My reply here:
There is no such thing as “market failure”. That’s just a term for “outcome I don’t like”
maybe if government got out of the way we’d see these solutions. People are quite innovative and I’m sure solutions I can’t fathom would crop up.
But lets take one example I presume is meant here. Someone needs emergency care and has no insurance or means to pay. Well we already had a solution for that but government killed it. We used to have numerous charitable church run hospitals that would supply such care at no or little cost. But then government got involved with Medicaid and Medicare and started paying everyone so why do stuff for free? Now everyone expects a hand out expecting to be paid by government and the church run hospitals lost their reason to exist and went away (there are only a handful left now).
Government distorts the market and creates the very failures that are so often pointed to.
The fallacy here is believing that 51% of the populations deems policy x so important that they elect people to carry out policy x but absent government somehow those same 51% would just shrug their shoulders and do nothing? No. They would support anyone trying to achieve end they desire
And then a good exchange below fleshing out the details a bit:
Well you’ve got several scenarios mixed in here which are all quite dissimilar. If as you claim there is no market for some scenario how can that be a market failure? That’s like saying Christianity failed as a religion because it didn’t aid in maintaining societal cohesion in 12th century Mayan society. If something isn’t present how can its absence be blamed on it. Anyway.
To be clear, constrained or limited choices do not constitute “failure”. Just because options are limited doesn’t mean one is being “forced” into a choice. Force only applies if violence or the threat thereof is being employed to constrain ones choice (eg I choose to freely give my wallet to the mugger…my choice was constrained by the threat of violence so it’s not a real choice nor truly voluntary). But your example is no different than saying we are forced to work because Mother Nature threatens us with starvation if we don’t earn money to buy or grow our food. This fact of existence limits our choices in what we can do everyday of our lives. So if I break my leg and I end up in the hospital and my only option given there is amputation or death even though there actually does exist a better option at a different hospital two states over still doesn’t constitute failure. That’s just life. It’s no different then being in the wrong place at the wrong time…we don’t call that life failure. Sure it would be great if you could pull up an app on your phone that told you exactly where to go for the best care and you could teleport there in a second, but people who died before organ transplants existed weren’t sitting around discussing how the market had failed them because it had not invented a cure. Options in life are always constrained by the simple facts of our existence; who are parents are, where we live, where we go to school, who are neighbors are, what language(s) we speak etc. all of those factors can contribute to outcomes we deem positive or negative. Markets are no different because markets as a thing don’t exist…it’s just people doing stuff for other people. So going back to the hospital example and the broken leg, if you happen to end up in the best hospital in the country for that does that then “prove” markets work?
I think what you’re getting at is the classic “”information problem”. This is what the socialist believe, that a perfect market would be a socialist market because with perfect information the state could direct precisely the right amount of each good to produce just in time to satisfy all needs, and so all would be employed, with zero waste and maximum efficiency. And so anything that falls short of this utopian perfection is considered imperfect or a “failed” market. It’s an impossible standard as we are not omniscient beings, so perhaps it makes interfering intellectual fodder, but in the real world is of no real consequence.
its funny how markets are deemed to fail because one can come up with either real or hypothetical scenarios where some outcome was negative…yet such failures exist today under our state controlled markets and somehow that is never seen as a failure of state control. Indeed it just produces calls for more control. Indeed, if whipping the patient isn’t helping then surely the solution is to whip him even more.
If you end up a hospital where your only options are amputate or die, and there’s another hospital somewhere else that provides better options but you can’t get there in time… then yeah, that’s just life. No person making any decisions for you, no violence is being imposed. It’s no different than the fact that you have to work to eat.
But there is still, nevertheless, a choice to be made: to accept treatment and live, or to refuse treatment and die. Typically, accepting. Or, in perhaps a less sever case, to accept treatment and retain full function, or to refuse treatment and end up losing a limb or otherwise permanently disabled.
Accepting treatment typically involves incurring costs. Ergo, a rational actor may choose to refuse treatment, if they consider that the costs involved at the hospital they can get to are higher than the natural costs of refusing. And people do, in fact, do that with fairly high frequency in the real world.
So far, no problem. But now you have someone who comes into your hospital unconscious, or otherwise mentally incompetent. They cannotmake that choice. Right now, if such a person ends up in the ER down the street from my house, they are given whatever treatment the ER doc decides is necessary to preserve life & limb… and then they are sent an enormous bill for services they could not consent to, the payment of which is not always but can be enforced by state violence.
So, how would a determined libertarian solve this? Do you simply nottreat such patients, say “that’s just life” and let them die so as not to infringe on their freedom of choice and bodily integrity? Do you treat them as a charitable act recognizing that they cannot be contractually bound to actually pay you for those services? Or do you have another option to offer?
I think that this scenario would be such an extreme outlier (i.e. a person with no insurance, no identifying information, completely family-less and friendless, suffers a life threatening injury and is also unconcious) that indirect (outside groups) or direct (the hospital itself) would cover these 0.01% occurrences without a second thought.
It think the question to treat without explicit consent is a common libertarian debating point and there are differing opinions on it… but in my opinion you can call it implied consent or “when in doubt” principle or whatever, but I think it is entirely reasonable for people to assume that every person will always prefer any alternative to death and to then act on that assumption. Or to proceed on the course that reasonably seems it should produce the least amount of harm.
I just can’t see how anyone can argue with that position. To argue against it is to argue that you prefer to die over the notion of your right of consent being violated. Right. I don’t think you’ll find many takers on that one. 😉
Now maybe someone’s religion says they should not get medical treatment and they would prefer death, but doing so is not a rights violation per se as they are perfectly free to kill themselves later if they don’t like the outcome of being treated and the person doing the treating is acting in a reasonable and reciprocial way (that is they acted in a way they would wish to be acted upon were they in the same state).
