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Samizdata quote of the day

We have to break people away from the choice habit that everyone has

Marcus Merz

Truly there is are few things more valuable than an honest enemy, for by their own words they are revealed.

The state has been astonishingly successful at “breaking people away from the choice habit” in the UK, where arguing for choice in medical care results in people looking as you incredulously as if space monkeys are flying our of your mouth.

34 comments to Samizdata quote of the day

  • Nick (Blame The French) Gray

    But you can still choose, in Britain, between authoritarian right and/or left, correct?
    so what’s the big deal?

  • Rich Rostrom

    At least in Britain, one can choose one’s medical services if one pays directly for them. In Canada, until recently, private purchase of medical services was illegal.

  • Lee Moore

    There’s nothing at all wrong with health providers (or any other kind of providers) trying to “break people away from the choice habit that everyone has” if they believe they can offer better value for money by offering less choice. It’s just like offering a cheap set menu, rather than (or as well as) a more expensive full menu. So long as no one is preventing consumers from choosing a “narrow choice” option or a “wide choice” option and paying the market price for their choice.

    The problem is the government setting rules that restrict the offerings that providers can offer, that’s the choice restriction that’s to be condemned. But a provider offering a narrow choice product is just ordinary commerce. I don’t know how far up the government’s bum Mr Merz is, or if he’s been lobbying away to support the government’s removing choices from consumers, but if – a big if – he’s innocent of that, then him advertising his narrow choice product, and trying to persuade consumers that a wider choice product is a waste of money is fair game.

  • Paul Marks

    Sadly true Perry – sadly true.

    The basic point of the doctrine of “licensing” (and regulations and government run services) is that people are not capable of making rational choices – after all there is nothing stopping the Guardian-BBC class making their case to the people (they control the schools and the universities as well as much of the media).

    The position of the elite is that even AFTER the have made their case, many people would still make the “wrong” choice – and, therefore, should not be allowed to choose.

    They (the elite) are evil – the truth is as brutally simple as that.

  • There’s nothing at all wrong with health providers (or any other kind of providers) trying to “break people away from the choice habit that everyone has” if they believe they can offer better value for money by offering less choice. (…) But a provider offering a narrow choice product is just ordinary commerce.

    No, this completely and utterly misconstrues what this is about. This seems to suggest what is happening here is “mere commerce” or “capitalism at work”. It ain’t. Whilst operating within a rigged massively state manipulated “market”, Merz is arguing for “the system” to be adjusted even more for the Big Vendor’s convenience, so that they can help the state realise its vision of an even more politically directable medical system. This is pure Big Biz dancing hand in hand with state corporatism.

  • Charles Pooter

    Even the NHS is preferable to the corporatist mess that is US healthcare (a mess made only worse by the Chosen One’s interventions). At least in the UK we know exactly who is to blame for the poor healthcare standards and I don’t think we lose much by lacking an industry whose entire purpose is to make healthcare as expensive as possible.

  • john in cheshire

    It seems to me that these days fascist statements, by just about anyone, are widely promoted by the usual media organs as if they indisputable truisms. Until all these individuals and institutions suffer a cost for their wickedness they will continue unchecked. Of course, their actions will eventually be their undoing, it’s just a matter of time.

  • Charles, that may be true in theory, but in practice the US system worked better than any other I know of (granted, I don’t know them all). I would argue that it was not significantly more expensive to patients than the NHS, keeping in mind that you pay for NHS through taxes, while in the US you did not (I am speaking in past tense, because only He knows what the hell is going on with the new system in the US). Add to that the quality of care, and as bad as many aspects of the US system were, I think it was still among the least bad in the world. I could be wrong.

  • There is indeed some truth to that Charles. Yet the US Corporatist model (whatever that is) is hardly the only alternative to full blown socialist medical care.

