Monday, June 6, 2011

Is Medicare sacrosanct?

In his column today, Paul Krugman declares that the Ryan plan for Medicare is something out of "vouchercare" and would be inferior to the current system. On one side, I am agnostic about this; a voucher scheme still has the government not only in control of the purse strings, but also acting as the distributor of medical care.

Now, Krugman has no problem with either of these roles of government, but he wants the state to send the checks because he says that it will better "control costs." He then uses Canada's medical system as a positive example of cost control.

While Krugman is free to say what he wants, I find this statement to conflict with what many people are saying about Canada's system:
Consider Canada, which has a national health insurance program, actually called Medicare, that is similar to the program we have for the elderly, but less open-ended and more cost-conscious. In 1970, Canada and the United States both spent about 7 percent of their G.D.P. on health care. Since then, as United States health spending has soared to 16 percent of G.D.P., Canadian spending has risen much more modestly, to only 10.5 percent of G.D.P. And while Canadian health care isn’t perfect, it’s not bad.
Bad, of course, is a relative term. There is almost no medical innovation in Canada, and much of medical care there is a time warp, as medical capital deteriorates and there is no incentive for medical providers to acquire new capital.

Take the following example: Montreal, which has about three million people, has three MRI devices, while Allegany County, Maryland, where I work, has 80,000 people and three such devices. In Montreal, a person in need of an MRI has to wait six months (unless the person has political connections), while in Allegany County, the wait is miniscule, perhaps a day to set up the appointment.

Why the disparity? To a Canadian medical provider, an MRI is just a cost, as the firm cannot make a profit from this piece of capital. So, one of the most innovative medical devices today is seen as pure cost in Canada.

When one speaks of lowering costs, we are talking administrative numbers, not opportunity cost. (Yes, I know. Keynesians believe that Opportunity Cost is an oppressive tyranny left over from those bad old Classicals.) The real costs are borne by individuals who have care withheld from them, and that is endemic in Canada, whether or not Krugman wants to admit it.

The larger issue as I see it is that Krugman believes that medical care should be in control of the state. He simply cannot see any role for markets and private enterprise, entrepreneurship and, Horrors!, real prices. Medical innovation, as he sees it, is the result of pure research and that can be done much more efficiently from the government side, since political considerations never enter into any production equation. In other words, Krugman actually believes that state-run care will provide better results at cheaper costs.

Thus, his belief that Medicare, which was created 46 years ago, is Holy and Sacrosanct. Despite the fact that it, like everything else associated with the U.S. Government is going broke, Krugman still remains the True Believer that government medical care will give us good care, plenty of innovation, and low costs. Not possible.

While I have no idea how he would respond to a recent action by the FDA, which seized "birthing pools" because the government claims they are "unregistered medical equipment." As one bureaucrat declared:
Pregnancy is an illness and birth is a medical event. Therefore, a pool that a woman gives birth in should be classified as medical equipment.
Interestingly, Portland, Oregon, hardly is a bastion of conservative Republicanism or even libertarianism. It is a community heavily steeped in statism, and so the reality of the very statism that they support crashes down upon them. (Since the FDA considers pregnancy to be a disease, maybe that is why the government is so anxious for there to be abortion on demand.)

79 comments:

AP Lerner said...

"There is almost no medical innovation in Canada"

Care to share a link or some sort of proof, or should we just take you're word? At least Krugmna makes an attempt to support his ideology with some facts and/or data.

http://theincidentaleconomist.com/wordpress/in-defense-of-canada/

"Montreal, which has about three million people, has three MRI devices, while Allegany County, Maryland, where I work, has 80,000 people and three such devices"

Care to share a link or some sort of proof, or should we just take you're word? Care to share some sort of methodology or empirical evidence supporting how many per capita MRI machines are optimal?

"like everything else associated with the U.S. Government is going broke"

Could you please explain, with actual data and facts, how the US Government can go broke? Specifically, could you show how an issuer of a currency, who is the monopoly supplier of that currency, become insolvent.

FYI - here is what insolvent means.

http://en.wikipedia.org/wiki/Ins

"As one bureaucrat declared: Pregnancy is an illness and birth is a medical event. Therefore, a pool that a woman gives birth in should be classified as medical equipment."

Care to share the name of said bureaucrat, because I could not mind it in the link? Or should we just trust some random quote on a random website? I once read on a random website unemployment was going to 4% in two years, should I believe it? Oh wait, that wasn't a random website, that was Paul Ryan's Path to Prosperity.

In all seriousness, do you do any real analysis?

I'm curious, you are still an academic, right? Have you ever heard of citations? Footnotes? Proof? If I submitted a paper anything like your blogs, I would have been kicked out of university. But then again, I went to a university where open minded, thoughtful, intelligent debate, based facts was encouraged.

Will said...

I do not understand where you are getting your information, Professor, but distortions don't add anything to a discussion.

Looking at the hospitals affiliated with McGill University (http://muhc.ca/), the Davis-Jewish has one MRI, Montreal General has one, Montreal Children's has one, Montreal Neurological Institute has two, and St. Mary's has one. Thats six MRIs in that hospital group, although one of them is used mainly for research and not diagnostic medicine. The french language hospitals also have a few MRIs, and Montreal also has ten or so private MRI clinics, each with their own machine.

The wait times in Canada can be quite long in the more sparsely populated provinces, but in Quebec (including Montreal) but the average wait for an MRI is one to three weeks, depending on the type of test, which is comparable to wait times in the US (for comparison, one hospital I worked in, Akron Children's consistently had 1 month+ waits). This according to discussions with doctors at the ISMRM conference a few weeks ago.

In general, for non-elective procedures, wait times in the US are usually comparable to those in Canada. Canada's are higher, but not life threateningly so (Canada has generally better outcomes in most metrics than the US) http://content.healthaffairs.org/content/29/12/2323.abstract

In short, your post is factually incorrect on the number of MRI and on the wait times. In the future, please link to actual sources for information, it will cut down on incorrect information.

Mike M said...

AP are you a natural smartass or do you have to really work at it?

The man writes a public blog, do you really think he would put these facts out for the record without foundation? Or perhaps you are used to that tactic from the government you so love that you become suspicious of everyone.

