Question for strident capitalists...

As an aside, I'm curious how a RBE would deal with the sale of expert knowledge? In the cardiovascular surgeon example, there's already a limit to the number of people with the skill set to train new doctors. However, unlike land or crops, these are people (well, knowledge contained within people). A computer can't 'allocate' their knowledge.

 

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There is also the nice example (described in Friedman's "machinery of freedom") of admitted mass murder ten thousands of people by the US.

By the regulation instance which has given the admission to sell beta-blockers in the US only ten years after they were allowed in Europe. If they would have allowed them ten years early, the expectation of the number of lives which would have been saved with this medicine in the US would have been in the order of tenth of thousands. Thus, because it was forbidden by the regulation, tenth of thousands have died without necessity, murdered by the regulation.

The problem is the interest of the regulation office. Allowing some medicine which leads to some harm will be noticed - the harm will be visible. Not allowing some medicine does not cause visible cases of harm - some people die without the medicine, but to prove that they would have survived with the medicine is difficult. So they tend to err on the side of not allowing new medicine. (Even worse, the Big Firms, which sell the established medicine, are usually on their side too.)

 

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That's not what you said. What you said was that you had a great experience in Japan.

That was in the middle of a series of posts in which you maligned the US system, saying a lot of bad things about it - many of which are perfectly true.

So you had a great experience in a country with a more socialized medical care and insurance system than the US. And you are not the first - that's a common report. And that is supported by statistics, in which the US ranks very low (34th, in the last evaluation I saw) among countries with modern medical care systems, in its outcomes. This despite having the most expensive medical care on the planet, by a long shot.

So the most expensive and worst performing medical care system in the Western world is also the least socialized. Coincidence?

The inability to distinguish failing to allow a certain probability of death prevention from murder is going to make utter hash out of all those arguments self-described libertarians make involving "violence".

btw: As long as we're doing cost/benefit and talking about the pressure from interested corporations In the United States, there are examples like this one:

 

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Of course, the "murder" is purely polemical wording. But what has been done has really killed people.

And, given that you also know very well that this was polemics, and not an "inability to distinguish", I think we are quit.

This is already beyond my ability to understand.

I have given an argument why the very principle is dangerous, because prejudiced toward not allowing good medicine, because having allowed bad medicine is visible, but having not allowed good medicine not. And what follows? A reference to the most famous case where a bad medicine allowed in a lot of countries has really caused visible harm. So, you present as a hero the person who has not allowed this in the US. Not because she has known it is harmful at that time, simply because more studies are needed.

So, to become a hero in your eyes is easy. All you have to do is not to allow any new medicine, and to hope that some day one of the medicines you have forbidden appears harmful in some other country. Those who die because they cannot use the forbidden new medicine are some sort of side effects of "failing to allow a certain probability of death prevention" A remarkable phrase, reading it out of context one would never guess that some people have died because of this.

 

How would I know that?

A principle also known as the fundamental ethical principle of good medicine: "First, do no harm."

That's not what Frances Kelsey did, though, is it. Plenty of new medicines were allowed on that director's watch.

Hero? Just a bureaucrat doing their job right, and an illustration of the kinds of pressure actually involved in this stuff. You were pretending that the corporate free market pressure was from the good guys.

 

We are not Japanese. This wouldn't happen in 2010 Japan. Will it in the future? Maybe. But it didn't and probably wouldn't. Why? Because Japanese have a totally different culture.

Here's some generalizations: Japanese are free to leave their fruit and produce outside at night without any fear at all of it being stolen. Japanese have vending machines that sell everything from candy and soda to cigarettes and whiskey - unsupervised sitting outside, available to anyone. Yet these are not broken into and there's no problem of underaged kids buying from them. Kids walk home alone through any part of any city without hardly a care in the world. Japan is nearly 99.8% Japanese. They speak a language that is structured around wet rice farming and studies in China strongly suggest this leads to a completely different way of 'thinking' about society when compared to wheat farmers.