    But…

    That is why the state has worked to tirelessly and effectively at making it axiomatic to most people that the alternative to the NHS is NO MEDICAL CARE AT ALL FOR POOR PEOPLE. People really do think that. If you oppose the NHS, you want all poor people to just die in a ditch. Therefore, it does not matter how bad it gets as the alternative is… nothing at all. The Staffs scandal should have lead to people rioting in the streets demanding the end of the NHS, and scores of people going to jail for the rest of their live. Did it? Pfffffff.

  • Single-payer legal care, now. Because there’s not one lawyer in the country worth more than minimum wage.

    Ever regulation that’s put on doctors ought also be put on the lawyers, and then we’ll see how popular regulation is.

  • Lee Moore

    Perry : Whilst operating within a rigged massively state manipulated “market”, Merz is arguing for “the system” to be adjusted even more for the Big Vendor’s convenience, so that they can help the state realise its vision of an even more politically directable medical system. This is pure Big Biz dancing hand in hand with state corporatism.

    You’re obviously privy to further remarks that Mr Merz must have made elsewhere than in the NYT report. The sum total of his NYT remarks are :

    “We have to break people away from the choice habit that everyone has,” said Marcus Merz, the chief executive of PreferredOne, an insurer in Golden Valley, Minn., that is owned by two health systems and a physician group. “We’re all trying to break away from this fixation on open access and broad networks.”

    which may betoken what you claim, or it may betoken his conviction that open access and broad networks are a waste of money, an opinion he’s perfectly entitled to, IMHO. It’s true that he operates in a heavily regulated market, which has just become even more heavily regulated; and it’s also true that after Hilary’s experience in the 1990s, Obama was careful to sweeten the new regulations with many bribes for the insurers, so Mr Merz may indeed be a happy Obamacare cheerleader. But one cannot deduce that simply from his remarks as reported in the NYT.

  • PreferredOne Am I the only one who finds this name disturbingly symbolic?

  • Well yes, Lee. Can we just agree that we all here are always speculating about any news item at all, because most of us have not had the chance to ask the actual persons quoted in such items to clarify their meanings and intents to a tee?

  • Mr Ed

    We have to break people

    Every Leftist’s dream, and many people’s reality.

  • But one cannot deduce that simply from his remarks as reported in the NYT.

    Indeed, which is why Google is our friend. Merz started registering on my loathsome-metre some time ago :D

  • John K

    I think the one thing one can safely say about the US health system is that it resembles a “free market” about as much as GUM resembled Fortnum & Mason. They both might have been called department stores, but there the comparison ended.

  • Laird

    John K, no one today says that the US health care system bears any resemblance to a free market. It wasn’t particularly “free” before Obamacare, either, but the remaining vestiges have now been clearly stripped away. The only difference between our system and the British NHS is that we’ve out-sourced the payment process to nominally private concerns. That won’t last.

  • Lee Moore

    Alisa : “Can we just agree that we all here are always speculating about any news item at all, because most of us have not had the chance to ask the actual persons quoted in such items to clarify their meanings and intents to a tee?”

    Well sorta. Obviously one should never believe anything in a newspaper, including the date, especially the NYT. But I always like to feel that samizdata is a bit of a haven from ya boo sucks and gotcha and taking out of context, which is ubiquitous elsewhere. So when someone is quoted as saying something that might be objectionable, but which might be perfectly OK, depending on the context, I prefer not to leap to conclusions and condemnations. It’s so MSNBC. Or NYT. That’s not to say I’m against sensible inference, but I don’t think we have enough in the NYT story alone to infer he is wicked.

    But if Perry says the fellow has form, I’m happy to believe him.

  • Fair enough, Lee.

  • Regional

    As with life and everything, you can’t keep Anzacing your bed, you have to make it properly.

