, or incompetents, because they are politically what Obama’s looking for, politically loyal, primarily political operatives. This is especially noticeable in the realm of foreign policy; I’ve written about it many many times before. See this for an example of what I’ve written on the subject.
So what happened with the rollouts was not an anomaly, it was the norm for Obama. Good at campaigning, however.
I doubt Obama ever planned to oversee the implementation. His idea of an accomplishment is to make a speech or sign a bill. If there ever was anyone who is least qualified to be president, he is it.
I should add that Mitsu’s argument that policy wonks or MBAs should not be running tech industry projects also holds true for bureaucrats trying to pick winners and losers in the private sector. It is pretty much an indictment of everything the Obama admin does concerning the economy.
I don’t think having a policy wonk involved would necessarily be bad–provided said wonk knew what he or she didn’t know. Obama’s problem is that he regularly appoints people based on appeasing radical constituents, the academic inelligensia, or political hacks. He doesn’t like people who think outside his box, unless perhaps he can throw them under the bus should things get sticky.
I agree. There’s nothing wrong with policy people per se. As they say, some of my best friends are policy people. They just need to know their limits, and one of them is the fact that they cannot directly oversee a technical project themselves — they have to get someone strong to be in charge of integration and be in charge of all the contractors and oversee the architecture and the QA process and so forth. That didn’t happen here.
As for whether or not Obama is worse or better than other presidents at this — Bush Jr. had a pretty spectacularly bad record of having people who knew very little about what they were doing on the ground in charge of things (Katrina + FEMA + Michael Brown? The team of incompetents handling both the prewar intelligence and the execution of the Iraq War?) I do think that, in general, the Federal government, whether Democratic or Republican, tends to be inefficient and ineffective at running projects like this. It kind of goes with the territory, for better or worse, which is why I agree with conservatives that the government ought to stay out of things to the extent possible, and they shouldn’t be trusted with operations, because no matter who is in charge, it tends not to go well. As it happens, however, for the most part the budget of the Federal government, with the exception of the military, is primarily about moving money around; the money that gets spent on actually executing operations is relatively small compared to the overall budget. I.e., the vast majority of money spend on, say, Federal student loans, just gets disbursed directly to students. Same goes for Social Security, Medicare, and many other government programs. Which is as it should be, because the government isn’t well-suited to executing complex operations in a timely and efficient fashion. They EVENTUALLY get it done, usually (Medicare Part D, which was championed by the Bush Administration, was also a disaster at the outset for similar reasons, but they eventually got it working).
In this case it’s a bit more worrisome as the fiscal stability of Obamacare depends on the thing working soon, since it isn’t an entitlement like Medicare Part D but rather it is an insurance market. For the market to work, people have to be able to actually purchase things in the market. Thus, the failure here is more significant than it was in the case of Medicare Part D.
I support Obamacare because I think it’s a relatively market-based approach to extending health coverage to people with preexisting conditions and the poor. There are other ways, like single payer insurance, but that is a lot more government intrusion, and for the time being I’m inclined to give a market-based approach a chance. It’s still by far the most market-oriented approach in any industrialized nation. The fact is, you have to implement it via some sort of health care exchange of some kind — thus, I think it’s a necessary evil that the exchange be run by the government. However, as I’ve written before it isn’t surprising the Federal effort is the one that is floundering the most. States are more nimble, more flexible.
I should clarify — I shouldn’t have said the Federal government shouldn’t ever be trusted with operations; I mean that it should delegate operations to competent experts (which didn’t happen here) and not try to directly oversee it itself — if the goal was getting a high priority complex operation done correctly and on time. The Feds seem to be able to eventually get things working given enough time and money — usually not that efficiently. So, clearly, it should be incumbent upon us as a people to lean in the direction of delegating less operational control to the Federal government.