In Japan women normally stay at home and raise children, it's shameful not to be married and start a family by 30, kids who think too 'individually' are seen as a problem and they need to be coerced, through fear and punishment if necessary, to 'fit in' as a part of a group, not to think as an individual (which is seen as a negative trait). If you're a Japanese who naturally is not inclined to think like this, Japan will be a very very hard place to live. Japan has a high suicide rate. Japan has a word for working yourself to death. Japan has thousands of kids who never leave their bedroom. Foreigners are not welcomed as they are in the USA. Japanese don't let their kids pick out what they like to eat - that they'd think insane. Parent tell kids what they are going to eat. Japanese are generally Buddhist. Japan has many problems - mostly economically, due to structural problems in society that stem from a large old population. What they do not have a problem with society as we have. They would also suffer the economic problems, rather than import labor and screw up their society. Both Germany and Italy have much lower rates of population growth, for them they solve this by importing labor and then complaining about ghettos. In Australia nearly 1 in 4 are foreign born. The USA has a relatively open boarder and we simply normalize to the ghettos. These solutions are never going to be acceptable to Japan of all generations. America serves as an example of what not to do.

When Americans were waving their flags for Obama, I had Japanese laughing at me at what a joke American politics are.

The two private hospital examples I gave would remind your of the 1950s, not 2015. Here men ran the hospital and women were the nurses. Men sat down and simply clapped their hand while loudly commanding tea be brought to them saying "Ocha!". A woman bowed and quickly brought tea. This is a world where respect is all important. Where people know each other and use shame to ostracize those that don't fit in. Welfare isn't a way of life, it's a disgrace. Outsiders are pointed at, starred at and pondered about. Black face comedy is still on TV in Japan. They think it's funny to take the piss out of foreigners. Japanese naturally think they are superior to other 'races'.

Are you getting you the picture? We are not them. They are not us. I've lived in Japan. I have family in Japan. I know plenty about Japan. I may even return and live there again. I can tell you right now, what works in Japan, works because of Japanese.

Here's an example not a lot of people outside of Japan know. In American being two-faced is seen as bad. We're taught to be upfront and to be honest with one another. We're taught that being individuals is important and celebrate our individuality. In Japan being two-faces is seen as good. Being able to hide one's personal feelings and to lie in the face of another in a way they makes them feel good is a virtue. What's important is society - not you. Not your place in it.

Japan has a lot of problems, graduating functional illiterates isn't one of them. Incompetently trained medical doctors is not one of them. I'm telling you, these ARE problems for us though. And I've seen the worse of them in countries with "Free" healthcare.

So, given the fact that these monopolistic public institutions are run by people who couldn't give two rips about the quality of graduating MD, what is your solution?

 

Welcome to Fascism.

I do have another question though. You mentioned the EPA and brought up some (limited) examples of pollution.

Firstly, I'd like to know why people were not able to take the polluters to court and seek retribution for property damage?

Secondly, let's suppose for the sake of argument that 50 years ago the only viable solution was to give some groups of humans (the EPA) the use of force against innocent groups of humans (presumably the polluters weren't breaking any laws and didn't commit and legal property damage, which I find hard to believe, but as I said, for the sake of argument). Well, it's been 5 f*cking decades. Half a gawd damn century has passed. WHY haven't we come up with a non-violent solution to this problem? Or is it now that we've given in to the temptation of using violence, there's no desire to solve this problem non-violently? What do you suppose happens to a country, a culture, that learns to love violence against the innocent? I bet they start thinking of 'innocent' people as 'guilty'. Their complicit involvement in violence becomes a way of life.

And what we DO know - is since the EPA was started, no non-violent solutions have developed. The EPA has stunted Progress. Which is what ALL so-called Progressive policies do. Worse, over time they act to distort, twist and Regress society. Which is what we live in now. Medicine that costs to much and will probably kill you. Government Schools with functional illiterates rates of 1 in 5. Never ending wars. Central Banks that bail out the criminals. Police that shot innocent humans. And etc...