It’s a blog, not a PhD thesis requiring academic citation for every utterance.

You do make a fair point about governments not going broke. Governments that are a monopolistic supplier of their currency don’t go broke. Their currencies do. And thus their citizens are relegated to a reduction in their standard of living.

All of which is why the inevitable conclusion of the Greece (and others) situation is to split out of the Euro, go back to the Drachma, devalue by 30-50% and impoverish their citizens.

Mike M said...

Will, thank you. At least your challenge of the facts was constructive.

Will said...

Further, I can find no actual news articles on the seizure of any birthing pools, only a series of blog type posts all quoting a facebook post of Barbara Harper's.

In a limited investigation, I went to four sites (two international) that sell birthing pools, and emailed them asking if they would have any difficulty shipping me a birthing pool. All four have now responded and said if I pay for rush delivery I can have my very own birthing pool by the end of the business day Wednesday. The international sites told me that there are no regulations in place for birthing pools.

I think you've fallen victim to a new-age wackadoo trying to gin up a fake conspiracy to prove an FDA-backed big pharma conspiracy to ply expensive medication to naive expectant mothers.

Bala said...

"The wait times in Canada can be quite long in the more sparsely populated provinces, but in Quebec (including Montreal) but the average wait for an MRI is one to three weeks, "

Good point. Out here in India where I live and where government provides almost no healthcare except run quite a few government hospitals which no one who can afford bis healthcare (which is not too expensive, btw) visits, the wait is less than 24 hours.

Just making a point, you see :)

Bala said...

I forgot to add a point. I can even choose where to get my MRI done. Different providers offer it at different prices. Competition, you see?

Bala said...

AP,

You are truly hilarious. Your persistent refusal to grapple with economics and your perpetual confounding of accounting with economics makes for a fair bit of entertainment. The best part is that you are soooooo ignorant that you reveal it again and again.

"Could you please explain, with actual data and facts, how the US Government can go broke?"

See how quickly you reveal your complete, abject ignorance? In Economics (which is a social science, incidentally), data and facts explain nothing, do you get it? That job is done by an animal called THEORY. Economic theory says that as more monetary units are issued, it reduces the value of all existing monetary units including the pre-existing ones compared to what it would have been without the fresh issue. The concept that explains this is called the law of diminishing marginal utility as applied to money.

The point at which a government goes broke is where people no longer accept the money it issues because the money has become worthless in addition to depreciating so rapidly that people can't even rely on it to be a good buy as toilet paper or, as in Zimbabwe, as replacement for firewood. Please explain how issuing more money that people refuse to accept because it is worth very little and loses 90% of its value before they can get to the store with it is possible at all.

Incidentally, why did the governments in Weimar Germany and Zimbabwe go broke?

Or do you have a theory that explains how the government can issue any amount of money it wishes without reducing the value of pre-existing units of the money? Have you started your anti-marginal revolution already?

You MMTers are genuinely hilarious.

Will said...

Bala, I was under the impression that India is suffering from a shortage of medical physicists/highly trained staff which has led to fairly long wait times for MRI procedures for most patients- this was a general impression I get from at an international conference, so I have no specifics.

I'm largely unfamiliar with India's medical system. How frequently are MRI's used in diagnoses? Are physicians pushing for full-body MRI screening scans? Is it routine for head trauma/concussions to have "just-in-case" brain scans? Basically, I'm curious, and would like data.

Bala said...

Will,

By your own admission, you are quite unfamiliar with the way the healthcare business operates in India. With the exception of a monopoly over licensing and a few (usually rotten) government hospitals, people are free to offer and choose healthcare. Doctors and patients together decide if a particular procedure is required or not. People voluntarily take medical insurance to cover themselves against unforeseen circumstances like accidents.

All this sort of takes care of costs as well as waiting times. It's does not provide universal coverage, but people are free to choose, you see.

Bala said...

Will,

Just to be sure, I called a private lab in Chennai at 4:50 am (now) and asked if they offer MRI scans. I specifically asked what a spinal MRI costs. The reply was. "Please come in at 7 am. It will cost you Rs. 9000'.

10 years ago, when I really took a spinal MRI, I paid Rs. 8000 and got it done in 1 day. Accounting for inflation, I should say costs of MRI scans have been cut by at least half in Chennai. How is it out there?

Try it yourself. Google on 'MRI in Chennai', select a link that lists many private labs that offer MRI scanning and speak to them yourself. Get your facts yourself when it is possible.

Alternately, you could call +914445555555 and ask. That's one outlet of a set-up called Bharat Scans that has multiple outlets in Chennai city.

There are many merits to a free market in healthcare, you see.

Bala said...

Will,

I called a 2nd set-up called Scans World. I was told to come at 8.30. The price quoted was Rs. 8000. The number is +914440000008. Just try it.

Bala said...

Will,

What's funnier is that at neither place was I asked which doctor prescribed an MRI. Out here, getting an MRI is just like getting prescription drugs at the drug store - Walk in and get it.

Those at the conference must have been talking of the shortage including in government hospitals. That wouldn't surprise me considering they are government hospitals and offer these services at throwaway prices, meaning there must be a huuuuuuuuge waiting line for them.

William L. Anderson said...

I found these links, for what they are worth, which tell a somewhat different story about wait times in Canada. (I suppose that the stories about Canadians driving to the USA for care are just made up.)

http://answers.yahoo.com/question/index?qid=20090508190902AAXlf9Z

http://www.vhl.org/newsletter/vhl2001/01bjmric.php

http://www.anausa.org/smf/index.php?topic=516.0

If you are an animal, your wait time is not that long, since veterinary care in Canada is not paid for by the government.

Bob Roddis said...

Let’s not speculate. You can look up Canadian medical wait times. I looked up Windsor, Ontario, ¼ south of Detroit within a range of 25 km.

http://tinyurl.com/3q9zlgh

MRI:

Provincial Wait Time 108 days
(9 out of 10 patients complete their procedures in this time)

Windsor Regional Hospital 29 days
Hotel-Dieu Grace Hospital 60 days

CT:

Provincial Wait Time 39 days
(9 out of 10 patients complete their procedures in this time)
Windsor Regional Hospital 21 days

Hotel-Dieu Grace Hospital 22 days

I was in an auto accident in Detroit in July 2010 and was taken to an inner-city Detroit hospital at 2:30 a.m. with only a bruised rib. I got my cat-scan at 6:30 a.m. on a Sunday morning, 4 hours after being admitted. The hospital I was at was 13 miles north of Hotel-Dieu Grace.