If that sounds libertarian, it is — I agree with the general libertarian point of view that government tends to do worse than the private sector in most operational roles. Where I disagree is that libertarians believe that almost nothing should be done by the Feds — whereas I tend to think there are cases where the free market, completely unregulated, can lead to unstable outcomes or escalating costs (health care, financial speculation). In those cases, the government, it seems to me, can and should step in. But it’s not going to be pretty, or efficient, while it is doing so, which is why you really want to fashion regulations and social programs in as minimal a way as you can get away with. It’s a tradeoff, in other words, in my view, but I’m not that far from libertarians in the sense that I agree that in general these kinds of debacles are to be expected when the government is trying to implement pretty much anything.
Military contracts are famous for waste, for instance — yet we all tend to agree that the military is one area where we have to cede control to the government. Nevertheless, it is going to be inefficient, by virtue of its very nature. This is not to say the private sector doesn’t have its own sources of inefficiency — profit motives can lead to inefficiency as well. There’s no completely pure solution that avoids all inefficiency.
@Mitsu
Hooboy…
“It’s a failure that could have easily been foreseen, and I have to say that I’m very disappointed in Todd Park for not having warned the Administration about this.”
–Yeah…If only comrade Stalin knew. Do you know that the administration wasn’t warned, or is that what you want to believe? And if someone said this, how do you know they weren’t lying to cover their asses?
“You have to put top-level tech talent in charge of sprawling, complex tech projects, not government policy wonks.”
–That depends on what you’re trying to accomplish. If you want POLITICAL control, then the last thing you’d do is put a non-political person in charge of it. I disagree with your basic premise: that the Obama administration did this to improve healthcare in America.
“Bush Jr….Michael Brown…Iraq intelligence…conduct of the war…”
–I might agree about Michael Brown.
Iraq intelligence: I assume you’re referring to WMDs. The buildup took so long that Saddam could’ve moved them to Syria. We will probably never know for sure.
Conduct of the War: We eventually won that war, and counter-insurgency ops are hard. Obama lost the peace by refusing to put in the minimal effort to get a status of forces agreement.
“[The Federal budget] is primarily about moving money around
–Yes. Moving money away from the productive citizens to subsidize the unproductive ones. This is not a value-neutral or consequence-free endeavor: did you happen to see the story about the Louisiana Walmart EBT thing? That’s the future of America if Obama has anything to say about it. And subsidizing education in America via transfer payments is the MAIN CAUSE of tuition inflation. Now if you graduate, you owe a mountain of debt.
“I support Obamacare because I think it’s a relatively market-based approach to extending health coverage to people with preexisting conditions and the poor”
–There hasn’t been even a “mostly-” market based healthcare in this country since the 60’s. Since most of the meddling was directed towards retirees, it wasn’t noticeable until they started retiring. Don’t get me started on insurance not being legal to purchase out-of-state. I will not tolerate the idea that Obamacare exchanges equal the free market. That is not true. When they fail, I will NOT accept the argument that “capitalism” failed.
“…single-payer…”
— In order to get to single-payer, Obamacare must collapse. Such a collapse will be evidence of government’s incompetence. In the face of such evidence, the only way to believe govt. could competently institute single-payer is to believe that all the many mistakes were innocent accidents, and not the result of irresistible forces. Then, you have to believe that the personnel in charge are capable of learning from their mistakes. I’ve seen no evidence of that.
BHO, an insecure little boy on the inside, wears a thin skinned kabuki mask facade as the most intelligent and insightful member of the species to ever breathe the atomosphere and piss water. The boring work of actual, sincere negogiations, crafting legislation and regulations, and implementation of 1/4 baked ideas are not things he wants to dirty his precious little hands over. Spiteful, arrogant, and petty come to mind whenever I hear the messiah speak….. something I have mostly avoided these last 5 years.
“…whereas I tend to think there are cases where the free market, completely unregulated, can lead to unstable outcomes or escalating costs…”
There is no free, unregulated market; especially when health care is the topic of interest. It is DC, swayed by big money, that distorts the market place. It is DC that over the decades – going back to Lincoln – which has corrupted the market place.
