Rationing Parcel Delivery Services
(cc photo by laffertyryan)
As John Holbo suggests, one of the odder elements of the health care debate is that conservative appear to have concocted a special one-off meaning of the term “rationing” to apply to government guarantees of basic health insurance coverage. They observe that insofar as the government guarantees basic health insurance coverage to everyone, the government probably can’t actually deliver an unlimited quantity of health care services without breaking the bank. Therefore, at some point someone will probably not get some service he or she might way. This is rationing and it’s evil and the solution, for unclear reasons, is for the government to deliver no guaranteed services whatsoever since . . . well . . it’s not clear how that’s better since either way you could still pay out of pocket.
Conservatives don’t talk about anything else in this way. The United States Postal Service provides certain kinds of guaranteed mail delivery services. It will not, however, just do anything mail-related that you might want. This doesn’t lead to “rationing” of parcel delivery services, it leads to the existence of private sector shipping companies that you can pay to do other stuff for you.
Similarly, your kid is entitled to go to a public school. They’ll teach him reading and writing and some science and history and probably Spanish or French or some such. But in the vast majority of places, you can’t have your kid taught Japanese at taxpayer expense. Again, though, we don’t live in a dystopian universe of “language rationing” in which it’s impossible to learn Japanese, you’d just have to pay someone else to do it. We of course could ban the market in private foreign language instruction, but it’s not clear why we would do that, and the existence of public sector provision of Spanish language instruction doesn’t in any sense imply a ban on the teaching of other foreign languages. What’s more, even if you’re incredibly troubled by the fact that today’s poor children don’t have the chance to learn Japanese in public school it’s still the case that eliminating public schools and lowering taxes isn’t going to leave those kids any better off. They still won’t know Japanese and now they also won’t be able to read.
42 Responses to “Rationing Parcel Delivery Services”
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August 11th, 2009 at 1:09 pm
I think this is very well put and an important point (which kind of makes the silly typo (”way” for “want”) more glaring).
The commenters at McArdles post (linked in Holbo’s post) seem to be claiming that, as a practical matter, government provision of health care will lead to fewer choices for people eventually. The reasoning behing this conclusion wasn’t completely clear to me, but it seemed to be based on “Free Market Always Good, Government Program Always Bad” logic.
August 11th, 2009 at 1:11 pm
Actual government rationing in the United States:
http://en.wikipedia.org/wiki/Rationing#United_States
August 11th, 2009 at 1:13 pm
In all fairness, conservatives aren’t very friendly to programs like the post office and public schools either. There is a legitimate gripe that for government run programs with any kind of progressive impact, a wealthy person is going to get less services than they would have by just buying them privately. On the surface, this seems unfair. I think the left needs to do a better job explaining why the benefits of government programs outway this sort of visceral sense of unfairness.
August 11th, 2009 at 1:13 pm
Yeah, but what about the socialism and the Obamacare and the death panels and the government-subsidized UFO abductions? Huh? What about them?
August 11th, 2009 at 1:18 pm
And what about the paragraph 64? You know, the one that institutes Storm Troopers to kill old people and cute babies?
August 11th, 2009 at 1:25 pm
That may make sense, but then what are all the angry old white people going to yell and make signs about?
Really, you need to think about the unfortunate people who love their insurance so much they take off work to go disrupt town hall meetings. Who will consider the plight of the well-off and adequately insured?
August 11th, 2009 at 1:27 pm
Because an actual, tangible benefit is actual and tangible, and a visceral sense is only a sense?
August 11th, 2009 at 1:29 pm
Tell that to Megan McArdle. She either went over to the dark side or is much dumber of what anyone thought.
August 11th, 2009 at 1:30 pm
This post is much too sane for the current healthcare debate. It would be improved by declaring that the policy you oppose would, if enacted, result in the death of your children.
August 11th, 2009 at 1:32 pm
If conservatives or libertarians have arguments to make, they’re about whether the proposed changes are better or more efficient or deliver better quality or more quality to more people or not.
Given that conservatives and libertarians long ago reconciled themselves to the welfare state, they’re in no position to make the kind of broad socialism/rationing etc. arguments. These are nonsense.
August 11th, 2009 at 1:33 pm
I think the left needs to do a better job explaining why the benefits of government programs outway this sort of visceral sense of unfairness.
I have a better idea. Why don’t Democrats who were elected to reform the health insurance system go ahead and do their job? What is the point of talking about this *again* when we’ve already collectively decided that we were going with Obama? How many times do we have to decide to do this thing before we agree that we’ve decided?
August 11th, 2009 at 1:34 pm
Tough call.
And it’s Order 66. The euthanasia teams will swing into action out of their black helicoptors, killing the very old, the very young, and anyone who comes in worse than second in the cripple races.
August 11th, 2009 at 1:35 pm
Post office is, of course, a very different story. You don’t subscribe to the post office services, it’s a fee-for-service kinda thing.
