Recycling is not enough

In this corner of the world recycling is almost universal.  Plastics, glass, metals, compost and drink containers are separated from the rest of the garbage.  Some people also take their own shopping bags to the supermarket.  The exceptions are that we have not mastered the technology of recycling energy and most of us continue to drive a lot

Unfortunately we are still experiencing environmental degradation, inflation and unemployment.  Recycling is not enough.  Its main function is to allow us to feel we are doing something. It allows us to ignore the real issues –  population levels and values.

I believe the most important way in to protect the environment is to reduce the number of people trying to live on this planet.  There are just too many people and I do not like the idea of saying some people should not have the same standard of living as others.  Who is to decide who gets shorted?

I also recognize it is a near impossibility as we cannot tell people not to have sex and not to have children.  What are the consequences of not taking action to reduce the population?  When the Europeans came to North America they brought with them some new diseases and close to 90 per cent of the native population died.  I understand there is some archaeological evidence that there was a similar population reduction in the Mediterranean some millenia ago.  If these precedents hold for us, then there is likely to be one hell of a stench.

We also need to get over our fear of death as so much energy and resources go into prolonging life.  Quite a few years ago The Economist reported that 80 per cent of health care spending is in the last six months of life.  I do not want to go into the 80 per cent and I hope that when my time comes I and those close to me will be able to accept it gracefully.

The other big challenge to protect  the environment deals with values many of which are a part of our committment to economic growth.

According to anthropologist James Suzman who recently published the book Affluence without Abundance, the most successful and long-lasting civilization was that of the Bushmen of the Kalahari desert.  These hunters and gatherers “worked” only ten to 15 hours a week.  As they relocated up to ten times a year they had little interest in material things and their society had high equality.  We cannot all go back to being hunters and gathers but we can choose some of their values and apply them to our daily lives.

If we really want to protect the environment then we should have fewer children, live in place, live a healthy lifestyle, have fewer and smaller toys, drive less, go easy on the travel and work as little as possible.  Recycling may make us feel we are doing something but it is not enough.

 

 

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Health care – a complex issue

The provision of health care in contemporary society is almost as complex as the human body.  As the economy continues its decline health care will probably become an even more emotional and difficult issue.

There are three things that make health care complicated.  The consequences of poor health are generally pain and discomfort, a lot of us expect the government to take responsibility for our well-being and there are lots of other claims on scarce resources..

We all know that eventually we are going to die, but that does not stop most of us from trying to prolong life as much as possible, even if it means living in pain or as vegetables.   Some years ago The Economist stated in an article that 80 per cent of health care spending is in the last six months of life.  If this was true, if it is still true, then there is a lot of potential to reduce health care spending without sacrificing much human enjoyment of life.  But how is one to make the decisions to terminate health care. One has to note doctor assisted suicide is becoming more prevalent.

Medical  care is ideal for insurance although who should run it is open for debate.  We never know when we may face a medical crisis which could bankrupt us.  Sharing the risk makes a lot of sense.  A problem with most insurance schemes is some people have higher risks than others.  We all have to cope with the stresses of living and sometime the coping mechanisms are detrimental to our health and increase the risk we will need medical attention.  To what extent should we be responsible for other people’s lifestyle issues?  There may be no satisfactory answer to that question.  Maybe insurance should be for people with equal risks.  For example people who smoke could be in one insurance pool.  That sounds like a can of worms.

Some people believe governments are better at providing service than private businesses as they do not have the profit motive.  I disagree because there are no profits when one has a truly competitive market and because people in government have lots of other interests which override the interests of their customers – like staying in power.  I believe the best way for health care would be private coverage with lots of competition.  Governments can ensure everyone is covered by making it mandatory.

Health care is further complicated as it involves the allocation of resources.  Most of us make a variety of demands upon the resources available to us.  As well as health care we want education,  housing, defense, environmental protection, vacations, libraries, entertainment and cultural activities.  All of these compete for resources with help of powerful lobby/marketing groups.  As a lot of us expect government to help with some of these, governments have difficult decisions to make.  This writer would prefer most of these to be provided via competitive markets so that most of the decisions could be made by individuals.  A guaranteed income scheme would ensure everyone has the opportunity for the same standard of living as most other people.

Health care is a highly emotional issue which touches on human existence.  This writer tries to live a balanced life – some things which are good for my health and some things which are less good.  When my turn comes I hope I will be able to accept it gratefully.

The difficulties of free market health care

A free market in health care as called for in this video from the Mises Institute would be great, however there are three things that make it difficult:  health care is based largely on crises, competition in the industry is already very restricted and a lot of purchasing decisions are made in highly emotional situations.

Here is a transcription of the last sentence which is the main point.

 

“If we would just allow the free market to work, if we could eliminate the third-party payer system, the government subsidies on the expenditure side that drive prices up there’s no reason why a truly free market in health care goods and services couldn’t be just as effective in the U.S. as the market for computers, the market for software, the market for automobiles or the market for anything else.”

 

One of the things which distinguishes health care from computers, software or automobiles is that health care is largely based on  crises.  Generally most of us seek health care services for an emergency.  We go to a doctor because he/she has specialized knowledge that will help us out of the crisis.  This of course gives the people in the industry a great deal of power over us and creates potential for exploitation.

We go to a doctor for the specialized knowledge but we also go because doctors have a legal license to prescribe the magic pills that sometimes cure us or limit the symptoms of our illness.  To me a free market requires perfect competition   One of the ways the health care industry uses its power to exploit is to get governments to pass legislation which restricts competition.  Governments restrict competition through licensing, copyright and patents all of which are very  much a part of the health care industry.