Currently, the only free, unregulated market is the underground economy and it grows day by day because it is free and unregulated. I engage in free trade frequently whenever I trade my time and abilities for food from local farmers or in other areas. Whenever possible I pay no taxes. And fuck you leftists and the NSA and the rest of the alphabet soup. I don’t want or need you. I will live or die on my own.
I’m voting for Parker!
Sadly, I don’t think any of this “news” will make a difference; the MSM will NOT report it, the low information voters won’t hear about it or they will believe the lies that the “racist Tea Party folks” are at fault, and so the cycle of government dependancy will continue until that is left is bread and circuses.
>If you want POLITICAL control
So, you’re saying Obama wanted “political” control so he mandated, knowingly and purposefully, staffers who would oversee an operation that was bound to blow up and fail. What sense this makes even in a dark conspiracy theory, I have no idea. The failure of the healthcare.gov site, as far as I can tell, doesn’t serve any end whatever, even if you think Obama is some sort of agent of Stalinism as many of you seem to think.
>Moving money away from productive
The irony here is the states that contribute the most to the Federal coffers are mostly blue states, and the states that take the most are red states. Blue states tend to be wealthier, more productive, better educated, and lower crime than red states.
Stuxnet. Part deux.
“The irony here is the states that contribute the most to the Federal coffers are mostly blue states, and the states that take the most are red states. Blue states tend to be wealthier, more productive, better educated, and lower crime than red states.” So says Mitsu, The Reasonable One.
Note the word choices of Mitsu:
“Contribute” (suggests voluntary giving) by Dem state residents
“Take” (suggests involuntary seizure) by Repub States”
Neither is true, of course. All reults from the Federal sausage machine in DC, which is hardly devoid of Dems.
“Tend to be wealthier, more productive, better educated and lower crime” than (Repub) states- I will counter that the Repub states in the Old South are also those with the highest % of Afro-Ams. What does Mitsu say to that that is not raacist?
Why is it the “wealthier” locales have the highest tax (aka seizure by governments) rates? As to lower crime, the less wealthy, less educated portions of Dem states have seriously lower crime rates than the Dem-controlled large urbans; see Chicago v. rest of IL, LA v. rural CA, etc.
I broke my own rule never to read Mitsu again. Ah well. But not my rule against using “Red” and “Blue”, imposed by the media. We all know what to be Red really means.
Don Carlos, Mitsu’s distortions also include linking Bush to Katrina but failing to mention Obama and Hurricane Sandy or the Deepwater Horizon oil spill. Mitsu is just a lying hack.
Don Carlos, 11:41 am —
Excellent deconstruction.
My own favorite is the first example, “contribute”. I’m reminded of Madame Hillary speaking in terms of “asking” the rich to give more. No. When it’s coerced, it’s not “asking”. Do I get the opportunity to graciously decline the invitation?
(For, should I decline the invitation, Hillary’s people will compel me to appear in court, and should I decline *that* invitation, they will do a house call and graciously appear at my place of residence — with weapons. And they’ll graciously use them against me and mine if I haven’t reconsidered the invitation.)
Anyway, like Don Carlos, I was amused just a little by the notion of “[b]lue states tend[ing] to be wealthier, more productive, better educated, and lower crime than red states.” For example, Illinois contains Chicago, blue as cities come.
– Is Illinois wealthier? Have all those Sons of Obama have been averaged in, or all those proud owners of obamaphones? There isn’t *that* much population outside of Chicago.
– More productive? Are rural states like, for example, the Dakotas more productive than Illinois? News to oil-rich North Dakota, news to the South Dakota farmers. Or is productivity measured by tonnage of paper pushed rather than oil or food coaxed from the ground?
– Better educated? We’ve put in a lot of time here and elsewhere about how and *why* the academy tends left. When a community is an academic community, well then, yes, better “educated”, “educated” in quotes because “education” can mean book learning or it can have much broader definition. Is being a Shakespeare expert better educated than being an expert oil driller? or auto mechanic? or home builder? Only by a narrow definition of “educated”.