But the public schools and the police – yes, that’s almost exactly the same thing as a public heathcare plan would be.
August 11th, 2009 at 1:38 pm
Matt, you’re being too nice to them. Seriously.
August 11th, 2009 at 1:40 pm
The euthanasia teams will swing into action out of their black helicoptors, killing the very old, the very young, and anyone who comes in worse than second in the cripple races.
I believe the teams are to be composed of amoral married gays who will perform forced sex acts on the victims prior to executing them. That’s all in the secret codicil.
August 11th, 2009 at 1:41 pm
Henry @ 8: Please note that those options are not mutually exclusive.
August 11th, 2009 at 1:45 pm
Unsaid is that the right wants to end public schooling and the USPS and leave education and parcel delivery untouched by government hands. The government is for fighting wars and keeping birth control from women. Duh!
August 11th, 2009 at 1:45 pm
We need government financed health care for the same reason that we need government financed fire departments. Fires and disease spread and if my neighbors get sick (or their house catches fire) it will hurt me too.
That doesn’t mean there will be less money spent on alarm systems, or sprinklers, or that there will be less innovation in fire reduction technologies. It just means that we will have one big water tank that will cover the whole community, not individual ponds in backyards for those that can afford them.
August 11th, 2009 at 1:46 pm
People are less rational about health care rationing because you need it when you need it and people are afraid of things getting worse. But also people are assuming (rightly) that liberals intend one day for government health care to at the very least dominate the market. And at that point it’s not exactly the same thing as sending your kid to a private school or choosing UPS. Of course it’s not the same thing now, either, but that’s a different argument.
August 11th, 2009 at 1:53 pm
I think you and John are actually being overly generous. There’s no reason to anticipate any problem with rationing beyond what private health insurance would result in unless you assume that the public plan will be a much less efficient than private health care. I suppose folks like Megan just take that as an axiom but based on the level of care and amount of spending we see in places with strong public healthcare, I’m very much unconvinced. Well, okay, there are reasons besides efficiency why these things might cost private health insurance companies less, namely that they don’t actually cover a good percentage of the population and that they sometimes manage to deny payment for people they do cover. But somehow I don’t think that “If we don’t deny granny her pacemaker, we’ll have to deny granny her pacemaker!” will play especially well.
And, wait, isn’t this end-of-life type stuff almost entirely about old people anyway? People who are already covered by Medicare? Why would expanding public health coverage to younger people cause us any significant problems as far as end-of-life stuff is concerned?
August 11th, 2009 at 1:56 pm
Right. Medicare doesn’t cover everything either–most patients choose a supplemental plan—but you don’t hear anyone calling to scrap that program entirely.
August 11th, 2009 at 1:58 pm
They still won’t know Japanese and now they also won’t be able to read.
Future Republican voters, then.
August 11th, 2009 at 2:00 pm
Why would expanding public health coverage to younger people cause us any significant problems as far as end-of-life stuff is concerned?
Because in order to pay for the younger people you’ve got to set grandpa on the proverbial ice floe. /chewy on the outside, crunchy on the inside.
August 11th, 2009 at 2:08 pm
“Fires and disease spread and if my neighbors get sick (or their house catches fire) it will hurt me too.”
I didn’t realize broken bones and arthritis and cataracts were contagious. Hmph. Learn something new every day.
August 11th, 2009 at 2:30 pm
Henry Says:
“Tell that to Megan McArdle. She either went over to the dark side or is much dumber of what anyone thought.”
‘Went over’? She was *born* over, no matter what sob story she has about Evul Hippeeez in college torturing her for fighting in Vietnam, or whatever. Her libertarian snarkism was always very restrained during 8 years of GOP uber Alles.
August 11th, 2009 at 2:34 pm
As fun as this is, I thought I would be serious for a moment and point out that the government probably could not, in fact, outlaw private education in Japanese. Some states tried to outlaw private education in 20s (when they were worried about Germans secretly taking over or something) and the Supreme Court smacked them down pretty quickly.
August 11th, 2009 at 2:53 pm
Holbo’s ignorance combined with Matt’s is a dangerous thing.
The insurance reforms that are meant to drive everyone to the government plan effectively prevent the emergence of a top-up insurance market.
Matt and his friend Ezra and their friends in the “bending the curve” camp think that private spending on health care has negative externalities–that, to use Holbo’s example, allowing Granny to buy a pacemaker on her own drives up costs for everyone else.
August 11th, 2009 at 2:56 pm
Not receiving Japanese lessons isn’t quite the same as being denied specific medical care. Even if the care being denied is unnecessary (or even counterproductive) the patient might still want it and fear the loss of autonomy, however irrational or misguided that fear might be. No one fears the loss of proficiency in Japanese to quite that degree.
Not only are not all patients informed, some are not even informable — but they are still part of the body politic and their legitimate concerns must be acknowledged. This could have been easier if their fears were not so badly abused by turf-protecting reactionaries.