The very fact that since the EPA was introduced that half a century later we're stuck with it is an lesson on why we need LIMITED government. It should be noted, the US Government itself is now the largest polluter in the history of the world.

The road to Hell is paved with good intentions.

 

Ok, I can change my personal expectations about your mental abilities toward "stupid", if you insist that you were unable to understand this.

On the free market, there would be no such pressure, because there would be no institution to forbid. In the bureaucratic market, there is pressure from many sides - the corporation which produces the new medicine wants it allowed, all the competitors want it forbidden. So, the only question is who pays more.

And, another problem with anti-libertarian propaganda: The big firms are in no way the "good guys" for most libertarians. Instead, without the pressure, through lobbying, of the big firms there would be much more free market and much more competition on these markets, with much less regulation.

But to present the opponent as the supporter of some "bad guys" is an old propaganda technique, you obviosly love this technique, presenting me now as a supporter of big business, after presenting me as a supporter of some racist politician.

 

And the corporation involved would have been selling their drug all over the US as well as Europe.

Your fantasy world again - in real life most of the time all the corporations want the bureaucrat to automatically approve everything, and never interfere with what any corporation wants to do. The pressure from the corporate side is from one side. Big corporations want small government.

The exceptions are rare, and do not apply to the US drug companies.

You agree with their political positions and their efforts to remove the burden of government regulation from their dealings. In their dealings with the government, you are on their side. And you have a blind spot for the centralization, bureaucracy, and other features of big business you ascribe to big government alone.

I didn't say you supported them, I said you shared their principles - that your political positions, principles, and so forth, were similar to the point of identity with theirs. My approach there is based on the assumption that you do not support them - that seeing your principles in real life action will lead you to re-evaluate your principles.

 

The problem is that there is no simple way to measure how "socialized" a system is. The systems of all developed countries are highly regulated. What harms is this overregulation. But what is more regulated and what is less regulated is also not easy to establish. There may be a whole bookshelf of regulation in one country which appears quite harmless in reality, and a single paragraph in another country which leads to catastrophic results.

The point is that prices one has to pay in the US for medical services are astronomical, in comparison with the rest of the world, with almost no exception. A free market would lead to the same prices everywhere, with some adjustment toward higher prices in richer regions, but not with such astronomical dimensions. Thus, it is the US regulation which leads to these exceptional prices, not the free market.

No. There are a lot of questions where the US is simply exceptional, atypical. Private ownership of weapons, greatest prison population, greatest military budget. The two-party fake-democracy system is also atypical. And the way medicine is controlled is exceptional too, leading to exceptionally high prices.

 

They tried. It wasn't easy. Big corporations have the best lawyers on retainer, the laws written in their favor, every advantage.

The EPA is a non-violent solution. It is the alternative to rounding up a posse and lynching the corporate executives who attempt to bury toxic waste where they shouldn't - which would be self defense, but not conducive to civilized society.

 

LOL. The US government is controlled by the big corporations, this is not a secret, I think even the left agrees with this. So, why it is not small at all, but becomes bigger and bigger?

No, small firms want small government. Big firms want big governement, because they have the power to influence and control it.

I think you are a victim of left propaganda. For big corporations, governement regulation is not a burden at all, but a protection against competition. They pay the lobby which writes the regulations, thus, they are written in a way that these big firms fit with the regulation anyway (or, as a variant, have planned to make the "now required" modifications anyway), but they hurt the small firms and competitors.

First, even if this would be indeed so, it would be irrelevant. Because the question is if the principles I propose are good or not. There will, in every case, winners and losers if some principles are introduced. The question is not who is the winner and who is the loser, the question is if for the society as a whole the influence will be positive or negative.

I don't believe, but, ok, for the sake of the argument: In this case, your argumentation has no hope, because I choose my principles not because they are useful for some particular group, but because I have understood that the society as a whole profits. So, I will not change them because a group I don't like will profit, and a group I like will be harmed. In fact, I do not even change them if I see that I will be among the losers.

