
Faux-Privilege vs. Freedom - prajjwal
http://raganwald.posterous.com/faux-privilege-vs-freedom
======
Justsignedup
There is one other reason to keep the non-privileged from paying for better
benefits:

Imagine for a minute that everyone had BASIC health insurance. Provided by the
government. If they get cancer, it will be paid for. If they sneeze, they will
pay out-of-pocket for a doctor. Doctors who are AMAZING will charge... 200 for
a visit. Not so amazing ones... 30.

Woah there. If your doctor charges you 150 per visit, you will be sure as hell
checking that the doctor is good. While at $30 whatever. If you pay for your
drugs, you will be damn sure you need them at $150 a pop. But at $15 a pop,
meh better be safe than sorry.

Now an insurance company comes along... Hold up, sure I'll pay for it but how
easy is it to make claims? Are they actually paying out or are they just
giving you red tape?

It goes on.

Look at the COMPETITION created:

Doctors compete on skill to get not only clients who pay next to nothing per
visit but pay hundreds to the doctor, but also on how much they charge.

Treatments compete on effectiveness. Will I pay $10k for a treatment that may
be equally as effective as a $1k treatment?

Insurance companies compete on coverage/serving customers. Because anyone can
leave and switch, and if they don't they have the safety net. Insurance
companies now stop having the per-person monopoly. Very rarely do people have
any choice in insurance companies.

Employers have employees who have only the risk of lack of salary when leaving
a job. Though that risk is bad, especially when owning a mortgage.

The competition created becomes crazy. Entire monopolistic business models get
toppled. And all for a very very small price. The fun part is once the free
market kicks in, prices will plumet too. Competition will ensure to that. We
just have to make sure competition gets a chance.

~~~
jisaacstone
Hey I love the free market too and I once thought as you did, until I looked
at the data.

Back in 2006 I pulled the latest WHO data and looked at % of medical industry
privatized vs overall health of the populace (an function of factors such as
infant mortality and lives lost to communicable diseases) in OECD countries.

As best I could tell there was a negative correlation between privatization
and quality of care. As I recall the USA was the worst (by far), Australia's
hybrid system put them near the middle, and Japan was on top.

Sure the sample data is small and the USA is very very far from a pure market
at this point, but it was enough of a wake-up call for me that I stopped
blindly believing in economic models.

After all it is only a model, not reality.

Health care may in fact be a 'natural monopoly' such as water or power, or it
may be better as a government controlled industry such as education or
defence. Only a few radicals think the government should not run or regulate
any industry.

Some things to consider:

> Is is better that people always visit the doctor when they have a minor
> concern? (like 'if they sneeze . . .') because if people are paying out of
> pocket even at $100 many will not go.

> Many rural areas have only one hospital. Their emergency room is a monopoly.
> In a perfect market they could charge whatever they wanted and people would
> still go.

> Can the average person 'make sure a doctor is good?' Do they know how to
> make such a judgement?

> If doctors needed to compete, would it necessary be a sill-based
> competition? Is there a correlation between customer satisfaction and early
> detection for things like annual physicals?

> Do we want to have a society where you level of income determines your
> quality of care (and probably life expectancy)

I agree that the current US system is close to the worst thing possible,
virtually no competition due to insurance being tied to employers, and also
virtually no safety net.

I was uninsured for two and a half years. When I went to the hospital and
asked how much things cost no one knew. Twice I was misinformed by more than a
hundred dollars.

So yeah I think the model you propose may well be better than what we
currently have, but I sincerely doubt it is the best possible.

------
benaiah
This article irks me, not because I disagree with it (I do), but because it
misrepresents the position it attacks. It claims to set up a balanced view of
its opposition, but then hamstrings this view by only considering a tiny piece
of it.

The author dismiss everyone who disagrees with him as "privileged" and wanting
to "benefit from your fear". This is ridiculous and insulting. There are
countless people who advocate the free market, not to entrench their position,
