Demand at Price = $0

These two articles were back to back in my feed reader this morning.  First, Joe Biden argues that medical procedures should be free if you feel you need one

“Everyone knows, everyone in this room knows that President Obama has increased the benefits available to people on Medicare by the action he took,” Biden said. “You are now able to go get a wellness exam, and guys, if you conclude you need a colonoscopy because of the feeling you had or you need a breast health examination, you don’t have to pay a co-pay for that.”

And then I got this from China

As part of its 8 day Golden Week celebration, China's central planners decided to do a good thing for the people and remove all tolls from expressways. That was the populist explanation. The fundamental one was that this act would somehow spur the economy. Alas, while the same people may have saved some transit money in the process, what they did not save was on transit times. As South China Morning Post reports, millions were promptly stuck in traffic jams as a result of the politburo's generosity. From SCMP: "A bid by authorities tostimulate the economy by suspending road tolls for the "golden week" holiday brought huge tailbacks across the mainland yesterday as almost 86 million travelers took to the roads. That's 13.3 per cent more than on the first day of the National Day holiday last year." And then the fun began.

"One traveller blogged that he could only move 200 metres in an hour on the Zhengzhou to Shijiazhuang expressway in Henan province. Others said the queue of cars on the Guangzhou to Shenzhen expressway was 40 kilometres long. All roads leading out of Guangdong were jammed, with cars moving at about a kilometre an hour in front of some toll gates. Provincial traffic-management authorities estimated traffic on expressways would increase by 40 to 80 per cent compared with the same period last year, the Shenzhen Special Zone Daily reported. The People's Daily reported dozens of accidents on 24 highways across the mainland, further aggravating the congestion."

Since the government still keeps hammering down doctor supply, through enforcement of tough licensing procedures and through price caps (that keep getting cut) on doctor visits, we should soon be seeing the equivalent of this highway traffic jam in medicine.  Which is why every socialized medicine country in the world has queues and why their citizens keep flying to the US for treatment.


  1. NL7:

    Notice Biden did not say this was a giveaway to people who cannot afford these procedures. So basically he wants the government or insurers to pay for something that middle class people vaguely want but aren't willing to pay for. Not even a co-pay. They would rather drink coffee and buy DVDs than bear the minimal brunt of their mild hypochondria, so young healthy taxpayers are stuck with higher premiums and/or higher taxes. That's how Biden gets reelected. Then we all pretend Democrats are the party of the young just because their racism, homophobia, and xenophobia are slightly less blatant than the GOP.

  2. Morven:

    Biden is, however, largely full of bullshit on that one, because you don't get procedures for free just for wanting them. There are limits, because full-on free health care buffet is impossible even for the richest country on earth.

    It's worth pointing out that in the US, most people really do have to deal with a queue as well, we just don't call it that. It's the insurance approval dance. A lot of health insurances will quite deliberately make it hard to get approval for expensive things. If you have to wait six months to get a procedure done because it takes that long to go back and forth until approval's granted, that's effectively rationing care as well. It's testing how badly you really need it.

    But then, the current American health-care system manages to be a horrid mess.

  3. LarryG:

    Biden was talking about screening which catches problems earlier and save money downstream.

    Universal healthcare is basic health care - and is not all you want or need but if you can afford more/better then get it.

    People in Sweden, Singapore, Australia, New Zealand all have UHC. How many of them fly to the US to get more/better?

    not too many.

    We need a little more truth here and a little less ideological propaganda.

  4. nehemiah:

    Actually LarryG, Singapore has a mandatory health savings account system (6% of earning required). People are the buyers of their own health services.

    Coyote's point on free screening is not whether it is a good or bad thing, but whether it will result in severe resource constraints. Will high risk people be impacted because they cannot get their screening procedure in a timely manner due to all the low risk folks taking advantage of the freebies. Although I'll admit that might not be the case with colon cancer screenings.

  5. Douglas:

    Let's presume that your premise is correct, Larry, and that such early screenings lead to longer lives. Doesn't that mean more demand on the system because I live longer? A smoker may die young of lung cancer, but once he's gone, he no longer needs any further medical services.

    Further, we're now seeing examples where screenings are actually costing us more than if we did nothing, not to mention the toll from the surgery itself: "Surgery for prostate cancer was no better in saving lives than observation over a 10-year period, according to one of the first rigorous studies to compare the two approaches in American men with early-stage disease.

  6. MingoV:

    "... the government still keeps hammering down doctor supply, through
    enforcement of tough licensing procedures and through price caps (that
    keep getting cut) on doctor visits..."

    The first part of the statement is incorrect. The federal government does not reduce the supply of physicians via licensing requirements. It has two other mechanisms for reducing supply. The first is through its financial support of medical schools. The schools got addicted to federal aid decades ago. Then, the federal government told schools how many medical students they could admit. If they went over their quota, their federal funding was drastically reduced. This kept medical school enrollment at about 16,000 for over twenty years despite a growing population, an aging population, and the ability to treat more diseases.

    The second federal government control point is medical residency training. Teaching hospitals receive funds for interns and residents via Medicare. Again, they became addicted to the funding. The federal government decided over twenty years ago (based on flawed studies) that there were too many specialists who were driving up the costs of medical care. The government then told teaching hospitals to reduce residency training slots for specialty fields and increase them for family practice, internal medicine, and obstetrics & gynecology. Because of the huge advances in medical sciences over the past few decades, medicine is more complex than ever. It is hard for the specialists to keep up with their fields. Generalists who want to provide more than just routine care for common conditions cannot possibly keep up. We need more specialists.

    Thus, the federal government created a situation where we have too few physicians and too few specialists. That's why waiting times for the latter can be months. Obama realized that ObamaCare will cause many physicians to retire or do something else. In 2010, for the first time, medical schools were allowed to increase class sizes. The enrollment for 2011 jumped to 18,000. That's too little, too late, because those students won't graduate until 2015 and won't finish their residency training until 2018 or later. ObamaCare will be fully activated in 2014, so we can expect long waits at physician offices.

  7. mesaeconoguy:

    Universal health care is neither universal, nor "care" - it does not result in better outcomes, and is not cheaper. You are incorrect if you believe otherwise.

    Larry, I reommend a full cranialectomy followed by full rectal shutoff, since you keep getting your head impacted deep in there.

  8. jimbeaux:

    I find it curious that Biden singled out men when he said "and guys, if you conclude you need a colonoscopy...". If you look at the listing of what preventative services are offered, you see listings for Adults, Women, and Children. That's right - men do not have their own category. No prostate screening, no testicular cancer screening... there are 16 services offered to adults and 22 offered to women, including some testing which obviously should be offered to men as well - but it isn't. Why do women to get free gonorrhea screening, and free AIDS screening - but not men? Men have a shorter lifespan, are more like to die of heart attacks, more likely to die of cancer, and are more likely to commit suicide. And yet we are only mentioned in the free services twice: Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked, and Aspirin use for men and women of certain ages. Check it out for yourself:

    ...and then sign the petition to stop sexism in the Affordable Health Care Act:

  9. Brotio:

    You need a new insurer. I have Blue Cross and have never had to do the approval dance, whether for colonoscopy, hernia surgery, or the medical tests and scans when diagnosed with high blood pressure. Methinks made some excellent points about queues in UHC countries recently over at Carpe Diem.