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Wednesday, February 21, 2007
Thomas Sowell :: Townhall.com Columnist
Priceless Politics: Part II
by Thomas Sowell
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Will the Dems' health care Christmas Present to America be an improvement or detriment to our health care system?


With all the advances in sophisticated analysis by professional economists, very little of even the basic principles of economics has gotten down to the average citizen and voter.

Many, if not most, of the economic policies advocated by politicians today would never pass muster if the average voter understood as much economics as an economist like Alfred Marshall understood 100 years ago or David Ricardo 200 years ago.

Nothing is more basic in economics than prices -- and yet the role of prices is repeatedly ignored or even misrepresented by politicians and the media.

What do prices do?

Prices impose the most effective kind of rationing -- self-rationing. Why is rationing necessary? Because what everybody wants always adds up to more than there is.

It doesn't matter whether you are talking about a capitalist economy, a socialist economy, a feudal economy or whatever. Resources are limited but desires are not. That is the basic and defining problem of economics.

Prices force you to limit your claims on what other people have produced to the value of what you have produced for other people. Prices force you to limit how much of product A you buy because you need to keep some money to buy product B.

While prices convey these limitations, they do not cause them. No economy -- capitalist, socialist, feudal or whatever -- can keep consuming more than it produces. Producing more of product A means using up resources needed to produce product B.

Simple and obvious as all this may seem, politicians blithely ignore it when they promise to make the prices of housing or health care or other things "reasonable" or "affordable."

Nothing is easier for any government than to impose price controls. Governments have been doing that for thousands of years. What governments cannot control are the underlying realities expressed through prices.

What does the history of thousands of years of price controls tell us?

The first thing undermined or destroyed is self-rationing. When you pay the full price of going to a doctor, you go there when you have a broken leg but not when you have the sniffles or a minor skin rash. When the government makes health care "affordable," you go there for sniffles and a minor skin rash.

The underlying reality has not changed, however. The doctor's time is still limited, and the time that you take up with your sniffles or skin rash is time that somebody else with a broken leg -- or perhaps cancer -- has to wait to get an appointment.

Government-run health care systems in countries around the world have longer waits -- sometimes months -- to get medical attention. In other words, the rationing goes on, but more haphazardly, because prices do not force people to ration themselves according to the seriousness of their problem.

It is the same story when housing prices are controlled by government. Rent control has allowed some people to take up more housing space than they would if they had to pay the full price that reflects other people's demand for housing.

The net result, whether in New York or San Francisco or elsewhere, is a lot of apartments with just one person living in each, and lots of families who cannot find a vacant place to move into. Housing shortages have resulted from rent control in cities around the world.

Housing shortages mean that some people are forced to live far from their jobs and commute, and some become homeless on the street. Homelessness tends to be greater in cities with rent control -- New York and San Francisco again being classic examples.

Economists have long been saying that there is no free lunch but politicians get elected by promising free lunches. Controlling prices creates the illusion of free lunches.

Prices not only ration existing supplies, they also determine how many new supplies will be forthcoming. When a new pharmaceutical drug costs an average of $800 million to develop, there is no point talking about "affordable" medications.

Either the $800 million is going to be paid or the supply of new drugs will dry up. Controlling prices does not change that.

This is part two of a three part series. To read "Priceless Politics" click here, for "Priceless Politics: Part III" click here.

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About The Author
Thomas Sowell is a senior fellow at the Hoover Institute and author of The Housing Boom and Bust.
 
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Sorry for the double post...
"How about a horror story from France about a bunch of old people dying in a hospital ward in the heat of summer because that hospital ward did not have air conditioning?" -- France has its problems, but they also have "horror stories" about longer life spans, greater satisfaction levels, lower death rates for toddlers, young people, etc.... but that's actually the only horror story (rationing-related or otherwise) that I've heard of outside of the U.K. or Canada. Once again, however, France only spends around 10% of its GDP on healthcare, while the U.S. spends around 15% (and growing, I'm pretty sure).