– Lower crime? When Chicago is still in Illinois? Urban areas generally are Crime Universities, to borrow from the preceding item. Blue *urban* areas are crime magnets, and it’s not at all clear that blue non-urban areas are any freer of crime than are red non-urban areas.
Aaaaahh, why bother? Don Carlos has already covered the ground, and quite well. “I broke my own rule never to read Mitsu again,” he groans. Try harder, brother Don!
“So, you’re saying Obama wanted “political” control so he mandated, knowingly and purposefully, staffers who would oversee an operation that was bound to blow up and fail.”
— That’s a straw-man argument…at least the last part. I suspect Obama chose companies to construct Obamacare as some sort of Democrat-kickback scheme. He’s done it before with greentech. He may not have wanted it to fail, but there were other POLITICAL considerations that came well before expertise.
“Obama is some sort of agent of Stalinism”
— The reference I was making was to the relationship between Stalin and his apologists…analogous to Obama and his apologists. The true believers couldn’t accept the idea that Stalin knew about (much less directed) the mass starvation of a segment of his own population in order to gain political power. They grabbed onto the flimsiest of excuses, which resulted in mass-denial. They would say, “this famine is the result of horrible policy, and the truth is being kept from the Dear Leader.” BTW, I do believe Obama is a socialist…and I mean that in the worst sense.
“The irony here is the states that contribute the most to the Federal coffers are mostly blue states, and the states that take the most are red states”
I assume you’re using gross figures instead of the more appropriate per-capita figures. It’s hardly surprising that California with one-eighth of the entire US population would “contribute” more in gross numbers.
>I assume you’re using gross figures
I’m using per capita figures. And I’m just talking about Federal dollars, which of course is uniform in terms of tax rates across all the states.
The thing that’s so peculiar about your fear that Obama is somehow like Stalin is that there are so many actually socialist democratic states (like, say, Norway or Sweden) and so many democratic welfare states (like most of Western Europe) that have laws and social policy that is FAR to the left of anything Obama has EVER proposed, or, for that matter, anything that any American national politician has ever proposed, and as I’ve often pointed out, those states are not totalitarian, they don’t have gulags, they have massive capitalist enterprises, have democratic elections and are nothing like the USSR. Yes, I can see the fear you guys have that everything even slightly “socialist” is going to start us on the slippery slope to becoming the USSR, but since almost every other industrialized nation is ALREADY far to the left of us in terms of economic policy, it’s hard to understand from whence your fear arises. Obamacare, as I’ve pointed out a number of times, isn’t even slightly as government-centered as the health care systems in pretty much every other democratic capitalist country in the world.
We have other things that are government-run universal services, like, say, the fire department, or libraries, or public schools, and those also haven’t put us on the path to becoming a totalitarian state.
I actually admire a bunch of things in the libertarian world view, I think the free market IS better for most things, and so forth. But I don’t think some degree of government regulation and some government attempts to address poverty and lack of health coverage is inherently totalitarian. It just isn’t borne out by the facts. And no, I don’t think Obama is anything like Stalin.
Stalin was a totalitarian dictator who murdered millions of his own people. Nearly every American, Democrat or Republican, is and ought to be opposed to that kind of politics.
mitsu, it’s good to know if we want the dem talking points, we can ask you for your opinion.
@Mitsu
“The thing that’s so peculiar about your fear that Obama is somehow like Stalin…”
Okay, I’ll explain this point one last time. I was comparing the two men’s FOLLOWERS, not the men themselves. Both had/have cults of personality…a blind faith in their goodness that borders on religious zealotry.
As for socialist democratic states, your examples are small, homogenous societies. Hardly an exportable model.
Oh, and the implication of your post is that blue states are better-educated, more productive and more altruistic. If that’s true, why is there net migration out of those states to red states like Texas?
People are choosing to give up the good life voluntarily?
My personal fear is not that we become the former Soviet Union, it is that we are quickly becoming France.
Chapter One of the Obamacare implementation sounds like a horror story written by Friedrich Hayek. See “Use of Knowledge in Society;” “Road to Serfdom.” Meshing what are already over ten thousand pages of regulations may be insuperable task, no matter how well-meaning and capable the contractors.