6071 West Outer Drive, Detroit, MI 48235-2679

1030 Ouellette Avenue, Windsor, ON N9A 1E1, Canada

http://tinyurl.com/3br47qx

Bala said...

Bob,

And since you introduced CT scans into the discussion, just a couple of months ago, I was advised a chest CT scan for which I was able to choose my timing of the scan within 24 hours of the doctor prescribing it. Even that delay was because I was supposed to go on an empty stomach whereas I had just eaten something when I had visited the doctor. It cost me around Rs. 7000 in a top notch (by Indian standards) hospital (the Fortis Malar in Chennai) while it would have been much less in an independent lab.

These fools will never learn the merits of a free-market (as in free from government intervention) healthcare. They are too indoctrinated and full of bullshit to do so.

Bala said...

Bob,

I was citing my case because it wasn't even an emergency case. It was a precautionary scan as I was suffering from severe chest congestion for 2 months. Just making sure that the trolls don't pick on your accident as an 'emergency' to explain why you got your CT done immediately.

Will said...

Professor, Toronto is in Ontario, which is not the same province that Montreal is in. The wait times I quoted in my above post concern Quebec, as Montreal was the city you discussed in your blog post.

All three of your new links discuss Ontario, and the most recent of your links is a two year old yahoo-answer post, which is anecdotal at best. One of your links is a full decade out of date.

For future info- you can directly query Ontario wait times-
http://www.health.gov.on.ca/en/public/programs/waittimes/

The average wait time in Toronto appears to be about one-three days for non-contrast scans (generally injury wear-and-tear sort of scans) , and one-three months for diagnostic imaging. The range is because (much like the US) different hospitals have radically different wait times.

This is half of the six months you posited in your initial post. Keep in mind there are hospitals in the US that routinely run one to two month waits for outpatient diagnostic scans. Toronto appears to have MRI waits roughly 30% longer than New York City hospitals (I picked NYC because of its close distance to Toronto). Toronto appears to have emergency room waiting times roughly 10x (1000%) better than New York. The average emergency room wait time for King's County in NYC appears to be about 45 HOURS! Compare that to the 4.5-5 for Ontario emergency room waits.

And, yes, the stories about Canadians driving to the US for healthcare ARE largely made up, which is well known to anyone who has studied health policy in any detail. Look at the peer reviewed literature- http://content.healthaffairs.org/content/21/3/19.full

As far as I know, the above is the authoritative study on the issue, and they found that less than a hundredth of a percent of Canadians come across the border for treatment in any given year- a negligible amount compared to the number treated by Canada's health service.

Also, comparing to vet MRIs is just silly- the majority of the US and Canada have almost no demand for vet MRIs. Its a luxury service.

Will said...

Bala- in both Canada and the US, the exact same sort of no-wait private clinics are available for same day scans. If you compare private MRI clinics to India to private MRI clinics in the US and Canada, you'll find the same thing- no wait, you can get a scan right now. The people who are waiting in line are people who don't want or can't afford to pay the full out of pocket cost.


Bob, you are comparing a trauma CAT scan to diagnostic imaging. These are very different things. In Canada, much like the US, these are moved to the front of the line. As far as I know, the waits for trauma, no contrast MRIs in Canada are in the hours to days depending on where you are and the seriousness of the injury (i.e. a few hours for an abdominal scan after a car accident, a few days for a rotator cuff injury playing tennis).

And let my be clear- I am in no way advocating for a Canadian system. I just wanted to correct the errors in the blog post.

Anonymous said...

FAIL!

You've reached a new low with this post. Made up numbers and yahoo answers as facts. That is in addition to the shoddy reasoning and misinformed attacks against Krugman (he wants government to run ALL your healthcare. He will not stop until the government owns your child!). FAIL!

You're an economist right?

Bala said...

"If you compare private MRI clinics to India to private MRI clinics in the US and Canada, you'll find the same thing- no wait, you can get a scan right now"

I'm mot the least bit surprised. My point was simply that I am quite surprised to even see people talking of shortages and waiting lines when all my life (of 37 years) I have not seen such waiting lines for healthcare where I live. Your next statement

"The people who are waiting in line are people who don't want or can't afford to pay the full out of pocket cost."

explains it all. It is not the least bit surprising that at a price lower than the market clearing price shortages develop and that there are huge waiting lines. Why then is there so much resistance to allowing the market to clear by leaving it free? Why do these people don't want or can't afford to pay DESERVE their MRI scan (or whatever other healthcare)? Why should they get what they are not ready to pay for? And on top of it all, since someone has to pay eventually and that happens to be a number of other people who are robbed in the nae of taxation and stolen from under the guise of inflation, what is your justification for this entire scheme of wealth redistribution?

My friends in the US (and I have many) tell me that pay-as-you-use healthcare is horrendously expensive. Why so? Why do I get the feeling that this is because of prior government intervention? Why is eliminating those interventions not a solution?

Lord Keynes said...

Will,

Your fine efforts are wasted on ideological idiots.

Will said...

Bala- "Why do these people don't want or can't afford to pay DESERVE their MRI scan (or whatever other healthcare)?"

Most view healthcare as a moral issue- the US declaration of independence enshrines a right to life, which I would argue should include a basic access to health care. Further, keeping people productive is as important as maintaining other forms of capital.

"My friends in the US (and I have many) tell me that pay-as-you-use healthcare is horrendously expensive. Why so?"

The average Indian income (according to McKinsey global institute) is something like 45 400 INR. That means one outpatient MRI (at the price you quoted) is 20% of yearly income. As a comparison, the median salary in the US is something like $45000. An outpatient mri is $700-$1000. Thats 2% of yearly income. Canada's average income is something like 35000 CAD, and a private MRI is about $900, which is about 2.5% of yearly income. Is the much more free market really providing more accessible care?