August 11th, 2009 at 3:16 pm
The insurance reforms that are meant to drive everyone to the government plan effectively prevent the emergence of a top-up insurance market.
Frankly, the existing bunch of parasites have forfeited their right to participate in a top-up capacity. They are bad actors, and need to go away and be replaced by the kind of private insurers that exist in countries with actual healthcare systems.
August 11th, 2009 at 3:19 pm
I’ve never really seen this substantiated in an argument, and even in countries with far more pervasive state control of medicine than the current proposals, like the UK, there is a top-up private medical insurance market, even in the face of the evil gummint owning hospitals and employing doctors.
August 11th, 2009 at 4:20 pm
Actually, I’m pretty sure that outlawing foreign language instruction is considered a violation of substantive Due Process. The SCOTUS overturned such a law in (I think) Kansas back in the ‘teens or ’20s (specifically, German).
August 11th, 2009 at 4:41 pm
Come rain, or sleet, or gloom of night, I would like to deliver mail to Mailbox Peak.
August 11th, 2009 at 4:49 pm
On a related note, the co-existence of the U.S. Postal Service (a government corporation)with FedEx and UPS,etc disproves the claim that goverment provision of a service guarantees that private providers will be put out of business(L. Graham’s current argument against the public option). The USPS hasn’t killed off these other services, and in fact, USPS provides a lot of business to them (ships using FedEx planes, etc).
August 11th, 2009 at 5:13 pm
[...] Matt Yglesias [...]
August 11th, 2009 at 7:36 pm
“The commenters at McArdles post (linked in Holbo’s post) seem to be claiming that, as a practical matter, government provision of health care will lead to fewer choices for people eventually. “
You know I have made a personal vow not to check McArdle’s blog as much as I to, because it makes steam come out of my head. However, I do try and wrap my brain around what she is saying, and it’s difficult because so much of her long blog posts have a central thesis that is impervious to reason, empirical evidence or studiesm, that thesis being: government is bad and it should be avoided at all costs no matter what. I know that sounds glib and a little broad, but really, it’s true. McArdle will ramble on and on (and she admits they are rambles) without a single study or any shred of empirical evidence to back her up. I read her and it’s mostly just personal philosophy and emotional reactions against government, all the time.
And the “eventually” stuff, yes focusing on an idealized, doom filled future that may happen or may not happend (and actually won’t the likelihood that there will be government controlling every aspect of our lives is cloe to nil) while ignoring the present, real-time proglems of literally millions of people being uninsured and/or having their healthcare “rationed” right now by the private sector. I know this seems hyperbolic but I think it’s true: I see these people being more concerned with an idelogically pure libertarian society than with people dying because of our current system (and I’m being generous), It is creepy how idelogically focused some of these commentators are and McArdle too: her blog and many of her commentators express fear-based reaction to government over and over again, impervious to pragmatism or empiricism. It’s bizarre.
August 11th, 2009 at 10:01 pm
Such thoughtful analogies. The Post Office not delivering my letter to the moon is exactly the same as a government run health bureaucracy not giving my 80 year old mother a hip replacement because she is too old, according to the panel of goverment paid medical gurus. And the public schools not teaching certain less-popular languages is precisely the same as refusing medical care to a baby in utero because she isn’t a person yet, according to the non-partisan, non-political goverment medical board. Ignorance must truly be bliss.
August 12th, 2009 at 7:32 am
As it happens my otherwise horrible public middle school in Milwaukee actually offered Japanese (but no Spanish, French, etc). So I spent three years learning it at taxpayer expense!
August 12th, 2009 at 8:36 am
How is excluding people who cannot afford to pay better than rationing?
August 12th, 2009 at 1:12 pm
Ditto, Dad. Also, it’s not a matter of excluding people who cannot afford to pay vs. rationing, those are not our only options. We could create a hybrid system where basic care can be provided to all people — the problem is ensuring that insurance companies who provide more coverage do not get edged out of the market, which can happen all too easily.
I think it’s important that we provide healthcare for people who can’t afford it themselves, and stop breaking our hospital system because people use the ER as primary care, but it seems antithetical to a lot of principles of democracy, capitalism, etc. (which you can spurn if you’d like) to create a system whereby people who’ve worked their butts off to get to the top can’t pay for lifesaving experimental treatments.
August 12th, 2009 at 2:29 pm
[...] Yglesias seconds this: [...]
August 13th, 2009 at 12:36 am
So if the current providers are soaking their customers so grossly why not start the “MattY Uber Health Insurance Non-Profit?” It should be wildly successful if it only collects half the insanely high profits of it’s competitors.
August 16th, 2009 at 5:46 pm
[...] Yglesias on the false use of the word “rationing" when talking about health care: Similarly, your kid is entitled to go to a public school. They’ll teach him reading and writing [...]