Related thoughts by Steve Hayward: http://www.powerlineblog.com/archives/2013/10/compare-contrast-part-ii-or-why-hayek-is-right-again.php
@lb100
Shorter Steve Hayward: The government will never have enough information to run 1/6th of the economy.
Plus, the economy changes on a second-by-second basis and government operators have agendas outside the stated ones. Never gonna work.
” I actually admire a bunch of things in the libertarian world view”.
HaHaHaHaHa.
Sure you do.
>Sure you do
I do. Hayek was obviously right that a centrally-run economy would be massively inefficient, because of information bottlenecks. No matter how well-meaning, a state-run economy is never going to work well. That’s an argument I made against Soviet-style economics many years ago in my debates against some of my far left friends.
But there are problems with unregulated markets as well; tragedy of the commons and market bubbles and crashes. I do not buy the Austrian explanation that all bubbles are somehow due to government intrusion. Study after study shows that speculative bubbles form and massive market instability results due to psychological factors (people being afraid to miss out on the rising market even if it has risen above all rational calculations of value.) Hence, some prudent regulation can improve the stability of markets even if most of the operation of the market is in the private sector.
I think the entrepreneurial strength of the US is partly due to the more friendly policies we have both in terms of law and culture with respect to risk taking. However, countries like France, which are far more socialist than we will ever be, aren’t Stalinist hellholes. They’re less dynamic in terms of their economy and I agree we shouldn’t go as far as they have, because I prefer the American attitude towards risk. I’m in the tech industry in the US because it is more dynamic than that in other countries. That’s partly due to our more favorable systems that support investment and entrepreneurship.
But we can in my view have social programs, health insurance exchanges, some regulation of financial markets, etc., without destroying the entrepreneurial economy. California is about where my politics lie and it is to the left of what you guys prefer but still a huge driver of the tech economy. Their regulatory and tax environment is still capable of producing massive innovation.
“it ain’t ignorance causes so much trouble; it’s folks knowing so much that ain’t so.” – Josh Billings
Remember the goal of the administration is a single payer system. The first order of business is to bankrupt the insurance companies so the government can rescue them. The first “enrollees” are high risk with significant health problems. Young, uninsured will never enroll at the rate necessary to cover the costs of the severely ill.
The whole system is designed to fail. The “problems” with the website is planned so that the government has something to blame for the failure (bad website) instead of the real reason, bad economics.
Mitszu, you can’t repeal the law of supply and demand. As an example, Obamacare is going to increase demand on primary care doctors. But the supply of primary care doctors is actually dropping. Result = shortages (i.e. long waiting lines) especially where prices are inelastic.
A great example of this is the recent reduction in Medicare reimbursements. A drop in the amount of reimbursement is causing a shortage of primary care doctors who will take Medicare patients.
Additionally, you argument about about unregulated markets is silly. In fact, it is regulated markets that allow inefficiencies to continue to build until such time as the market corrects it. A look at the most recent Real Estate bubble, brought on not by Wall Street but by underwriting standards promulgated by Fannie Mae and Freddie Mac, is a perfect example. The government was convinced that they were helping the “markets” by lowering underwriting standards so that “everyone can own a house”. Until suddenly, people (the market) realized that houses selling for $1,000 a square foot was unsustainable. Again, the government increased demand, without taking into account that the law of supply and demand can only be delayed, not repealed.
>The goal of the administration is single payer
First of all, single payer is not as horrible as it sounds — especially when you allow supplemental insurance (as does nearly every country that has single payer). The advantage of single payer is that you streamline a lot of paperwork, which saves money. The disadvantage in terms of lack of competition is greatly ameliorated by the fact that you can buy supplemental insurance. However, at present, I still believe a regulated exchange has a chance of being better than single payer. And your thesis that Obama is secretly trying to bankrupt the insurance companies is mere paranoia, not supported by anything whatsoever, least of all Obama’s consistent opposition to single payer throughout his career — and the fact that insurance companies came out IN FAVOR of Obamacare.
