Free Health Care vs Free Food and Water

[c9]

Paul Wells raises a simple question that I don't have a good answer for: if we consider food and water and health care all essential to life, why is there no government monopoly over food and water, but there is over health care?

I strongly support the idea of government-paid-for and you-can't-buy-better health care, but I'm very interested in hearing arguments that make me rethink my position. Mostly, I'm concerned that:

• Groups of people screw stuff up (in government we call this bureaucracy and red tape, but it exists in business too) but in government the overall goal is different than in a business (very roughly: "help" instead of "profit").
  
• A business is legally obligated to make money for shareholders, while governments don't have that restriction. This is not a bug, it's a feature.
• A so-called two-tier system (where the rich folk can buy faster care) would cause the better medical professionals to go where the money is, and then the care would worsen in quality and speed for the rest of the population.

So anyway: does this mean that I should support socialized food and water in addition to medicine? I don't know. But it's interesting to think about.

I haven't seen SiCKO yet, but hope to soon. I'm not really the target audience though.

Comments

[canuckotter.livejournal.com]

I'm sure Joel's roommates would be delighted to argue with you on this topic. :-)

Personally... I'm divided. Free, public health care is a great idea, but it costs a TON of money. Money doesn't grow on trees, and we've got a hundred thousand other things that we could be doing with that money -- including other things that are strictly for the public good, such as better-funded agricultural research, alternative fuel production, remotely-intelligent public transit, and so on. And considering how badly the public health care system fails when you start pulling money out of it for all those other things, it makes me a little cautious about just saying "No, only free health care is allowed!"

I'm pretty sure I've heard that there are some European countries (or possibly Australia?) that have public/private health care partnerships that reduce the public cost and actually improve the quality of service all around, even for strictly public health care. But since I don't remember where exactly I heard that or what country(ies) were being talked about, it probably doesn't mean much.

[c9.livejournal.com]

The USA is basically the last western democracy to not have some form of universal health care. But every country does it differently, and there are lots of pros and cons.

I'm quite open to the idea of private clinics hospitals in which the government pays for the services, but I don't know enough about how it all works to really judge proposals unfortunately.

It's interesting that you say "other things that are strictly for the public good". Is universal health care not for the public good? I do get that you can't start ranking all this stuff or you'll go nuts. :)

[erinrogo.livejournal.com]

Dude,

The government does have a monopoly over water. All navigable waterways are owned by the federal government, the rest are provincial, and the provincial government is in charge of water treatment plants, the pipe system that gets it to your home, the sewers, etc. The hydro companies that you pay are heavily regulated, if they're even completely private?

In terms of food, it's also a very heavily regulated and subsidized industry. Without government intervention food would be far more expensive - in fact, Canada has nearly the lowest food prices in the world compared to average income. So food isn't exactly a monopoly, but it's not run on a pure business model either. Hence the extreme anger of most third world governments whose economies have been redesigned to export food to us while North American and European governments continue to be protectionist. Of course, I'd like to see even more food localism rather than greater trade openness, but that will require that subsidies shift towards small farmers who are growing food for human consumption rather than commodities and animal feed.

[skeezix1000.livejournal.com]

In typical fashion, Wells has oversimplified it. Yes, we need all three. But he's comparing apples to oranges, so to speak. The reality is that major health problems can result in health bills that few of us would be able to afford. Think of the thousands and thousands of dollars it costs to treat most serious ailments. A weekly grocery bill does not compare. For some Canadians, it might be a struggle to pay for groceries (and, frankly, we should as a society make sure everyone, esp. children, is properly fed), but food does come in a range of prices and generally people can afford to buy it. And regardless of what difficulties some people might have coming up with cash to buy food, it just isn't comparable to the amount of money they would need to ensure decent health care for themselves and their families. Similarly, clean and safe water is actually provided by the state at a ridiculously low rate (given the infrastructure necessary to bring it to our taps), even though we have the option to waste our money on bottled water.

[canuckotter.livejournal.com]

For the last bit... I was comparing those options with things like tax cuts, or sports team subsidies, or expanded highways, or more military spending, or other things that people have asked the government to spend money on that are more of a benefit to large groups of individuals rather than society as a whole.

[sisyphus238.livejournal.com]

Who pays for the fire department, or the police?
It's a point made in the movie that we don't question those public services but when it comes to universal health care, it's a different ball of wax. Since you're Canadian, it's a completely other ball of wax as well. The occupied territory to your south could learn something from your more, in my opinion, civilized country.