"And you have not addressed the theoretical underpinnings of Sowell's argument. Address those first, before assaulting us with potentially irrelevant anecdotal evidence." --

Theoretical underpinnings --

I actually partially agree with them. If you made more people pay for all of their medical care then people would obviously be more likely to go to the doctor less, demand would decrease and average prices might decline somewhat. But there's more to it than that. The danger in danger in leaving people's healthcare subject to the profit motive is that the poor, unemployed and sickly NEVER provide a profitable market for high-quality medical care. Taking the government out of the process could lower prices for rich people, at least theoretically, but they could then increase when as a result more of those poor and lower-middle class people started getting sick since they decided to "ration their own healthcare to deal with costs" and having to have operations and treatments far more expensive than the regular visits that could have prevented them. The doctors are then faced with the option to either deny that person care (inhumane) or subsidize it somehow, raising prices for everyone else.

To stbmom
"There isn't a person in the United States that doesn't have access to healthcare." -- Emergency care? True. But not always preventative care, or potentially life saving operations, drugs, and surgeries that are non-emergency and beyond their means. The ones hurt the most are the lower-middle class guys (and poor people without kids) just well-off enough to not qualify for Medicaid but not well-off enough to afford quality medical care.

"Canada and the U.K. do not automatically have better healthcare than in the U.S. - in fact the U.S. often has people from those countries coming for specific treatments." -- Although I doubt many poor people are scrambling to get here to use our healthcare system.

"I would much rather pay for my own healthcare and have the option of shopping around for the best doctor - even if they cost more, than to have someone else pay for it and I might possibly be stuck with a moron." -- I believe most countries with universal health coverage give people the option to pay for their own care.

To stbmom
"There isn't a person in the United States that doesn't have access to healthcare." -- Emergency care? True. But not always preventative care, or potentially life saving operations, drugs, and surgeries that are non-emergency and beyond their means. The ones hurt the most are the lower-middle class guys (and poor people without kids) just well-off enough to not qualify for Medicaid but not well-off enough to afford quality medical care.

"Canada and the U.K. do not automatically have better healthcare than in the U.S. - in fact the U.S. often has people from those countries coming for specific treatments." -- Although I doubt many poor people are scrambling to get here to use our healthcare system.

"I would much rather pay for my own healthcare and have the option of shopping around for the best doctor - even if they cost more, than to have someone else pay for it and I might possibly be stuck with a moron." -- I believe most countries with universal health coverage give people the option to pay for their own care.

For the record
There isn't a person in the United States that doesn't have access to healthcare. Well, unless they live somewhere that doesn't have a hospital, clinic, or other facility within 200 miles - probably quite rare.
So please, stop saying that because you have worker subsidised healthcare your country is somehow better than the U.S. Not everyone in the U.S. has health covered, free, or low cost healthcare - but everyone still has access.
Canada and the U.K. do not automatically have better healthcare than in the U.S. - in fact the U.S. often has people from those countries coming for specific treatments. Plus, healthcare is ONLY as good as the clinician providing it. I have had good doctors and bad doctors and my healthcare was MUCH better under a good doctor. Are you trying to say all doctors are good in the U.K or Canada?
That is the problem with the facade of universal healthcare - it doesn't matter if everyone has equal access to healthcare, you still have the luck of the draw as far as the actual clinician. I would much rather pay for my own healthcare and have the option of shopping around for the best doctor - even if they cost more, than to have someone else pay for it and I might possibly be stuck with a moron.

Not quite Tom....
Regarding you comments regarding health care, have you ever lived in a country with National Health? Have you ever used it? Your asumptions are way off the mark.

Because these systems do provide preventative care to people that need it, you have less sick people using the medical system and they require less care, not more. In addition, these systems do offer a tiered system that gives those who can afford a supplimentary insurance policy more urgent care, and those who need it but can't afford it the care they require rather than sweeping them under the rug until they show up at the emergency room and cost the taxpayers ten times more. If you want more empirical data, just ask Arnold. He's run the numbers and he gets it.