 

You don't need to. All the ways of measuring how socialized a system is put the US as the least socialized of the Western first world medical systems. You don't really need to get too detailed in your rankings - it's the US system, and everybody else's.

The evidence is that those prices would be the high ones we see in the market based US system.

The US has less regulation, not more, and more market influence, not less. The evidence is that the US prices are the closest to the market prices which everyone would be led to. The evidence is that the market set up in the US is what leads to the high prices. Lot s of systems have lots or regulation, including every regulation the US has and them a lot more, government ownership of much of the system, etc, but they don't have such high prices. Nobody else's system has such market domination, and nobody else's system has such high prices.

 

Ah, point of rhetoric - two factors: big corporations want small government as it applies to them. They are perfectly happy with big government if it does not regulate them or cost them money - they don't fight it. and 2) The want a small government but they screw up. They think they can control government, especially its growth, far more than they can. They think they can get this or that use out of government, without it growing on them.

And as is their nature they blame others for the growth they have fostered.

So when you see society as a whole suffering and being damaged, as it was during Lester Maddox et al's ascendency and imposition of your principles, you may re-evaluate your principles.

It isn't just individual black people who are harmed by white racial bigotry, you know. Your principles give free rein to seriously harmful social behaviors, and everyone suffers the consequences.

 

So did Big Tobacco. They lost.

Anyway, this is an example of Property Rights. One of the key areas where I stated the State has a limited role. Is it difficult? I don't see why. If it's a clear case of a company (big or otherwise) dumping chemicals that results in someone's property being soiled, then they are entitled to compensation. A jury of randomly selected people who live in the area (presumably they'd have an incentive to see a reasonable outcome) OR alternatively some other system - maybe a judge would make a ruling on Property Rights. The fact is, the EPA and other regulatory agencies were called into existence primarily to protect Big Businesses (who pay the lion share of taxes) from frivolous lawsuits and claims of Property damage. The last thing a company wants to worry about is being sued. And any company is going to produce some pollution.

Again, this is not an insurmountable mountain. It's just a case of private property being damaged. Simple straightforward laws that protect private property are all that are needed.

You do not need a Regulatory agency when people are guilty. You need one when they are innocent.
The EPA is a violent solution.

Here I'll try an explain one more time. IF we have private property rights, and a company pollutes, then what is required in a FREE society is the right to sue said company for damages. Juries are called and Judges ensure fair trials. I don't think you'll find many juries too confused about whether or not rivers ablaze with chemical fires are polluted or not. Thus, IF the company has caused property damage THEN they are guilty and will be forced by a limited State to pay compensation - including the use of deadly force if necessary. IF the company is innocent, then that's the end of it in a FREE society.

The EPA is part of the State, the State has the special privilege of using force against innocent people - that's it's role in society. That's WHY it was limited in the first place.

What are you talking about? That would happen in either system. If someone buries toxic waste on your property and they are found guilty in a court of Law - then the police/posse will 'round them up' and if they resist, possibly even kill them.

In free and unfree societies the guilty are 'rounded up'. The difference is in the unfree society, innocent people are ALSO rounded up. If the EPA determines you cannot live on your land, because you violated a regulation they just wrote today, then you, an innocent person morally, will have yourself put in prison and your property taken. That's the difference. Yes, it's difficult to live in a free society. And each step we take AWAY from a free society (ex: EPA) it gets harder. Until, one day, you find you're living in a Fascistic crap-hole where the State that was limited can tell you who you can legally marry, what you can eat, who you can trade with and what, it will tax your labor by the hour and sell bonds on your children's future labor to bail out the very same crooked corporate executives you worry about. The same State you want to protect people from pollution will be the largest polluter in history, it'll drop chemical bombs on villages of women and their small daughter, and you'll pay for it all or go to prison. It'll use radioactive bullets in never ending wars, all the while stealing prosperity from you and giving it to the cronies that work in it. It'll go on and on and on until you or your children or their children are living in a police State where you can't even sell god damn lemonaid without asking permission from our beloved State.