The third factor which makes the health care industry different from  others is the deep emotions involved with injuries, pain and end of life.  When we purchase health care we are often experiencing deep emotions.  Once again this creates potential for exploitation.

So, how do we deal with the health care industry and how do we ensure everyone has proper access.

If we  were all perfect people we would reduce the demand for health care by living a healthy lifestyle.  We would also all manage our finances so that we always had funds available for emergencies.

As we are not all perfect then insurance, a third-party payer,  becomes an option to consider.  But most of us think and act mostly for the short-term and insurance is expensive and for the long-term.  For me this leaves a dilemma.  I don’t like the government saying we have to have to purchase insurance but neither do I like to see people suffering although I believe ultimately most of us have to take responsibility for our actions.

The man from the Mises Institute says “if we were to allow the free market to work”.  To try this would put us into a power struggle with health care practitioners who benefit from a lack of competition.  In a crisis situation where help requires specialized knowledge, the customer is not always right.

If we do want to take on these guys, then one approach would be to challenge the licensing.  I rather like Milton Friedman’s suggestion of certification rather than licensing.  Certification could be by different agencies and with different standards.  It would be up to customers to check the certification of the people with whom they deal.

In conclusion, it is not clear that a free market in health care is even possible let alone could it be as effective as the markets for computers, software, automobiles or anything else.  Sometimes there are no satisfactory answers.

High pay packages and restricted competition

The Economist appears to be defending high pay packages for company bosses in this article about the current focus of criticism.  The argument is that $52 million is justified by performance but one has to ask if this performance is based on the skills of the chief executive and if so what skills.

The general rule is that firms make profits by getting governments to pass legislation which restricts competition.shokunin_businessman

I don’t know much about the health care industry (the firm is McKesson, a big American wholesaler of drugs and other health-care supplies) but this industry involves a lot of emotions in that many people will use a lot of purchasing power in the hope of living an extra two years – possibly in a nursing home.  It is also an industry that depends upon patents for its profits.

It is not clear to me that this firm is making huge profits because of the skills of its boss.  Maybe the smartest thing this guy did was to get into the health care industry.

I am also wondering about the ethics and morality of a firm (or industry) that uses patents to exploit people’s emotions to make excessive profits.  But what the heck, some of the points in this post probably apply to a lot of other industries.

Health care greed

This post was inspired by a rather long article on why health care in the United States is so expensive.

As I read the first section I was thinking that when it comes to greed some health care people make Wall Street bankers look like amateurs.  By my values the bankers are higher on the ethical ladder than some medical people because the bankers are conning people who are just as greedy.  Medical people are exploiting people when they are sick and at their most vulnerable.

metalmarious_Medicine_and_a_StethoscopeOne of the more interesting university courses I took was sociology of work in which the professor talked about the professional encounter.  We go to a professional when we are in a crisis situation and because the professional has specialized knowledge which can be used to get us out of the crisis.

This gives the professional a great deal of power over us and according to the article it appears some in the he medical profession take full advantage of it.

How do we protect ourselves from medical exploitation?  Normally I would say increase competition.  But one probably doesn’t want to take time to compare prices when having a heart attack.

 

To some extent we can choose a family doctor.  More competition would make this easier.  We might get a little more competition if health people were to be certified by associations rather than licensed by governments in that associations could certify more practitioners and more different types of practitioner.

Maybe the best way to protect ourselves is to live a healthy lifestyle – exercise, eat mostly healthy foods and practice defensive driving.  Even so it is hard to imagine anyone getting through life without interacting with the medical profession.

Criteria for a health care plan

 

With health care likely to become a big issue in the U.S. election and an issue in many other countries here are three points against which I would want included in   a health care plan

First I believe we should have a collective responsibility to ensure all citizens have the opportunity to experience the same standard of living as all other citizens.  That includes health care

The second is that we should be able to make our own lifestyle decisions. Most if not all of us do and eat things which are long-term detrimental to our health and all of us have to take the consequences of those decisions.

The third is that quite a few years ago The Economist reported that 80 per cent of health care spending is in the last six months of life.  This should not be included in our collective responsibility although if a person or family has to resources and wants to go there they should be allowed.

Some years ago there was a story that the Chinese paid their doctors so long as they were healthy.  When they got sick the treatment started and the payments ended. Wouldn’t it be interesting if this concept could be incorporated into a health care plan.

 

If you liked this post your are invited to comment, press the like button and/or click  one of the share buttons. If you disagree you are invited to say why in a comment.  While I like the idea of sharing this platform, my personality is such that I don’t reply to many comments.

The power of professionals

This week’s The Economist has two articles on medicine and doctors in China which prompted the following thoughts.

One of the more fascinating courses I took in university was on the sociology of work where the professor spent some time talking about what makes a professional.

We go to a professional when we are in a crisis and the professional has specialized knowledge which can help us.

This gives professionals a great deal of power over us and it encourages them to let us think they know more than they do.

It also means some of them are able to take advantage of us and it appears this applies to doctors in lots of countries.

The way for us to deal with this is to try to live a reasonable lifestyle (exercise and good diet) and when our turn comes, try to accept it gracefully.

 

If you liked this post your are invited to comment, press the like button and/or click  one of the share buttons. If you disagree you are invited to say why in a comment.  While I like the idea of sharing this platform, my personality is such that I don’t reply to many comments.

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