I should also point out that the "underlying reality" of your argument is also specious to the extent that someone with cancer or a broken leg would not see the same doctor as a person with the sniffles or a skin rash. However, that same person with the sniffles can get treatment at a walk-in urgent care facility/pharmacy before it turns into Pnumonia and requires more extensive and expensive treatment.

To be sure, you can certainly improve the health systems in countries like Canada and the U.K., but the fact of the matter is that their citizens enjoy better health care and ultimately a better quality of life as a result. In this, as in many other areas of American life and culture, we are falling way behind.

As economists, you and I can live in the fantasy world of economic theory, but we both know that is why an Economics degree is a BA and not a BS. Before you spout out these theories as actionable facts, you should do some homework and talk to people who live in and use these other economic systems that you reject. You may be surprised at what you find....

As an aside, the fact that people can access health care whenever they want does not mean that they do. I don't know many people who enjoy visiting the doctor and I never noticed an abundance of the barely sick at the neighborhood urgent care facility or the local hospital in Canada....and I never had to wait any longer for an appointment or walk-in care than I do now in the U.S.



Sowell always forget Target markets
Mr. Sowell always forget about target markets when he talk about price. Sometimes price is not an indicator of scarcity. Sometimes a product is control by a producer because the producer is only interested in selling to a targeted market. For example, Bentley could make cheaper cars or they could make the same car for less just through automation but they choose not to because they only want to sell to people willing to pay $300,000 for a car. It's the same theory behind why the movie theaters charge so much for food. It because they only want to sell to people who are willing to pay a preimum to eat while watching a movie. If they were interested in selling food to everybody they would lower the price and they would be call diners not movie theaters.

Healthcare/Drug Companies do the same thing. They create some drug or going into a speciality to sell to a target market. They use their marketing power to convince everybody they need their service. For example, Lipitor or other cholesterol medicine, they are lifestyle drugs 50% of the people taking the drug probably don't need to take it. These drug use to be for people who had had a heart attacks then they became preventive drugs. Do you notice how they say 120/80 is now border line high blood pressure when it was normal forever. That's to sell more high blood pressure medicine.

All of healthcare is gear towards targeted markets which is why the cost doesn't come down.
In most business sector when a better products comes along the other products fade away. X-Rays are still around even though we have MIR, CAT Scans, and more advance scanning devices.

The government can play a role by forcing best practices and reduce the patent life on drugs to 15 years. I also think the government should subsized the education of medical professionals. I like the idea of Medical Pell Grants.

Cowboy Joe
"Sowell started this complaining about Municipal Golf Courses, from which you seem to be arguing about a Universal Right to Air Conditioning."

No, since the argument concerns the superior ability of a Free Market to allocate a scarce resource, and the scarce resource in question is not just Health Care but QUALITY Health Care, my point stands. "Universal Rights", so-called, are irrelevant.

Better Schools
Sounds like there are some better schools out there than I went to. My political science class in high school didn't even cover economics.

Just as a side note, the political science major at the local University doesn't require any classes on the constitution, founding of America, OR economics. But they do require classes on international relations and the UN.

What's wrong with that picture?

Fergus Mac Lennan
Sowell started this complaining about Municipal Golf Courses, from which you seem to be arguing about a Universal Right to Air Conditioning.

Your theoretical underpinnings seem to have lost their pings.

totalfrickengenius
How about a horror story from France about a bunch of old people dying in a hospital ward in the heat of summer because that hospital ward did not have air conditioning?

Regardless of whether or not your assertions about "horror stories about rationing" are correct, those aren't the ONLY horror stories.

And you have not addressed the theoretical underpinnings of Sowell's argument. Address those first, before assaulting us with potentially irrelevant anecdotal evidence.

Golf, etc.
Really???


How did the Germans build V-2s?

Did the Glorious Leader in North Korea build the Bomb in his garage?

Slave labor with the Nazis and the starvation of a nation with the Great Leader.

Why don't we offer The Great Leader a leveraged buyout. Perhaps we already have.