  • Vinegar Joe

    I now simply fly to Bangkok, Thailand for my medical care…..just as many Brits, Canadians and Americans do. Bumrungrad Hospital is just one of many medical facilities in SouthEast Asia offering excellent and inexpensive healthcare. And best of all, it’s near Soi 4. :)

    http://www.bumrungrad.com/

  • RAB

    Yes, my oldest friend, The Luddite Hippie of La Honda, also goes to Thailand to get his teeth fixed these days, instead of suffering Obummercare, and he’s a raging progressive Democrat.

  • Tedd

    Rich:

    Paying for your own health care is still illegal for all practical purposes in Canada, is it not? I know there was a supreme court decision a few years ago that changed the situation a little bit, but my understanding was that it didn’t really change the law very much. Or has there been some other change I’m not aware of?

  • Nick (Blame The French) Gray

    Alisa, please! If we did that, we might end up LIKING politicians, but not on Facebook! I often heard from my brother, a life-long left-leaner (the family black sheep), the claim that if we ever met Paul Keating, or Bill Shorten, or other Australian Labor leaders, we’d like them! Even if they are more civilised outside Parliament, so what? We have to make some judgement based on what we know, which is usually some media soundbyte, or press clipping. And I think that, over time, this would still give you a good summary of how they’d act when voting or legislating, which is the important point, after all is said and done. (Maybe Chamberlin was a nice, sweet man, but is he remembered for his niceness, or for ‘Peace in our time!’?)

  • Vinegar Joe

    “…..if we ever met Paul Keating, or Bill Shorten, or other Australian Labor leaders, we’d like them!”

    And Hitler loved dogs. :)

  • David

    Nick, I’ve met a few of the Labour leaders in Aus, your brother is quite wrong.
    Loathsome individuals.

  • Chip

    Medical tourism to Thailand, Singapore, Costa Rica and many other places is booming.

    Unfortunately it doesn’t represent more of a choice than it should, because you’re already taxed for your care in your home country.

    It’s just an extra expense for you, and a saving for your govt, which gets your money but doesn’t have to povide the care.

    In a way, it takes pressure of govt health care, ensuring it sticks around longer.

  • Medical care is a bit of a J curve with the NHS and other full on statist systems being higher up on the short leg than the US at present and the long leg having more market oriented systems. Break the royalty requirements on the CPT and the scales would fall from a critical mass of people’s eyes. In the US, to set up a price comparison web site using the government measurement system of what a medical procedure is (and coincidentally how everybody gets paid) and you expose yourself to significant royalty demands based on every unique visitor to your website. Were the US Congress simply to cut the AMA a check for the service of maintaining the system of measurement (CPT) instead of getting them to do it for free and getting tens of millions in royalties on the back end from users, we would quickly expose a great deal of wasted expenditure and be able to significantly improve the provision of medical care.

    It would be a wrenching experience but one that would improve care just about everywhere. It would also, by happy accident, actually fall within Congress’ remit as it explicitly has the power to set up weights and measures in the US Constitution and, presumably, pay for the maintenance of such systems.

  • Johnathan Pearce

    Choice is a “habit”, from which we must be “cured”.

    Pure evil. No other word really does this sort of mind-fuck justice.

  • Snorri Godhi

    I thought that Paul Keating is “far-right” by modern Anglosphere standards, since he actually liberalized the Aussie economy, instead of just slowing down the rate of growth of the State!

  • Nick (Blame The French) Gray

    He also did some other things that were beneficial, but always Canberra gained power by them. If he could centralise the economy, and do good, he would, and did, but if centralism would damage the economy (such as by marginalising the states), he still centralised. At one time, the people of Victoria (we have to use this phrase because ‘the Victorians’ sounds like we’re travelling backwards in time) voted for a government that wanted to stimulate their state by lessening union influence, so Keating gave them the option of being covered by a federal award, by-passing the state. He was always a centralist, whatever the overseas perception of him.

  • gongcult

    If you choose not to make a choice you still have made a choice-neal peart/Rush via Ayn Rand… scary stuff happening. Be aware my libertarian brothers & sisters …

  • Julie near Chicago

    What Johnathan said.