Also, India is far from a medical utopia even for those who can afford it. According to the Lancet's January series on India (which I just finished reading, and recommend if you are interested in health care policy), even private facilities in India suffer intermittent shortages of workhorse anti-biotics like erythromycin and doxy, which are widely available in all the countries with more socialized care.

This is creating a thriving market in worthless quackery being sold to desperate people.

Anonymous said...

"Your fine efforts are wasted on ideological idiots."

By what standards is that a 'fine' effort, genius?

Bala

Anonymous said...

"a right to life, which I would argue should include a basic access to health care."

And how would you argue that it is alright for some people to rob and steal from others? I ask that because there is no way a basic access to healthcare can be guaranteed for some by some without violating the property rights of many others.

The rest of your rather long and winding essay did not address the question I raised and which you pasted in your reply. Would you please answer that question?

Bala

Lord Keynes said...

"And how would you argue that it is alright for some people to rob and steal from others? I ask that because there is no way a basic access to healthcare can be guaranteed for some by some without violating the property rights of many others."

(1) It's only your unsupported assuption that people regard taxes as robbery:

“The IRS Oversight Board conducted an independent poll in 2005 that found 96 percent of the respondents agreed ‘it is every American’s civic duty to pay their fair share of taxes.’

The Pew Research Center in a similar study in 2006 found 79 percent of the respondents said that cheating Uncle Sam was ‘morally objectionable.’


Maxwell, S. 2000. The Price is Wrong: Understanding What Makes a Price Seem Fair and the True Cost of Unfair Pricing, John Wiley & Sons, Hoboken, N.J. p. 146.

(2) for anyone who rejects the fanasty of natural rights, utilitarian arguments fully justify progressive taxation: that coercion is used in the case of some people is no more significant than the fact coercion will be used against other people who break the law: e.g., if you park in handicapped zones or ambulance zones outside public hospitals your car will be towed and you'll be fined.

You might as well scream against "evil" government coercion stopping you from parking where you want, and see if you anyone will do anything but laugh at you.

Bob Roddis said...

If 80% of the populace believes in slavery (or cannibalism) of the other 20%, is that ok by utilitarian standards? If not, why not?

Since there are no natural rights, why can't we just eat genetically defective children? Or old senile people if electoral support is there?

Polls later showed the Germans thought they were free under the Nazis. I guess that made it all ok.

Bob Roddis said...

MRI in Toronto (wait times in days)

North York General Hospital 40
Mount Sinai Hospital 58
Rouge Valley Health System 71
St. Joseph's Health Centre 88
Scarborough Hospital 95
University Health Network 98
Sunnybrook Health Sciences Centre 116
Hospital for Sick Children 132
Toronto East General Hospital 145
Humber River Regional Hospital 166
St. Michael's Hospital 237

Bureaucratic diktat can never run things as smoothly as real prices. It's the nature of things. Quit fighting nature, you crazy statists.

Lord Keynes said...

If 80% of the populace believes in slavery (or cannibalism) of the other 20%, is that ok by utilitarian standards? If not, why not?

No, because an action's morality is not judged by popular approval, but its effects and consequences.

It is truly absurd to see your ignorant inability to understand that there have ALWAYS been utilitarian arguments against slavery, murder, totalitarianism etc. etc.

5 minutes of research on Google books could have shown you that.

Anonymous said...

LK,

We've been through this before. I have shown that your rule utilitarianism and your rule consequentialism are utter garbage. That you return with those very trashed concepts is very revealing.

And as Bob pointed, yours was indeed an argument by popularity. Hiding behind other lines of argument does not make it otherwise.

Bala

Lord Keynes said...

E.g., 5 minutes of research on Google books could have shown you this.

“The utilitarian impulse in antislavery thought was central to convincing many eighteenth- and nineteenth-century figures that slavery must be abolished. Utilitarian arguments were consistently advanced by most major proponents of abolition then in the Americas and in Europe .... Jeremy Bentham and John Stuart Mill, the two most eminent utilitarians of the nineteenth century, both concluded that, on utilitarian precepts, slavery must be abolished.’

“Ideological origins of Antislavery Thought,” in Peter P. Hinks, John R. McKivigan, R. Owen Williams, Encyclopedia of Antislavery and Abolition (Greenwood Press, Westport, CT, 2007), p. 351.

Lord Keynes said...

"And as Bob pointed, yours was indeed an argument by popularity."

It is no such thing: that is only your straw man argument.

The reason why progessive taxation IS moral is that it can be justified on utilitarian grounds, pure and simple.

You claim that "taxation is theft", but the empirical reality is that the majority of people don't think so. That is NOT an ethical argument justifying the morality of taxation, but a statement of fact. Deal with it.
Get over the fact most people think paying taxes is a duty and a moral thing to do.

Natural rights theory is a farce, and that is pretty much the only theory that can uphold absolute property rights.

Bob Roddis said...

Economic calculation and the pricing process are the epitome of utilitarian processes. LK hasn't a clue about either concept.

I guess in those rare instances where slavery and eating the old were utilitarian, there would be no moral objection, eh? In the next few years as we find we have fewer scarce resources due to the perpetual Keynesian depression, it will become obviously utilitarian just to shoot and eat old senile people.

Socialized medicine sure isn't "utilitarian". And I would agree that strict enforcement of property rights is not always utilitarian. I would also agree that having the police constantly monitoring food intake and the exercise regimes of the rabble under penalty of death for slackers would be utilitarian. Who wants to see the obese and poorly dressed at Wal-Mart? Yuk.

While we’re at it, let’s examine one of Keynes’ more profound insights:

“The theory of aggregated production, which is the point of the following book, nevertheless can be much easier adapted to the conditions of a totalitarian state [eines totalen Staates] than the theory of production and distribution of a given production put forth under conditions of free competition and a large degree of laissez-faire.”

Just a coincidence, I'm sure.

Bob Roddis said...

CT in Toronto (wait times in days)

North York General Hospital 19
Scarborough Hospital 21
Humber River Regional Hospital 28
Mount Sinai Hospital 29
University Health Network 31
Rouge Valley Health System 31
Sunnybrook Health Sciences Centre 39
St. Michael's Hospital 48
St. Joseph's Health Centre 55
Toronto East General Hospital 56

Anonymous said...