Sowell ignored another aspect
of the market...

that the "economic value" someone produces for society is largely determined by their place in that society. The poor always have access to less than the rich. When it comes to luxury items, plastic surgery, etc., sure, that's fine. But health care? Why must someone's access to healthcare be determined entirely by their "value to the economy? (aka their ability and willingness to play the "capitalist game")... how does that constitute a just society, when people are denied access to life-saving but non-emergency preventative care and surgeries simply because they don't have the money to pay for it? The "all those other countries with universal health care have horrible waiting lists" line is just "America has to be best at everything" dogma. The ONLY horror stories you ever hear about rationing and waiting lists come from two countries: Canada and the U.K. Those problems are most likely due to underfunding (they pay far less per-capita for healthcare than we do), which leads to doctor/supply shortages.

Except every other country in the industrialized world besides the U.S. has some version of universal health care or insurance. And you never hear horror stories about waiting lists from these countries because for the most part they don't exist, despite the fact that ALL of them spend a lower portion of their countries' GDP on healthcare than we do.

Cowby again
The government can force a company to sell polio and flu vaccines, as well as antibiotics at a particular price......


They can't make the company *produce* a product if the allowed price is uneconomical.

Cowby
The vaccine-maker needs to be paid for the vaccine, or the vaccine isn't made. And that shortage benefits nobody.


Golf, Doctors,and Rent Control
Just like a Broken Clock, maybe Marx might have been right,twice a day, or at least half right.

"To each according to his NEEDS." Not all poor
created their own fates. Many did, but not all.
charity is a Christian and a Human value.


Golf, Doctors and Rent Control
I have the highest regard for Dr. Sowell and have read , and re-read his books. Enlightened self interest, and the free market, usually are the most appropriate way to "let the good times roll." This is not always the case, particularly in matters concerning health and public safety.

Two examples: Penicillin and Polio Vaccine,and perhaps a third, Flu Vaccines. Should these medical advances been distributed based on the free market model or distributed to those at most risk?








Economics is required
I don't think you can graduate from high school in Alaska without taking economics. At least, that was one of the graduation requirements a couple of years ago and I haven't heard that it's been dropped. Government (what in college was called Political Science) is also required for graduation.

Economics in High School
Libertybob,

Both my son, who is now a junior in college, and my middle daughter, who is now a senior in high school, took an economics class in high school. It wasn't fluff, either. But you're right... it's not generally offered in high school, to my knowledge. But it should be. A little more economics and a little less interior decorating and floral design would be a good thing.

Rent Control
We had rent control here in Toronto until a couple of years ago. At that time the few apartments there were had to be rented with "key money" (a bribe) to the Landlord. And they are seriously out of date -- no amenities, refrigerators you have to defrost, etc. not to mention the size of shoe boxes. It was economically unfeasible for anyone to build more apartment buildings -- especially since the taxes on apartment buildings are five times (FIVE TIMES) that imposed on private homes, so none were built.

Within a few months of the lifting of rent control, the vacancy rate zoomed upward, and now on my street alone, buildings that are too small and backward for welfare clients in the USA are offering flat screen TVs and other Goodies to entice people to move into them. My building is emptying out -- I'm going myself to a building built for Americans who retire up here. Meanwhile there remains a class of people who maintain that rent control should be put back "because those landords paid off the mortgates on their buildings YEARS AGO." Try to explain to them about taxes and maintenance and their eyes glaze over. Once you have paid for something, there's simply no more money going out, and that's that.

And by the way, when people in Toronto say "affordable" they mean "free." That is, someone else should pay for it.

Wise 41hr
What are you talking about? Teaching economics in high school? That is never offered...

...maybe that is part of the problem...

Muscat: moreover...
... your understanding of market economics is woefully lacking. No one - NO ONE - claims that a market is inherently moral; it is only as moral as the society which employs it, and its success tends to vary proportionately with that morality. Moral values such as property rights and honesty enhance the operation of a market economy, they do not run counter to it (Yes, "property rights" are a moral value: THOU SHALT NOT STEAL and THOU SHALT NOT COVET THY NEIGHBOR'S ____________ are morally null values without the idea of property rights).

