Comments on: Municipalize Medicine?

By: Overcoming Bias : The Meds In Spain Vary Mainly By The Plains

Overcoming Bias : The Meds In Spain Vary Mainly By The Plains — Fri, 24 Jul 2009 02:32:51 +0000

[...] In June I proposed to municipalize medicine: [...]

By: Let’s Try Everything – Local Autonomy And Innovation In Government « Let A Thousand Nations Bloom

Mon, 29 Jun 2009 18:26:17 +0000

[...] socialized medicine (or radical free-market medicine) could be implemented on a state-by-state (or city-by-city) basis. Some experiments will work and be universally adopted, others will fail and be [...]

By: Alex J.

Alex J. — Wed, 10 Jun 2009 21:51:58 +0000

Conceivably to:
Treatments that aren’t subject to medicare/medicaid price limitations.
Treating people who wouldn’t have gotten treated before. (Say, cases w/ only small benefits.)
Treatments that didn’t exist before.

By: TheMoneyIllusion » That American entrepreneurial spirit

TheMoneyIllusion » That American entrepreneurial spirit — Wed, 10 Jun 2009 19:23:22 +0000

[...] Many on the left say we should adopt the European health care system. A good place to start would be federalism. The EU is roughly the size of the US, but has 27 members, each with their own health care system. If we are to copy Europe, the first thing to do is to delegate health care to the 50 states. No more Medicare and Medicaid. Any public health care should be fully funded at the state level, just as in Europe. My guess is that the good citizens of Houston and Dallas are not going to be enthusiastic about spending $15,000 per enrollee in McAllen, when the prestigious Mayo Clinic spends $6688 per enrollee. If those on the left aren’t enthused about this idea, then let’s not hear any more talk about copying Europe’s health care system. (After completeing this post I noticed that Robin Hanson had an even better idea.) [...]

By: Overcoming Bias : Remember The HMO Revolution

Overcoming Bias : Remember The HMO Revolution — Wed, 10 Jun 2009 10:00:35 +0000

[...] Arnold Kling suggested making the public plan a high-deductible catastrophic plan, and I suggested making medicine municipal. But Obama’s main hope is apparently none of these; it instead [...]

By: Kenny Evitt

Kenny Evitt — Sat, 06 Jun 2009 18:42:59 +0000

Robin – your blog isn’t the venue to determine the political palatableness of a reasonable sideways policy-tug.
Josh – yes, yes, your criticism and your proposals are all well and good, but they’re as a improbable as Robin’s innocuous suggestion. And just because something is illegal, doesn’t mean it doesn’t frequently occur, more so for illegals acts that are hard to identify and lightly punished.

By: Josh

Josh — Sat, 06 Jun 2009 16:27:06 +0000

Note that I said “compensation for individual physician services diminishes every year…”

And yet the price of medicine is going up. Is it new technology? an aging population? drugs? Maybe we’re not spending enough on services. I happen to think primary care is especially neglected. But something has to give, since we can’t spend 120% of GDP on health care.

By: retired urologist

retired urologist — Fri, 05 Jun 2009 22:45:53 +0000

@Josh:

Note that I said “compensation for individual physician services diminishes every year…”. I’m referring to the government-mediated agencies, Medicare and Medicaid, and their price codes for specific services. For example, I was reimbursed $2600 in 1979 for a certain surgical procedure that I performed, in 1979 dollars. When I retired in 2005, I was being reimbursed $700 for the same procedure, this time in devalued 2005 dollars. The difference in purchasing power is about 8-fold. Note that I could not collect any more than this Medicare allowance to make up the difference, even if the patient volunteered. As Casey Stengel often said: “You can look it up.”

By: Josh

Josh — Fri, 05 Jun 2009 22:32:34 +0000

Compensation for individual physician services diminishes every year and with each “reform”, perhaps a factor encouraging unnecessary interventions . . . healthcare costs are out of control . . .

I keep hearing stuff like this. Where is all that money going?

By: Josh

Josh — Fri, 05 Jun 2009 22:30:05 +0000

Employers can and do consider employee health when hiring, and deciding what wage to offer. They also can and do encourage unhealthy employees to leave.

Are you sure? I’m almost positive both of those actions are illegal. Anyway, a better response than the one I had earlier is that employer-based insurance isn’t ideal either.

Since governments are almost all geographically defined, I see no other way to decentralize via government than geographically.

You could pool people together randomly and then have them vote, via proxy if necessary, on a menu of policy choices. Or you could vote on a metric for well-being, propose a few different plans, and then set up a betting market to decide which plans were likely to lead to the highest well-being. The highest-ranking plans would be then administered for several of the random pools. There are lots of other ways to do it.