 

I'm still waiting for a solution to the current problem of corruptly and/or incompetently run, monopolistic multi-billion dollar, public institutions that 'regulate' medical licencing.
What is your solution to this problem?

Again, half a million Americans WILL die due to medical error and another 3 - 5 million will have serious life long complications. And this is getting worse, not better - worse.


Example: Suppose someone thinking cutting neuroanatomy classes 'makes sense', and just replace them with 'talking to patients about their problems' classes. You know, because medical students will forget most of their neuroanatomy anyway - and patients 'feelings' are important as a public 'service' provider. Or what about the bureaucrat who simply wants to meet some tick-in-the-box governmental schema and just decides, you know, let's cut neuroanatomy and replace with 'socialization classes'. One person may be well intended, the other may be devious. It really doesn't matter. At the end of the day either it's better to have a foundation in neuroanatomy or it's better to be good at talking to patients. How are we to know WHICH is better when there's only one game in town? Only one choice to be had? You get the same 'socialized' medical licence in one part of the country as in the other. It's all the same. Just like all Government education - everything is supposed to be standardized. If you think 1 in 5 functionally illiteracy is bad, I think you'd be shocked at the state of medical training.

 

Ok, already closer. But you ignore the point that most regulation is written by the firm lobbies themself - for their own domain. With the clear aim to get advantages in competition.

And this includes also regulations which costs them money - all they care is if it costs the competitors even more money. Typical examples: Regulations about minimal wages or security on the working place. The established firms have some standards, newcomers usually need time to reach them - thus, the problems this causes for newcomers are greater. Of course, they would be against it if these obligations would apply only to them alone, not to the competitors. But if it applies to the competitors too, and even more, the additional costs are not a problem, because, once they all have to pay them, the prices will increase to, even more, and they will profit.

Yes - but only if I understand why. If you simply tell me that it is, I see no reason to believe you. And, of course, I reject Jim Cow laws. Because I see a reason why they are harmful, and this is also in full agreement with my general philosophy of support for freedom of contract.

By boycotting a whole group of customers, one first of all hurts oneself. The group which is boycotted is only harmed if this boycott is massively supported by other people. The place where such boycotts will have a real power to harm are small villages, where it is easy to create majorities who boycott. In this case, the natural reaction of self-defense is to leave the village. Once the village is free from unwanted minorities, it will become an attractive place to live for other bigots. So, as the result, the bigots will be happy in their purely white/black/chinese/gay/hetero/whatever village, and the rest of the society will be more peaceful without these bigots too.

The socialist solution of the problems with bigots would be to imprison them in a reeducation camp, forever. The anarchistic solution is to allow them to segregate if they like. The effect would be, essentially, the same - all bigots segregated at a single place, the rest of the world protected from them. The differences: the bigots would be happier in the anarchistic variant, they would have to care for themself and protect their camp themself, thus, cost less for society (even pay taxes if there is a state yet).

 

Not to the private citizen, they didn't. They lost to the government.

I've already posted several ameliorations, some of which might prove complete "solutions" - adopting one of the 34 medical care systems that outperform the US system, chosen at random, for example. You need more? Expanding the role and population of nurses. Single payer medical education, with the normal strings attached to payment. Chisel at the plinth. But it's far from the top of the priority list - you sweat the petty stuff, OK?

So?

Of course you don't. And since you never heard of Lester Maddox, you obviously have no real life experience or personal knowledge of the workings of racism and other bigotries in the US, so what you are able to "see" is limited. That is why you simply assumed that if black people were denied motel lodging across the American South, or medical care, or any job that paid more than the lowest paid white man in town, it must be by government law, Jim Crow. It wasn't. It was freedom of contract, as enjoyed by racial bigots.