but rather to give them a fighting chance against the existing economic
hegemony in the first place. The "truly privileged" often _don't want_ a free
market, because the truly privileged are benefiting from the inherent
inequality in a restricted market. This is obviously not true for everyone -
but look at our recent bailouts of banks and car manufacturers. Do you think
they would rather have a free market that would force them to sink or swim
based on their own efficiency? Hell no! They would be out of business by now,
if it weren't for the government using the power to kill peculiar to the
government to coerce citizens into giving their money to mismanaged banks and
manufacturers, so they could reap the wealth that comes with taking risk and
offload all that risk onto everyone. (This, of course, ignores the fact that
much of the mismanagement, particularly of the banks, was forced upon them by
government regulation in the first place. For more information, I recommend
Thomas Sowell's _The Housing Boom and Bust_. [http://www.amazon.com/Housing-
Boom-Bust-Revised/dp/B004I1JQ9...](http://www.amazon.com/Housing-Boom-Bust-
Revised/dp/B004I1JQ98) \- not an affiliate link.)

I understand that he probably doesn't intend to defend the bailouts (though I
consider them, or something like them, inevitable in a restricted market). But
what he advocates is the same kind of thing - _forcing_ people to pay for
other people's risk (I understand that it's a very different scenario, because
this risk is unavoidable, but in this limited aspect it's quite similar). His
arguments make sense on the surface, and, indeed, perhaps universal health
care does work better in a model that is already fundamentally broken (I
seriously doubt this, but it's an argument for another time. But dismissing a
free market argument without considering how a free market might actually
work, assuming that it would operate without changing the rules that the
current healthcare system works under, is setting up a straw man and
triumphantly knocking him down.

You have to look deeper than just private healthcare insurance. When I argue
for free markets, I don't just argue for free market _insurance_. Why _is_
healthcare so expensive? Particularly when hospitals are usually built and
funded by the government anyway? Why do we need health insurance to avoid
going bankrupt?

A firm that began offering the same healthcare at lower prices would be
overflowing with customers (the current hospitals, which have exorbitant
prices, already are). So why doesn't anybody do that? First, because of the
litigatory nightmare that is the modern healthcare system that, because of an
absurdly low standard for malpractice suits (which are fine in principle, I
admit) require doctors and hospitals to pay enormous amounts in malpractice
insurance. Second, the restrictive and state-controlled medical licensing
scheme, which drives the price of medical education through the roof. Third,
the tremendous amount of regulation surrounding healthcare itself.

You may become indignant at this point, saying that total deregulation of the
healthcare market is nonsense and poppycock, and that, while deregulation may
drive many prices down so low as to be generally affordable without health
insurance, there will still be some situations that would still be expensive
enough to ruin most people. First, private licensing would still be available.
The boards and organizations that already exist to license healthcare would
still exist, they just wouldn't be controlled by the government, so you could
work outside of them, allowing for more affordable healthcare in less
restrictive licensing schemes. Clear malpractice and fraud would still be
crimes, of course. To address the second objection, private insurance would
still be available for those disastrous times, but it would be far cheaper
because the frequency of bank-busting medical treatment would be vastly
lowered. It would be affordable to pay for your own health insurance, rather
than using an employer's, making it easier to start your own business. And
that business would be started in an environment free of government-mandated
monopolies (by far and away the most common form - look at the problems with
Uber and Lyft), inconsistent and restrictive licensing schemes, and other
harmful and difficult-to-avoid forms of regulation.

\---

My point in this long comment isn't really to convince anyone of my economic
opinions. My point is simply that hand-waving my arguments away without
considering their actual implications and what I actually advocate is not an
argument at all. I'd love to engage in debate, but this is impossible if he's
unwilling to listen to my arguments.