Wells here

[(Anonymous)]

Sorry I can't be bothered logging in. Anyway: 1. Thanks for noticing and engaging the argument. 2. This guy, who I don't know, offers a fairly robust rebuttal of my position: http://paleshadow.livejournal.com/256611.html

3. When I wrote "American-style," I was being a bit provocative, although it seems to have worked, and therefore to have been worth it. Actually, of course US health care as such is probably even dumber than ours. But it's a great big world out there. The number of countries that FORBID market access to basic health care is vanishingly small (Canada), as is the number of countries that allow ONLY market access to basic care (USA). Even that is an oversimplification, of course, and I'd hate to piss Skeezix off any worse than I have. But my point, and I do have one, is this: nearly every industrialized country offers a core of state-sponsored care to make sure illness doesn't spiral anyone into the crapper, AND a supplementary market-determined level of extra care. In the latter case, it's almost never cash out of pocket that pays for extra care, it's insurance. Private insurance, company insurance, etc. When I was a student in France I had basic care and I paid, as almost every student in France does, a modest premium package for very substantial supplementary care. That's so obvious it genuinely baffles me that it's banned in Canada for most services.

Incidentally, the idea that market alternatives will skim off the best practitioners and leave the dross to the masses is also obviously true. In Canada, we call this preserve of the finest practitioners whom only the top dollar can buy by a name: Vermont. Ever noticed all the Canadian doctors there? If you close your eyes, maybe they'll go away.

[c9.livejournal.com]

Ahh, gotcha.

[c9.livejournal.com]

Dude,

I agree. I just feel like the sale of our water and food (excepting agri subsidies) is soooo close to being corporate-controlled, despite the various pseudo-controls we have now. Whereas the hospitals will take a bit more effort to get past the Canadian "no privatization" panic.

Agreed on food too -- I'd never thought of protectionism as an eco issue, but it actually is.

Re: Wells here

[skeezix1000.livejournal.com]

Hee.

But still, can't get my mind around "supplementary market-determined level of extra care". Yes, the Rosedale matron already can get better health care than the St. Jamestown mother, but why as a society should we be facilitating that? I'm hardly a socialist, BTW.

[c9.livejournal.com]

True, but one way to look at it is through the eyes of the poorest Canadian: it doesn't matter that you can buy a big mac for cheap, or get groceries for cheap, when the food is very unhealthy and still costs money and is still required for life. I do get what you're saying though.

[c9.livejournal.com]

Very true -- but another way to think about this: not *everyone* pays for fire/police, only the rich do. (here I'm defining rich as "not dirt poor" for simplicity) Why do they do it? Maybe because crime and fires hurt their property values?

It's a very cynical argument, but it fits the situation. If someone is poor and can't get health care, it doesn't affect my health care. If someone's house burns down, it could spread to my house.

Re: Wells here

[c9.livejournal.com]

Hi there Paul,

1. Happy to oblige. :)
2. Thanks for the link. It does put the pieces together well.
3. I was unaware of how polite and bilingual Vermont was! Perhaps I shall visit. I don't have a magic solution for this, but maybe it's so small that the system absorbs the impact without (much) pain, whereas creating a nationwide structure for the same stuff to happen would be too much.

I'm often jealous of columnists -- they're so confident in their opinions (which I can be too) but they have some facts to back them up. If only I had a Lexis-Nexis account or something. :)

[sisyphus238.livejournal.com]

I think there's a moral issue that isn't covered by utilitarian arguments. The thing is that in the US, we pay taxes that pay for fire departments, police, etc. and on top of that, if we have health insurance, we pay ever increasing premiums on policies that are intended to line the pockets of the insurance companies, not necessarily to cover our costs in the event of an emergency - and 40 million of us don't even have health insurance. I recently lost my job and with it what meager insurance I did have. I'm lucky because I'm healthy and take care of myself but should I have an accident I'm up the creek. Then there's the cost of drugs, the ads for which we are constantly bombarded, which are beyond the means of many older Americans who then are reduced to choosing between not taking the prescribed amount or cutting expenses in some other way to afford them. It's a racket. When bus loads of retirees head up to Canada to buy cheaper drugs it must mean something.

[sisyphus238.livejournal.com]

Happy Birthday by the way!

[c9.livejournal.com]

Thanks!