ROFLMAO...

"that the majority of people don't think so."

How is this not an argument by number? Yes. I get it. It is an argument by intimidation using numbers.

Bala

Bob Roddis said...

With great fanfare, we proudly announce the champion hospitals of Ontario with the shortest wait times for MRI [Feb-Mar-Apr 11] with a target of 28 days:

Peterborough Regional Health Centre 28
Sault Area Hospital 28
Windsor Regional Hospital 29
Northumberland Hills Hospital 40
North York General Hospital 40
Guelph General Hospital 41
Bluewater Health 42
Ross Memorial Hospital 43
Brantford General Hospital 45
Children's Hospital of Eastern Ontario 49

Lord Keynes said...

"The United States spends more on technology than Canada. In a 2004 study on medical imaging in Canada,[96] it was found that Canada had 4.6 MRI scanners per million population while the U.S. had 19.5 per million. Canada's 10.3 CT scanners per million also ranked behind the U.S., which had 29.5 per million.[97] The study did not attempt to assess whether the difference in the number of MRI and CT scanners had any effect on the medical outcomes or were a result of overcapacity but did observe that MRI scanners are used more intensively in Canada than either the U.S. or Great Britain.[98] This disparity in the availability of technology, some believe, results in longer wait times. In 1984 wait times of up to 22 months for an MRI were alleged in Saskatchewan.[99] However, according to more recent official statistics (2007), all emergency patients receive MRIs within 24 hours, those classified as urgent receive them in under 3 weeks and the maximum elective wait time is 19 weeks in Regina and 26 weeks in Saskatoon, the province's two largest metropolitan areas"

http://en.wikipedia.org/wiki/Comparison_of_the_health_care_systems_in_Canada_and_the_United_States

If you have an emergency, then get it immediately.

You show an inability to distinguish:

(1) emergency cases
(2) urgent treatment cases
(3) Semi-elective cases
(4) Elective cases.

The figures show that (1) and (2) get treatment and MRIs immediately, but (4) requires some wait times.

Precisely what any sane system would do. And Canada could easily cut waiting tiems of (4) by investing more money in MRIs etc, so it's just a policy decision.

Other countries with socialised medicine have greater access and machines because they willingness to spend more:

Norway 25 MRI units per million

Germany had 20 MRI units per million

Iceland 19.3 MRI units per million

Italy, 18.6 MRI units per million

http://santecarolina.blogspot.com/2010/06/mris-in-france.html

Bala said...

"You claim that "taxation is theft", but the empirical reality is that"

ROFLMAO. Your 'argument' is as hilarious as it gets. My argument on taxation is an exercise in reasoning that starts from the fundamental definition of taxation and robbery.

Simply put,

1. Taxation is coercive expropriation of individuals by government, in particular by its officials. The property thus expropriated is claimed to 'belong' to government. Hence, we say that it is indeed government that coercively expropriates the victims.

2. Coercive expropriation of individuals is robbery.

3. Hence, (this is a simple syllogism) taxation is robbery.

The response to this is not and can never be that the majority does not think this way. It involves punching holes in the reasoning. If you can't, you know what you should do.

Bala said...

"investing more money in MRIs etc, so it's just a policy decision."

Oh!!! The money for that grows on trees, does it? So creating that money and spending it has no detrimental economic effects, does it? So government really has a magic wand in its hands. WOW!!!!

Lord Keynes said...

"Oh!!! The money for that grows on trees, does it?

Ah.. no it doesn't.

So creating that money and spending it has no detrimental economic effects, does it?

If you're talking about ABCT, it's pure garbage:

http://socialdemocracy21stcentury.blogspot.com/2011/06/natural-rate-of-interest-wicksellian.html

http://socialdemocracy21stcentury.blogspot.com/2011/06/austrian-business-cycle-theory.html

So government really has a magic wand in its hands. WOW!!!! "

= stipdity that is an admission of defeat in argument.

Yes, the Canadan government can purchase more MRI machines any time it wants, just as the "socialist"/social democratic Norwegian / French / German / UK state can.

Prove me wrong.

Bob Roddis said...

Speaking of utilitarianism, Keynesian "stimulus" policies aren't utilitarian. They cause the boom/bust cycle and impair economic calculation leading to impoverishment.

BTW, who is supposed to make this "utilitarian" determination when others' rights are violated?

Finally, the US does not have a free market in medicine. It's a preposterously etatist interventionist system. I'm amazed anyone can actually be cure of anything using it. It took the idiots at Grace Sinai in Detroit twelve hours to figure out that I only had a minor rib bruise and I was held prisoner there for 12 hours. They originally sent out a bill for $6000 which was whittled down to $300, plus $179 for the CT and $43 for the ambulance. I should have just had a taxi take me home for $10.

AP Lerner said...

"I found these links, for what they are worth, which tell a somewhat different story about wait times in Canada. (I suppose that the stories about Canadians driving to the USA for care are just made up.)

http://answers.yahoo.com/question/index?qid=20090508190902AAXlf9Z"

So just to clarify, if one of your students submitted a research paper and used yahoo answers as a source, you would find this acceptable? The state of acadamia is worse than I thought. Students of Mr. Anderson, take notice. Don't know the answer to a question, make a yahoo answers page and cite it. What a joke.

Bala said...

AP,

Care to respond to this?

June 6, 2011 5:49 PM

Or are you just interested in being a smart alek who just wants to spray his meaningless drivel all over these boards?

Bala said...

LK,

I have no interest in wading through the cess-pool that you call your blog. Whatever you wish to say, say it here if you want a response.

And proving you wrong is very simple. Can you spell "The Law of Diminishing Marginal Utility"? Do you know how and why the mighty Roman Empire collapsed? What about Weimar Germany and Zimbabwe? When fiat money collapses, as it has to sooner or later, it will not get you toilet paper, leave alone MRI and CT scanners.

Lord Keynes said...

"Can you spell "The Law of Diminishing Marginal Utility"?"

Yeah, the "Law of Diminishing Marginal Utility" prevents Canada from purchasing more MRIs machines.

If you believe that, I know someone who will sell you the Eiffel Tower.

Is that the best you can do?

