Monday, February 3, 2020

Why government services will always stink

I posted this ten years ago and nothing has changed.  But the persistence of bad ideas is the only truly renewable resource, and with "Medicare for All" being a major campaign theme this year, it's back to the future.

TL;DR: Medicare For All will stink.  I have proof.

Originally posted February 1, 2010:

The definition of insanity ...

... is thinking - despite repeated examples to the contrary - that this time the same thing will give you different results. Don Surber looks at the UK.Gov's National Health Service, and finds them gaming the metrics:
Here is how it works: In order to cut down on waiting time, people are put in the hospital quicker, even though there are not enough beds.
No problem.
“They say the targets put pressure on hospitals to discharge people early to free up beds and have turned the NHS into a ‘revolving door’,” the London Daily Mail reported.
It is the National Health Service Hokey-Pokey. You put your patient in, you take your patient out…
Here’s an idea: Add more beds.
Oh wait, that would cost money.
At the risk of hurting a bunch of people's feelings, this is precisely what would have been predicted, even by people of marginal intelligence. At least if anyone looked at the decades of experience from places that rejected a market:
My informal survey suggested that some of the longest lines in Moscow were for shoes. At first I assumed that the inefficient Soviet economy did not produce enough shoes, and for that reason, even in the capital, people were forced to line up for hours to buy them. . . . Then I looked up the statistics. I was wrong. The Soviet Union was the largest producer of shoes in the world. It was turning out 800 million pairs of shoes a year--twice as many as Italy, three times as many as the United States, four times as many as China. Production amounted to more than three pairs of shoes per year for every Soviet man, woman, and child.
The problem with shoes, it turned out, was not an absolute shortage. It was a far more subtle malfunction. The comfort, the fit, the design, and the size mix of Soviet shoes were so out of sync with what people needed and wanted that they were willing to stand in line for hours to buy the occasional pair, usually imported, that they liked.

At the root of the dysfunction was the state's control of information. Prices are information--the information producers need in order to know what and how much to produce. In a market for a product as varied in material and design as footwear, shifting prices are like sensors taped to the skin of a patient in a medical experiment; they provide a constant flow of information about consumer needs and preferences. When the state controlled prices, it deprived producers of information about demand.
So, we see a system set up to achieve scores on particular metrics, whether or not the end consumer of the service is any good or not. As the post points out, the end consumer isn't the person getting the shoes (or medical care), it's the State. How on earth could you expect shoes that fit, or people being cured of their sickness?

But I'm sure that it will be different here under Obamacare. I mean, this isn't Russia, for crying out loud. Or even Britain (I mean, look at their teeth; srlsy, how can you expect tehm to understand modern medical technolo9gy?). The program here will be much more carefully crafted, with particular attention to what has not worked in the past, and without being gamed by all sorts of politically well-connected special interests.

Oh, wait ...

1 comment:

Old NFO said...

Nope, nothing has changed.