You have no conception of organized, societal, systematic, non-governmental, oppression of people. It simply doesn't exist in your world, because there isn't enough reality in it. You haven't fact- checked your theory. In your theoretical universe child labor cannot exist as a stable, long term free market institution. Motels and hospitals cannot be systematically denied on grounds of bigotry except by governmental force. Free market corporate monopolies cannot burden and oppress people's lives because they cannot exist for long enough. And so forth.

1) That's not what boycott means. Get a dictionary. 2) It isn't true. There are lots of situations in which refusing to do business with an entire group of people will benefit one's business. When the group has little money, and doing business with them will cost you the business of the rich, for example.

Or a couple of local bankers, businessmen you need, your best customers, etc.

You don't need very many bigots per "village", and human beings are perfectly capable of coordinating their efforts among any number of "villages", counties, States, or entire Confederacies - as you would know if you knew who Lester Maddox was, or had any other real life experience with this stuff.

Have you even considered the motel example? Take a second: no laws, no government, free market rules throughout, freedom of contract the entire basis, the entire area of the old Confederacy and neighboring States covered - black people were systematically refused motel accommodations. This harmed the entire community, black and white. It did all kinds of damage to all kinds of people in all kinds of ways. And it did it for years -generations. Stable situation.

The more space you give a rightwing self-described "libertarian", the sharper the tinfoil hat comes into focus.

 

Firstly, I agree that expanding the role of nurses would be a help, many can and do work as GP / Nurse Practitioner. This is a free-market solution. Specifically, you're suggesting that the increased competition would result in better medical outcomes. Is that correct?

There's two problems I can think of off the top of my head: (1) How do you maintain quality training? Suppose the Nurses are poorly trained in large public institutions (same problem as before) and (2) How do you enact this when the AMA is working hand-in-glove with the "Regulatory" agency (actually, it's composed of AMA members) specifically to use the government to limit the number of nurses and reduce their role as healthcare providers.

You're still stuck with Public institutions and their poor training of 'certified' medical practitioners. Saying "use one of any of the 34 other healthcare systems better than ours" is NOT a solution. We are not Germans and we are not Japanese and what works for THEM is not going to work for us. The USA has one of the largest healthcare industries in the world. Australia's healthcare industry is so small as to be non-existent. Australians sit on a pit of money called mining (at least they did, when the boom was on). UAE sits on a pile of oil. KSA does too. These nations do not have to invest, invent and compete in a highly technical advanced high-skill industry. They just buy what they need from the USA, Japan and Germany. This isn't going to work for the USA. What 'appears' to work in their countries cannot be replicated in ours. And, it's not really working all that well in AU, ENG and CAN as it is to begin with.

So far the only viable solution you've offered is to increase the healthcare practitioners. You're assuming the AMA dominated Regulatory agencies will allow this (many won't) and you're assuming they'll be competently qualified (many won't be). So you're still not fixing the problem. And there IS a problem.

 

No, it isn't. It's a change in the regulation of regulated service delivery. It fits perfectly with my preferred single payer insurance setup, eliminating most of the medical insurance industry in the US. I'm not suggesting that we set up a market in which the patient chooses between doctors and nurses when purchasing these services.

No, I'm suggesting that nurses would be cheaper to educate and hire for delivery of some medical services, and that would take some pressure off of medical schools. I said nothing about medical outcome in that respect. And there is no competition involved - all my stuff is single payer insurance, non-profit clinics and hospitals, public research, free market supply production.

Well if none of the solutions are going to work for the US, then we're stuck with the problem. But I see no reason not to try what works for lots of other people, rather than more of what doesn't work for anybody. If the all-powerful AMA blocks all the solutions, then we're SOL regardless of what we try.

If it comes down to it, if it's actually all that much of a hopeless disaster here we could simply pay a bunch of European schools to train all our doctors - outsource what we can't do at home, same as we outsourced a lot of our preparatory education to India and similar places.

And it's a minor problem anyway, compared with cost, non-delivery of services , and bureaucratic capitalistic inefficiency.