Did the "law of diminishing Marginal Utility" stop Italy from having 18.6 MRI units per million?

Or Norway having 25 MRI units per million?

Bala said...

"Did the "law of diminishing Marginal Utility" stop Italy from having 18.6 MRI units per million?

Or Norway having 25 MRI units per million?"

No, genius. It will eventually stop them. Don't forget that our challenge was

"Yes, the Canadan government can purchase more MRI machines any time it wants, just as the "socialist"/social democratic Norwegian / French / German / UK state can."

The key operative phrase there is "anytime it wants".

By your absolutely idiotic response, you just showed that like a true-blue Keynesian, you don't understand the most basic concepts in Economics. Go back to your chronicling, you fool.

Lord Keynes said...

"No, genius. It will eventually stop them. Don't forget that our challenge was"

They won't buy MRIs to infinity, idiot.

That argument made above is that waiting times are better in the US because of more MRI units per million of the population.

Therefore Canada needs to increase its number of MRI units to 15-20 per million to significantly cut waiting times. That could be done be quite minor spending adjustmenst from current revenue, say, by cutting some military programs and redirecting money to health care.

Anonymous said...

"They won't buy MRIs to infinity, idiot"

Genius! My argument does not require purchase to infinity. It requires money creation to the point where people abandon the money.

Adjustments from current revenue???? How then does government then spend more on defence production and amaze everyone by the pace of the recovery?

ROFLMAO

Bala

Lord Keynes said...

"'Genius! My argument does not require purchase to infinity. It requires money creation to the point where people abandon the money."

I repeat: that could be done quite easily by minor spending adjustmests from CURRENT REVENUE, say, by cutting some military programs and redirecting money to health care.
Clear?

"How then does government then spend more on defence production and amaze everyone by the pace of the recovery?"

It won't, idiot. This about changes in the diferent types of spending, cutting here and redirecting moeny to here, not total spending.

Will said...

Bala- when you have conflicting rights (in your case, the right to life vs. a very strictly defined right to property) you have to make compromises. Your argument is that the right to property IS MORE IMPORTANT than the right to life. I fundamentally disagree. Dead people have no property.

This conversation seems to have moved away from actual health care considerations. So I will leave with this

Bob- you are repeatedly posting times for Canadian diagnostic imaging (both CT and MRI). Its important to keep in mind these are different from emergency/trauma scans, which have waits of hours to days, as I mentioned above.

I've found in discussions I've had with people that they make the same comparison that you did above- the wait times quoted for Canadian hospitals compared to 'this one time, I was in an accident, went to a hospital and got a scan an hour later'. These are different lines and different waits. Canada's response times for these sorts of scans are basically equivalent to our own. In fact- its usually faster from entrance to the hospital to time of scan because emergency rooms in Canada are FAR less crowded.

The US waits for diagnostic imaging at many hospitals run one month+. Substantially shorter than Canada in most cases, but not an order of magnitude smaller.

LUCKILY BOTH CANADA AND THE US have private MRI clinics where you can get your scan if you want to pay for it now. However, these are so poorly utilized that they aren't taking much pressure off the hospitals. Why not? Because most people prefer to wait.

It might by the bias of my profession, but I think the health care debate in this country is extremely important. We are the richest country in the world, we spend by far the most on health care, and our outcomes (even for the wealthy) by any metric are generally worse than other first world nations. LEGITIMATE debate has to start from actual facts, which is why this blog post is so frustrating.


Professor Anderson- I hope you will correct your post on the number of MRIs in Montreal and the wait times for MRIs in Montreal. I also hope you'll either find a reputable source (something beyond a facebook post) for the supposedly seized birthing pools, or remove that section entirely. Its the intellectually honest thing to do.

Bala said...

Will,

"Your argument is that the right to property IS MORE IMPORTANT than the right to life."

No. My point is that you need to explain why the right to life has to include access to healthcare. My argument is that it does not and cannot. To do so requires a warped and unjustifiable definition of the right to life. As of now, you have only made an unjustified assertion. I asked for an answer. The other unanswered question I posed still remains unanswered.

Lord Keynes said...

"No. My point is that you need to explain why the right to life has to include access to healthcare."

If you have cancer, a severe heart attack, a very serious accident etc etc, and you cannot afford medical treatment you die.
Duh...

Bala said...

Will,

"Your argument is that the right to property IS MORE IMPORTANT than the right to life."

One more point. My point is that the right to property is a logical corollary of the right to life. Violation of the right to property is automatically a violation of the right to life.

Rights, properly defined, do not conflict. When they appear to do so, it's time to recognise that you have made a fundamental error.

p.s. The 'right to life' does not mean that you have a right to be kept alive and that others must provide you with sustenance. It only means that you are free to act to sustain your life as you deem fit. No man may initiate force against you to prevent you from doing so. But then that is applicable to everyone else as well. That means you have no business to initiate force against anyone else, all the more so if it is to take away their property. So you see, the right to life does not and cannot conflict with the right to property. The mistake is all yours.

Bala said...

"If you have cancer, a severe heart attack, a very serious accident etc etc, and you cannot afford medical treatment you die.
Duh..."

Genius. Pray tell us how this answers the question I posed.

p.s. I do understand that it is unfortunate. But since when did misfortune become sufficient justification to rob others?

Bala said...

LK,

One man's rights do not place any obligations on another man to provide him the means to exercise it. It only means that others may not initiate force to prevent him from exercising it.

Anonymous said...

Bala, you've simply adjusted a definition of right to life to suit your definition of property rights.

You have also limited your examples to disease like cancer, which in some bizarre libertarian universe I can see an argument against providing health care. But what about someone who is in a car accident and cannot afford care? Doesn't their right to life (strictly defined) apply then?

I'm sure you will right back some snarky remark that will insult my intelligence and call me ignorant - that is your mo on these posts. In my experience, that is a self-defense mechanism used by people who are from faulty premises and logic.

Lord Keynes said...

"One man's rights do not place any obligations on another man to provide him the means to exercise it."

Only in the fantasy natural rights ethics, where the naturalist fallacy is on display.