On the other hand, the primary difference between standards of living in the Middle Ages (when large chunks of population starved to death or died from curable diseases) vs. Now (when those things happen much less frequently) are largely due to the efficient workings of the Market Economy.

Muscat
What exactly is your point? Beyond venting about the human penchant for dualism, and what seems to be an entirely symbolic love for the idea of a third party, can you name any *specific* policy ideas which Nader espouses that you agree with?

If not, you are only spouting so much hot air.

To reiterate: a price is a mechanism to ration scarce goods. Either provide some argument why that notion is fallacious, or agree with it and explain what better axis there is to the theoretical solutions than the Socialist vs. Free-Market axis.

But for god's sake, man, stop blathering!

Reality
In the Army everyone is needed to get the job done. Medical care for soldiers is free but soldiers do not line up en-masse to go to the clinic--First Sergeants and Platoon Sergeants control the work to be done and the soldiers to do it. A soldier had better be sick or he had better be at work--"no riding the sick slip". Dependents are like the rest of society--free medical care is a "carrier" of the disease known as hypochondria.

Naive muscat
Does anyone actually believe there's a real difference between R and D. No such luck.

Ralph Nader has done one good
thing. He caused Albore to lose in 2000.

I hope he runs again on 08. He is making those noises now.

Dr. Sowell, once again an excellent article. I expect that tomorrow there will be near to 300 comments with moonbat socialists trying to make 2+2 = 6 all over again and TH posters futily trying to educate them. There’s just something about trying to polish a piece of excrement.

Economics 101
This is how they should teach high school economics! I have admired Dr. Sowell's ability to boil a problem right down to its fundamental essence and explain it in a way that even I can understand. Which is saying a lot since I received my education in the public schools. This series is no exception. The key phrase, at least in my opinion, was this:
"Prices force you to limit your claims on what other people have produced to the value of what you have produced for other people."

It's a valuable principal that I've tried to instill in my kids. If you want it, work for it. How badly you want it is directly related to how hard you're willing to work for it.

Thanks, Dr. Sowell.

no real choices
Republican democrat.

Republican democrat.

Republican democrat.

Well, there are the two sides of one coin.

Where are the real alternatives?

The same drama is rehashed every four years, and we see the intense theatrics of the great debate, but when it all comes down to it, the state cast is chosen in advance, and new faces or actors need be a Repubican or Democrat, or they don't get to speak on stage.
Oh yes, they can stand out in front and wave signs in the rain, "As long as they don't block entrance into the theatre.

Would that George Wallace had left a viable third party option!
Thank Goodness Ralph Nader keeps the idea alive, if even a small flicker of light in the banal darkness of Mainstream Popularity Polls.

But I want. . .
The problem with Dr. Sowell is not that he's wrong, but that we want him to be wrong. One way or the other a scarce good is rationed. Prices are the most transpartent way of doing that rationing.


Too confident in the noble market place
While it would be great to believe in a moral and virtuous market place, I cannot endorse such optimism.
The Roman Catholic Church in the Middle Ages promoted another sort of economy, neither Socialist or Capitalist.
Without a strong Christian influence in Society, any external system or design you cook up will be ruined by the very folks in charge.
You can't fool mother human nature.
The high middle ages were a great phase in Western Christian Society with the ideas of guild unions and private property being developed.
The false dichotomy of Capitalism vs Socialism is up for a real challenge.


Supply Side
Dr. Sowell neglects to mention the other side of the equation--when consumers do not bear the price, there is nothing to stop the supplier from overcharging. How many hospitals would continue to charge $400 for aspirin if patients had to pay out of their own pockets?

buzzkat
Maybe Americans are economically literate enough because I looked for the al-Democrat Party and couldn’t fine it. Since you’ve heard of it but it’s gone today, it must have become extinct overnight.

Party of the Ignorant
I've said it before and I will keep on saying it. If Americans were economically literate, the al-Democrat Party would go extinct overnight.
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