And at the end of the day the whole notion of rights is about reciprocity… we cannot demand rights for ourselves that we are not ourselves willing to honor for others. If we say we have the right to kill other people and take their stuff then we have little cause to complain when someone does that to us. If we say we only have a right to our body and our property etc then we are obligated to respect those same rights in others. So acting on this unconcious injured victim comes down not to what version of rights that victim lives by (unless you happen to know what they are and thus are able to act according to them, but we’re assuming in this extreme example we have no idea what they are) but rather what version you live by (the one treating him/her). You must act in a way that is consistent with your views or how you would want to be acted upon (“do unto others…”)
So the libertarian position in my mind then is “do unto others” and I think 99.999% of people or institutions would treat them, but for the small minority that wouldn’t and let them die, that should be “legal” in the sense there is no legal obligation to act… of course the real world ramifications of not acting would probably be quite similar to it being illegal. pretty much everyone who thought that was a dick move would boycott the hospital or doctor or whatever and they would flush all value in their reputation down the toilet. So you don’t need a “state” to force these things on people… the morality of that society will most directly reflect what actions are approved and what are shunned and thus tend to eliminate those that are shunned… you’re free to do whatever you want, but you’re not free to avoid what others think about you for doing whatever you want.
I think that this scenario would be such an extreme outlier (i.e. a person with no insurance, no identifying information, completely family-less and friendless, suffers a life threatening injury and is also unconcious)
No insurance is not, by itself, uncommon, even in post-Obama-care America. As for being completely friendless and familyless, that may indeed be an extreme outlier situation, but those aren’t actually necessary conditions. It is sufficient if friends & family cannot be contacted quickly, or if the person has not given power of attorney to make medical decisions to any of those friends or family. It is, for example, not uncommon for young adults without insurance, above the age of majority so that their parents can no longer make legal medical decisions for them, but still unmarried so there is no spouse with implied power of attorney, to be brought in or otherwise accompanied by friends who also have no legal rights to make decisions for them, after a hiking or biking or longboarding accident or something similar. And then they end up running GoFundMe campaigns to try to pay off their medical bills.
that indirect (outside groups) or direct (the hospital itself) would cover these 0.01% occurrences without a second thought.
Currently, that doesn’t happen. Right now, there are no large-scale charitable groups that reliably take care of these cases. Right now, hospitals rarely decide to just absorb the costs and let them off. So what would change in an ideal libertarian society to make that happen?
So the libertarian position in my mind then is “do unto others” and I think 99.999% of people or institutions would treat them,
By that do I correctly understand that you mean to imply that they would treat the patient without requiring payment for things that they cannot consent to?
but for the small minority that wouldn’t and let them die, that should be “legal” in the sense there is no legal obligation to act… of course the real world ramifications of not acting would probably be quite similar to it being illegal. pretty much everyone who thought that was a dick move would boycott the hospital or doctor or whatever and they would flush all value in their reputation down the toilet.
That does seem reasonable.
Well I was assuming a “libertarian” society in which case nearly everyone would have insurance 😉 because it would be so cheap, like car insurance… because medical costs would be reasonably and low. Otherwise it’s an unfair question, like assume everything is exactly as it is today but you just removed all government force… how would you solve this the day after that? Well of course you wouldn’t have some perfect solution as the entire structure of society has been distorted by state force such that we end up with these scenarios where medical costs are sky high and insunrace is likewise expensive due to mandates. It’s kinda like saying well the government forced me to sit in a wheelchair my whole life and the liberatrian solution is to get out of the wheelchair, but look when you get out you can’t walk, so clearly the libertarian solution is the wrong one.
But I would concede your point it might be a bit more common than 0.01% 😉 as one can still have family etc and not be able to get in touch in time. But far more people would have insurance so the question then just becomes one of how do we insure we can be identified and our insurance status determined if we are unconscious.
But not sure why you say that doesn’t happen right now? It does. I don’t recall the law’s name off hand but there is a federal mandate that hospitals must treat patients to the point they stablize them so they don’t die. They don’t have to “fix” everything, but they do have a legal obligation to keep them from dying. That does create some moral hazard as those that choose to remain uninsured know this and may rely on this in some small part. Now not everyone will but on the margins it must be happening.
In a libertarian world there would be a mix of hospitals that will treat you in these situations and those that won’t and might let you die… and you’ll never know which you might get, so this creates a big incentive to get insurance and carry that fact with you at all times!
But if the original question is asking how can we implement libertarian solutions within the framework of a state run society, i.e. just have some “reforms” while keeping everything else in place (mandates, regulations, certificates of need, moral hazards,e tc) then I don’t think there is such a solution… everything is connected, you can’t just change one small part without needing to change other parts in order for it all to work properly.
What doesn’t happen right now is not that people aren’t treated; that is indeed legally mandated for ERs. What doesn’t happen right now is hospitals waiving the bill if the patient doesn’t consent, or charitable organizations reliably pitching in to cover them.
It does, however, seem likely that the rate of such occurrences would increase if the cost of medical care were not so high, so perhaps that is a reasonable expectation in a fully libertarian context.
The problem is not so much the lack of means to pay, as it is the lack of ability to make a choice. If you are going to die or lose a limb in the next hour without treatment, or if you are unconscious, you have no ability to consider your options, and no ability to freely enter into contract with a service provider That’s a market failure, in the sense that, for all practical purposes, there is no market, not merely that the market produces an outcome you dislike.
Is the solution, therefore, that all such cases would simply have to be taken care of by charitable institutions