Explain how rights are “natural.” The whole concept “natural” in natural rights is totally spurious: there is no mechanism in nature that forces behaviour to confirm to natural rights in the way that matter confirms to gravity naturally. Rights are nothing more than human/ethical constructs: in no sense do rights exist in nature or are caused by nature.

Rothbard’s central arguments and foundation for natural rights is taken down by Edward Feser:

Edward Feser, "Rothbard as a philosopher," August 8, 2009

You say in the past that your a objectivist in ethics, but Rand's natural rights rubbish was refuted by Rollins in the Myth of Natural Rights.

Bala said...

"Bala, you've simply adjusted a definition of right to life to suit your definition of property rights. "

ROFLMAO. And how did you come to this mind-blowing conclusion when I have given neither my definition of 'right to life' nor how I arrived at it? Frankly, the onus is and was on you to give a definition of 'right to life' and explain how access to healthcare constitutes a necessary part of it. I have been asking, nay demanding it of you but you are steadfastly refusing to respond to that demand. I wonder why!


"You have also limited your examples to disease like cancer, which in some bizarre libertarian universe I can see an argument against providing health care."

This is even more hilarious. I did not choose those examples. Those were thrown at me.

"But what about someone who is in a car accident and cannot afford care? Doesn't their right to life (strictly defined) apply then?"

OK. First define "right to life" properly and we can then talk.

"I'm sure you will right back some snarky remark that will insult my intelligence and call me ignorant - that is your mo on these posts."

You have already done that implicitly by refusing to address the important questions I have raised rather politely.

"In my experience, that is a self-defense mechanism used by people who are from faulty premises and logic."

Good point. So do I take this as a confession given my previous statement?

p.s. I suspect you are Will

Bala said...

LK,

You just demonstrated why you are one of the most entertaining people I have or will ever know. One of the most hilarious sights is watching a person attack something he has no clue about. With our statement

"The whole concept “natural” in natural rights is totally spurious: there is no mechanism in nature that forces behaviour to confirm to natural rights in the way that matter confirms to gravity naturally. Rights are nothing more than human/ethical constructs: in no sense do rights exist in nature or are caused by nature."

you have shown that you have absolutely no understanding of what 'natural rights' are and how they are identified. Feser or whoever else may have written anything at all in an attempt to refute Rothbard or Rand, but then you are in absolutely no position to judge those works because you do not understand the very concept 'natural rights' that they are criticising. You do not even know if they are really attacking 'natural rights' or a straw-man version of it.

That in itself completely discredits any attempt by you to cite those 'works'. So, first understand what 'natural rights' are, reevaluate all your conclusions and then come back this discussion. Right now, you make no sense whatsoever.

How Keynesian!

Manny said...

My two cents.

I read a couple of economics/finance blogs every day, including prof. Krugman's blog. I was looking for a blog that would bring some valid counterpoints to prof. Krugman's arguments, and this is what I found by googling.

Coincidentally, my best friend lives in Montreal. I speak with her every single day, and in fact I was in Montreal two weeks ago visiting her. She happens to work as a radiology technician for the CHUM Notre-Dame Hospital in Montreal, and she tells me that there are TWO(2) MRI machines in her hospital, and that there are many private clinics in the city that also have MRI machines.

I asked her about the waiting times, and she said that at her hospital sometimes it can indeed take months(depending on what part of the body needs to be scanned), but that if it's an emergency it won't take that long. In addition, if you go to a private clinic, you can pretty much get it immediately.

I guess I'll have to keep looking for another blog...

Anonymous said...

Geez bala. Talk about inferiority complex. Got a small penis problem?

Anonymous said...

O bala... This isn't Will. You are so remarkably arrogant. Keynes plays your game but it just goes in circles.

For this example - a right to life as my right not to have my life taken by another person - either through murder or abortion. That is what most would consider a strict definition of right to life.

Here's what you did - you stated first that "To do so requires a warped and unjustifiable definition of the right to life" and then that "the right to property is a logical corollary of the right to life" and then that " The 'right to life' does not mean that you have a right to be kept alive and that others must provide you with sustenance. It only means that you are free to act to sustain your life as you deem fit. No man may initiate force against you to prevent you from doing so."

That is a narrow definition of right to life, that suits your definition of property rights. But then, even by your own stated standards there is grounds for provided healthcare for cases that there is the threat that my life might be taken from me unjustifiably and against my will - car accidents, attempted murder etc.. Even by this narrower definition of right to life you FAIL. But, if you wanted to expand on your own definition of a person's right to live their life as they deem fit, even disease seems to contradict with your own statement.

So if natural rights are invented human constructs with no basis in nature, how exactly do you justify property rights as the foundation of a society? Or is it back to the animal kingdom.

FAIL. Did you graduate high school?

Bala said...

" a right to life as my right not to have my life taken by another person - either through murder or abortion."

Warped right there. See? I told you so. So what if you are not Will. You are making as little sense.

"That is a narrow definition of right to life, that suits your definition of property rights."

Mere assertion. Justification please.

"But then, even by your own stated standards there is grounds for provided healthcare for cases that there is the threat that my life might be taken from me unjustifiably and against my will - car accidents, attempted murder etc"

Assertions again. You need to provide arguments. For instance, in an accident, you are at risk of losing your life. However, your life is not being taken away from you intentionally by another person. So, it is you who fails.

"Even by this narrower definition of right to life you FAIL. But, if you wanted to expand on your own definition of a person's right to live their life as they deem fit, even disease seems to contradict with your own statement."

Laughable. By my definition, if I contract a disease, I am free to act to seek a cure. I don't deserve healthcare. Same for you.

"So if natural rights are invented human constructs with no basis in nature, how exactly do you justify property rights as the foundation of a society?"

Who accepted the statement that they are human constructs with NO basis in nature? I didn't. That's just a pathetic effort to stuff words into my mouth.

And since you have decided to start the ad hominem, here's a bit of it back. Looks like you have been made sufficiently brain-dead by your public school.

Bala said...

"June 7, 2011 10:33 PM"

Assuming you are a man, send your wife/girlfriend over. She'll tell you if I have a small penis problem (i.e., if she still comes back to you)

Got the message? I give as good as I get. Go stuff it.

Bob Roddis said...

