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Comment: "Efficiency" is a slippery term

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"Efficiency" is a slippery term

For example, Medicare only has about 5% overhead costs versus private insurance at about 15%-20%. But Medicare has an approximately 20% fraud rate...effectively cancelling any 'efficiency.'

Also, it is certainly more 'efficient' to limit capital expenditures in medical care to eliminate duplicating services, but when you need more neo-natal incubators in one Canadian town than exist in an entire Canadian province, then perhaps the outrageous duplication of capital investment in multiple incubators in a modest sized Wyoming (or Montana?) city seems very efficient, as you can fly your wife there for a the safe delivery of your newborns. (true story)

It may also be more efficient to limit expenditures on people beyond a certain age, as they do in Germany, thereby condemning an 80 year old arthritic woman to a life of debillitating hip pain (also a true story).

Indeed, before Obama, Canadian and European economists were concerned that the medical inflation rate was higher in their countries than it was in the U.S., and they were considering reforms to make their systems more market oriented. (Source was Mark Steyn, I believe.) Maybe 'efficiency' is in the eye of the beholder.

Since over half of all money spent on healthcare in this country is spent by Federal and State governments, I think it is pretty clear where all the money is coming from that is driving the price increases. And, yes, it is the influx of money that drives up prices, whether it is gold, or corn, or education, or medical care.

To address your original concern, the 'free rider' problem, it is a fact of life that what one person does or doesn't do will have effects on other people. For example, the people who insist on only buying goods 'on sale' actually cause retailers to keep their regular prices higher for people who either cannot wait for a sale or who are less conscious of prices. Yet it would be ridiculous to have price controls just because impatient early adopters are willing to pay more than people who are willing to wait.

If a hospital wants to give away some of its' services to some patients while charging other patients, that is their prerogative. That was the basis of the charity hospital...pay if you can, but you won't get turned away if you can't. I'm not that old, but I was born in a hospital run by the Sisters of St Joseph. Ron Paul was a doctor in a charity hospital. Everyone got served. Not everyone paid, and those who did helped to subsidize those who didn't. Unfair? Not really. The services belonged to the hospital and the doctors to be given out as they saw fit. The services weren't mine to control.

I think that people get themselves all bent out of shape because they see someone getting something at a reduced rate, or free, and conclude that everyone else must be getting ripped off. Not so. Unless, of course, you consider the price you pay for a sweater in September to be a ripoff, and the price you pay in December to be unfairly subsidized.