~~~
jmcqk6
>A firm that began offering the same healthcare at lower prices would be
overflowing with customers (the current hospitals

I have a lot of problems with what you wrote, but will just focus on one
thing. You base your argument at least partially on the idea that hospitals
overflowing 'with customers' is a desirable thing. First, hospitals are
already overflowing with patients. Demand is not an issue.

Secondly, hospitals and other health care providers are in a different market
- the better the service, the less their customers need them. If they are
motivated by maximizing profit - they have two ways of doing it: keeping you
sick, or getting more sick people. Neither of those strategies are good
things.

You might argue that this isn't necessary, because there is always a supply of
sick people. I would refer you to my first point - demand isn't the issue, and
the point of the different healthcare providers are explicitly to reduce
demand.

~~~
benaiah
While it may have been accidentally implied, I never stated that hospitals
overflowing with customers is a good thing. I merely stated that if you
offered the same care for lower prices, you would have no shortage of
customers. In addition, when there is competition between hospitals, a patient
can choose one that has a lower incidence of return visits, for example.

Demand is _always_ an issue - in this case, high demand and a tightly limited
supply have resulted in astronomical pricing. We can't really affect demand,
other than to cure various diseases, but we can easily affect supply by easing
the intense regulation and government-mandated licensing monopoly.

I also never said that hospitals ought to be for-profit (though I wouldn't
suggest outlawing for-profit hospitals, either). There are many advantages to
a non-profit approach, and non-profits do _not_ have to have the government's
support to exist. I am only arguing that the government should get out of the
issue, except when it comes to judicial matters of crime or civil suits. An
organization can have a motivation other than profit - many do. Many
organizations (the Red Cross, for instance) would be more than happy if they
were unneeded and obsolete. I realize there are certainly some corrupt people
who would try to use their position for unjust personal gain, but this is
always the case, and would become harder to do than under the current model,
not easier.

(As a very firm Christian, I tend towards the idea that the best model for
hospitals is to be managed by the church (e.g., the numerous and beneficial
Catholic hospitals around the country), which would be in line with what I
previously said about non-profits, though I realize I am probably nearly alone
in that opinion on this forum. I don't believe that secular hospitals should
be outlawed and all hospitals should be required to be church hospitals,
merely that church hospitals are the best model.)

Regardless, my point wasn't really to argue the free market position in this
case. My comment was more to point out that the OP doesn't actually engage
with the arguments he claims to refute, as he doesn't look at what a free-
market advocate would actually say.

------
mpweiher
Exactly. When I moved to the Bay Area to work for Apple, it was all very nice
but had a strange "taste" to it, sort of like Cowslip's warren in _Watership
Down_.

It's not just the health insurance, it's also the college loans (and the
prospect of having to pay for your children's college) and the mortgages.
People with debt don't make much noise, and while people were likeable and
smart, there was an undercurrent of deferring to authority that seemed
bizarre.

------
forfengeligfaen
If you steal our words, how can we fight you? Maybe it's time to invent some
new ones.

'Privilege' never used to mean 'wealthy' or 'rich'. It meant "a special
advantage, immunity, permission, right, or benefit granted to or enjoyed by an
individual, class, or caste."

The word 'freedom' has also been subjected to a subtle change in meaning. The
word formerly meant freedom from coercion, from the arbitrary power of other
people. People who share your opinion have changed it to mean freedom from
necessity, release from the compulsion of the circumstances which inevitably
limit the range of choice of all of us.

------
rootedbox
"white american males working as computer programmers are not privileged" - It
may be hard for you to see privilege as in general everyone you grew up with
grew up with the same privileges as you, and now that you are a computer
programmer your peers are also equally privileged. But I can rest assure you..
that you are privileged..

I am a hispanic male working as a computer programmer, and maybe because of
that it's easier to see the privilege my occupation affords me as my
grandmother lives in a country where the median income after tax is 500
american.. Where every so often the police, and army decide to shoot it out in
the streets.. Where 51% of the population is beneath the poverty line..

Maybe it's easier for me to see privilege as I went to a highschool that was a
minority majority school in the poor part of town. Where some kids weren't
worried about there health care from the flu, but there health care from a
flying bullets within there apartment complex. Where the kids in the cafeteria
line that had white slips are getting there only meal of the day because it's
paid for by the government.

Not only do I think it's important to understand we are privileged; I believe
it is also our responsibility to act on that privilege to make sure all are
granted the same basics our life affords as engineers (job security, food,
health care, personal security[violence], time off to vote, etc). Only when
the general public is granted those basics will I even partially not think of
my self as not privileged.

~~~
raganwald
Obviously they enjoy _relative privilege_. I am a brown person, I was one of
three such in my high school, I assure you that I appreciate how privileged it
is for me to be male and middle class and have educated parents.

But all the same, I'd prefer to say that they are "less under-pivileged" in an
environment where they can be fired for what they do on Reddit in their spare
time, leaving them unable to provide for a wife with medical issues.

In the case I am thinking of, many people said that the privileged person in
question shouldn't have been doing unpopular things if he had a wife to
support. Which really underscores my point.

------
ChuckMcM
Really enjoyed that one. It is interesting that you can use the same mechanism
to frame the technological debate about open source and proprietary systems.
That one might really pump up the rage views though :-) nobody wants to feel
like they are being duped into carrying out someone else's agenda.

------
Tichy
No, it's not freedom if your only option is to get a job at some company and
then slave away in a boring job until retirement. There may be a safety net
against losing your job - but it ties you to said job. And all those safety
nets need to be paid for, if companies are being burdened with that it makes
it harder to start companies and become truly free.

I am actually very much for safety nets, but I don't see why companies should
have a special obligation to pay up. If society wants safety nets, society
should pay (and companies would pay their share via the taxes they pay, too).

------
BrianEatWorld
The removal of fear can also be considered a negative effect of a safety net
though. Without the fear of failure, whats to stop one from making improperly
weighed decisions? Isn't the fear of failure what drives the decision making
process to the right conclusion? As a thought experiment: In a world with a
marginally better safety net, would we really see cures for cancer or would we
just see more Pinterest for X or Facebook for X start-ups?

~~~
mkr-hn
It's easy to fall too deep into the abyss to recover when you fail. I would
rather have a strong safety net and let a few people collect on it than risk
it not being strong enough to do any good.

------
Orva
These freedoms mentioned (with addition of free education) are called
democracy in northern Europe. This is also why we have difficulty keeping
straight face when someone claims that US has democracy.

------
hammock
In the context of OP's argument, I fail to see how government safety nets
aren't just another example of "chains."

------
mkr-hn
It might have been a good idea to spend a paragraph or three defining
privilege as used in your post. Your use is valid, but it's going to annoy a
lot of people who are accustomed to rich white men trashing them, and they
might not be able to read it as intended.

------
eli_gottlieb
Actually, I agree. I live somewhere with some (albeit kinda crappy) safety
nets, and it's true: people are more likely to strike out on their own, start
a political party, start a business, or just do what they freaking want with
their lives in Israel than in the United States, where employment power is so
concentrated that offending corporate America is a death sentence.

It's not dramatic, it's just that normal for Israelis is far more open and
assertive than for Americans. Partially a cultural difference, but largely an
effect of not actually being _screwed for life_ by one bad decision.

------
gyardley
Oh look, a way to detect who's using an auto-submission script to try and get
karma.

Just because raganwald writes it doesn't mean it belongs here.