>you can’t repeal the law of supply and demand
Of course not. But the vast majority of Obamacare, aside from Medicare and Medicaid, does not fix prices — and Medicare and Medicaid have always had fixed prices. The prices are elastic and can change based on supply and demand.
However, it appears that the website contracting nightmare is vast and perhaps going to become a complete disaster:
http://www.slate.com/blogs/future_tense/2013/10/21/healthcare_gov_problems_why_5_million_lines_of_code_is_the_wrong_way_to.html
500 million lines of code — seriously. The contractors involved here are beyond incompetent. They should never be hired to build anything again.
Mitsu,
Obama doesn’t support single payer? Watch him on youtube: http://www.youtube.com/watch?v=fpAyan1fXCE
Obamacare doesn’t set prices? What about the 3:1 age rating band? (ratio of premiums for 64 and older vs. younger participants).
The “knowledge problem” identified by Hayek is much deeper than a simplistic contrast between “Soviet-style” and “unregulated” systems. And it’s not about what you call “information bottlenecks.”
In any event, the current system is far from “unregulated.” E.g., over the last 60 years, our betters have given us the Wage and Price Controls of WWII and the ascendance of insurance-based payments; Ted Kennedy’s HMO Act of 1973; countless insurance industry regulations; etc.; etc.; etc. The U.S. system is just less onerous than the rest of the world, where healthcare providers are adept at prescribing pain medications but limited in their ability to innovate and provide complex delivery systems.
Market actors establish the terms and conditions of their transactions, as well as prices. Surely you’re familiar with the idea of regulatory costs. What you call “the vast majority of Obamacare” is an array of rules conjured up by Congress (remember the “Cornhusker Kickback” and “Louisiana Purchase”), K Street insurance and other lobbyists, and a host of bureaucrats that have supplanted what would emerged through the trial-and-error process of voluntary exchange.
>single payer
I stand corrected. However, throughout his presidential campaign Obama’s plan was not only not single payer, it didn’t even have the individual mandate or any penalties for not buying health insurance — that has been tried in New York and it doesn’t work, for obvious reasons. If you don’t allow insurers to deny people with preexisting conditions and you also don’t have any penalties for not getting insurance, then obviously rates will skyrocket as they did in New York State, which had precisely that system. But an insurance market in which a large number of people cannot get health insurance at all because of preexisting conditions is a very problematic situation that really can only be fixed via some form of government intervention.
>is far from “unregulated”
Libertarian purists always bring up this argument to explain nearly any economic failure or inefficiency — it’s not unregulated *enough*! If only it really were a pure unregulated market! Etc. Of course there’s no market in the world that is a completely pure, unregulated market. The fact remains, however, that the health industry in our country is the *least* regulated of any industrialized nation, and it is also by far the most expensive per capita, and the average outcomes measures are only middling. We do well in a few areas (some cancers, etc.) but very poorly in many others (prenatal care, for one). Overall, our system is middle-of-the-road, despite its sky-high cost.
France, a country that many of you deride, has very short wait times, total choice of doctor, and a largely private medical system with a single payer government insurance program + supplemental insurance. And France’s health care costs are lower than ours, with at least comparable results, despite the fact that their market is much more government-controlled than ours.
The Austrian explanation for market bubbles and crashes as somehow always being related to the market not being “pure” enough just flies in the face of both scientific studies and common sense. Market bubbles are obviously driven by speculative frenzy — ever since the tulip bubble, we’ve seen it. Markets alone don’t solve all problems. That’s why I’m not a pure libertarian even though obviously there’s some validity to Hayek’s critique of central planning.
Mitsu,
Why no comment on the economics?
Nationalized single-payer will be the national equivalent of the Department of Motor Vehicles. Lack of competition kills innovation and customer service. Additionally, by extension, all healthcare providers become de facto employees of the government. And any information given to the government and its agents can and will be used against the political opponents of the party in power.
Saintknowitall,
Don’t you know that economics — and facts — are irrelevant, to those who (truly) believe?