Since I live 3 miles from the Canadian border and have received over-the-air Canadian radio and TV signals all of my life, I often listen or watch. My recollection was that private MRI were formerly illegal in Canada. This article supports that view and that private MRI clinics are now allowed in some provinces and have helped alleviate the wait times problem.

http://www.longwoods.com/content/20265

This is completely consistent with the Austrian view.

Bob Roddis said...

More on Quebec wait times and the introduction of private MRI clinics:

MRIs are useful for diagnosing joint and muscle injuries, but wait lists in Ottawa were 65 to 162 days long in December to January according to the province's wait times website.

The list at Hull hospital was 650 patients long last week, and each person on the list could expect to wait six to nine months for a scan, hospital spokesman Denis St-Jean said.

Private clinics such as St-Joseph MRI say they can see patients on the same day they book an appointment.

The clinic opened about a year ago with a $1.5 million MRI scanner, operated by doctors that include four radiologists from the Hull hospital who work at the clinic when they are off duty.

So far, the Ottawa hospitals have not responded the offer, and their Outaouais counterparts say they are not ready to make a decision.

The Outaouais public health agency has said it is ready to collaborate with private providers. In addition, Quebec's Bill 33, which establishes guaranteed wait times for procedures such as hip and knee replacements, and allows for some private health insurance, goes into effect in two months.


http://www.cbc.ca/news/canada/ottawa/story/2007/04/03/mri-070403.html

Anonymous said...

Bala, your mom is calling. Time to go home you little angry man! You've got your head so far up your behind you have gone completely blind. Utter arrogance on display, which is the sign of utter lack any intellectual honesty. Your responses consist mainly of "I know you are but what am I" type phrases. Ridiculous.

Stuff like this - "Mere assertion. Justification please." NO, I started with a narrow and fairly accepted definition of right to life, which consists of freedom from harm from another person.

Or here - "ssertions again. You need to provide arguments. For instance, in an accident, you are at risk of losing your life. However, your life is not being taken away from you intentionally by another person. So, it is you who fails." NO. If someone hits me in a car accident and I cannot afford medical care, even a limited definition of right to life is violated. If you want to focus on intentionality (which is not always there in an accident), how about if I am the victim of a mugging.

Or - "Who accepted the statement that they are human constructs with NO basis in nature? I didn't. That's just a pathetic effort to stuff words into my mouth." NO. You have not provided any justification for property rights as a fundamental building block of social life and I ensure you that any reference that you do make to the natural world will also prove as failed as attempting to do so with natural rights.

I could go on and on with your arrogant invective. Its time to move out of your mom's basement.

jason h said...

justification for property rights as a fundamental building block of social life

=

The principle of self ownership/determination implies you also own any derivatives of your self. Including any goods (i.e. property) you've exchanged.

Anonymous said...

Thanks Jason. Now how is that rooted in natural rights exactly?

Bala said...

"June 8, 2011 5:55 PM"

Those who don't have any arguments start calling others all sorts of names. It is your inferiority complex that makes you see arrogance in my comments. It is your inferiority complex once again that blinds you to the obvious point that the statements I labelled as assertions are actually just that - assertions. The very fact that you are incapable of comprehending something this basic says a lot about you.

"NO, I started with a narrow and fairly accepted definition of right to life, which consists of freedom from harm from another person."

This is an unjustified assertion because it is just an expression of your opinion with no explanation as to why it makes sense as a definition of the 'right ti life'. You need to explain what 'rights' are, what 'life' is, why man has 'rights', what is the source of man's 'rights' and how we come to the definition of the 'right to life' starting from axiomatic foundations. That you could not understand that this is why I labelled your statement an assertion shows how intellectually incompetent you are.

"You have not provided any justification for property rights as a fundamental building block of social life and I ensure you that any reference that you do make to the natural world will also prove as failed as attempting to do so with natural rights."

Like with LK, your linking 'natural' as used in 'natural rights' with the natural world shows that you, like LK, have absolutely no understanding of the 'natural rights' theory you are criticising. If I were in your position where I did not understand the thing I am criticising, I would shut the hell up.

It looks like you and I are made of different stuff.

Bala said...

"Thanks Jason. Now how is that rooted in natural rights exactly?"

First define the term 'natural rights' properly. I mean every bit of it.

Anonymous said...

Bala, mr. know it all himself. I call you names because I have followed your comments on here for a while and the invective you spit out. Can't handle a little payback?

Let's take your logic of argument even further - you need to explain what the letter "r" really means. What does it connote? Where does it come from? Its all deflection from the gaping holes in your nonsense.

And if LK and I are soooo ignorant of natural rights (which I have not critiqued yet), please, by all means educate us.

Time to go hack home bala.

Bala said...

"And if LK and I are soooo ignorant of natural rights (which I have not critiqued yet), please, by all means educate us. "

Pay me first :)

"you need to explain what the letter "r" really means"

This only reveals how vacuous you are. Thanks for the exposition.

Anonymous said...

" Can't handle a little payback?"

Oh! I can handle all this and more, genius. I hope you are prepared to take what I can throw at you. Except that you are soooooo stupid and vacuous that every a minute spent interacting with you is a criminal waste of my time.

Bala

Anonymous said...

Do you actually ever say anything bala? Seek help. I have to go back to the real world now - you know people with jobs who don't live in their parent's basement.

ekeyra said...

In between all the "I know you are but what am I" back and forth, did I learn that the omniscient and all powerful government had to turn to the filthy degrading private sector to provide additional mri access? Egads, youd think theyre perfectly elegant economic models and equations would have told them they needed more mri machines before having to sully themselves by requiring the services of a no-good business entity.

Bala said...

ekeyra,

:D

I don't think I can say any more.

Bob Roddis said...

From watching CBC TV several years ago, I learned about this Quebec lawsuit wherein the Supreme Court of Canada ruled 4-3 that the ban on private MRI services and such was unconstitutional (or whatever their word for that is):

http://www.cbc.ca/news/canada/story/2005/06/09/newscoc-health050609.html

Socialist shortages resulted in a demand for some private care. Further research would be necessary to discover the scope and impact of this new rule.

meenutoney said...

The receiving device transmits the signals to a computer. The computer creates a picture based on the radio signals emitted from the body. http://mriscan.blogspot.com