Who deserves a market wage?

( – promoted by undercovercalico)

Inherent in universal health care plans are price controls.  By bundling patients together under major health care insurance providers or the Federal government, patients gain the ability to collectively bargain with doctors, biotechnology and pharmaceutical companies, and nurses, lowering the cost that these people and companies can charge for their services.  By this method, more people are able to get more health care at a lower cost, with the sacrifice being that we can no longer use market mechanisms to influence our health care system.

Conventional market economics will suggest that this is an outright bad idea, since market mechanisms are more responsive and elastic than asymmetrical bargaining.  However, this can be dismissed as a serious rebuttal since health care markets are already deeply distorted by complicated insurance systems and the AMA cartel controlling doctor credentials.

But, there is an important practical and philosophical problem which this poses.  

Price controls are by default inclusive of wage controls, meaning that we will be controlling the potential wages of doctors and nurses.  The practical problem will be that talented people who are considering careers in medicine will choose other, more lucrative fields instead.  This has been true even within the medical field; in Japan, for example, the top students have been gravitating towards plastics and other specialties where price controls are not in effect.  While certainly, many people will remain in difficult but price controlled specialties such as cardiology, obstetrics, and oncology due to the challenge and the more noble desire of doing as much good as possible, this effect is real and documented.

I find the philosophical problem more challenging.  Namely, what right do we as a society have to dictate that individuals, by fact of their occupation, are not entitled to seek market value for their skills and labor?  

There is some precedent for this situation.  We do not, for example, allow former military personnel unrestricted access to the market for their skills.  But in that case, the skills were acquired at public expense.

What I am curious about, since this is a community which supports universal health care, is in philosophical arguments about moral rights of the state (and its people) versus the moral rights of individual doctors and nurses.  This is not a means test of universal health care programs; that they will expand the amount of health care provided at a bearable cost should be considered for the purposes of this essay a given.

Anyone have any thoughts?


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  1. …there seems to have been diminished interest in what I write lately; if that is because I have offended y’all in some way, I apologize.  If it is because the quality of my work has diminished, I’d appreciate being told so.

    Cheers, and a good day to everyone.

  2. I always find your writing to be of superb quality.

    I think you often ask questions that are either difficult to ponder, or ones we aren’t sure we want to answer.

    Given your libertarian-with-common- sense- and- dash- of- human- decency approach, you write out of the box on a blog full of people who do not always have the same grounding in philosophers you have and in many cases significantly less understanding of the practical applications of both macro and micro economic theory.

    So. The lack of response may be a mixture of “whoa he is a smart cookie and I don’t want to tangle with him” mixed with “we are having a fucking election and I am pissed”. If I got worried about talking to people I perceived to be sharper than I, I wouldn’t ever talk to anybody!

    I enjoy that various approaches you take. You often have a new angle on an “old” issue.

  3. is an oxymoron. Why do we have to have the insurance industry in the equation? Or vast corporations we now call hospitals. Some things like public utilities should not be ‘market driven’ especially when their purpose has nothing to do with the services that are needed by the public for the most basic needs.

    Universal Healthcare is not controlled by monster corporations who only care about deliver profit and whose main concern is the bottom line. Same with other services a civilized society requires like water, power, and infrastructure. I’m against mandates which are going to make me procure services that will not even bring me healthcare, I will still be at the mercy of a system which has long lost any concept of healing or nurturing.        

  4. malpractice insurance and administrative costs driven by monolithic health insurers are driving down not only doctor’s incomes but their desire to stay in the profession.

    i think universal health care is a good idea. but we need to be smart in the way we implement it. for example… gov’t covers catastrophic care and gives incentives to employers to share preventative care costs with employees (taken out in pre-tax dollars) with deductibles depending on income levels.

    also we can tax the net profits of all industries (polluters, makers of poisonous products like tobacco et al) with processes or products that destroy health. i don’t care if you think it’s fair, communism or what. no group of individuals should be able to make profit at the expense of others without sharing the consequences.

    400,000 thousand people/year sick from tobacco… then that industry must share the devastation. it is more important than free markets. it is about societal values.

    free markets and money have caused our troubles. we need to stop it. all industry needs to be regulated. ALL.

    one other thing. nothing is for free. somebody somewhere has to pay. i’m tired of free markets so i get to pay the same price in gas when SUV drivers should be shouldering the bulk of the increases. I’m tired of worrying about my water, the food i eat, and what war is next to fulfill the greed and need of the free market crowd.

    you have a philosophical problem? yeah. so do i.

    • robodd on May 14, 2008 at 04:31

    the costs of equipment and facilities, not labor?  Physician bills are typically, for instance, a small portion of a total medical bill.

    The real problem may be the exorbitant cost of cutting edge technology/medicine and the intellectual property rights incumbent therein.

  5. from selling their skills because they got them at public expense. Pilots do it all the time. The reason we don’t permit them to sell their skills in that fashion is because that act is destructive to society as a whole.

    Permitting people to demand their own price from people facing disability and death is also destructive to society. It makes for suboptimal prevention, even in the case of contagious diseases which is most definitely a matter of public concern.  

    • C Barr on May 14, 2008 at 06:53

    If we provided public funding to train doctors, then they wouldn’t have to charge the exorbinant amounts required to pay back their student loans.  We’d have more doctors expecting less pay for providing a public service.

  6. but whatever it is the ‘market’ forces (whatever those are) will make it hard to live on once it is achieved. LOL My neighbor who is a physical therapist for the elderly who live at home and a liberal Democrat expressed it well. She said that in our present society we are all forced to be competitive yuppies, just to raise our families and not live in desperation. My other neighbor a speculative realtor says ‘If you don’t make 100,000$ a year your screwed. It’s a screw or get screwed world.’

    Fair pay is a bad way to express what I meant, it just seems so out of whack money wise when the main consideration is maximum profit for corporations, and the market. When teachers, firemen, nurses, farmers, professions which are essential for a society are are forced to scramble and scrape for the basics. Were all working poor, slaves to the profit margins of the ten? percent who’s only goal is maximum profit. Competition has become our main value and all others left behind.          

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