Abject Geekery

Much of the debate in health care now dances around the issue of rationing.  While this is a valid concern when it comes to a centralized system designed to control bottom line pricing, it is the acme of foolishness to state or even imply that rationing does not exist in the current American system.  Of course rationing exists, its just that when it happens without direct mandate its referred to as “the market.”

Whenever scarcity of an item and demand for that item coexist a market is created for that item.   Few things in the world do not have scarcity of some degree.  The items that don’t have scarcity (or functionly no scarcity) have no market in normal time.  Air is plentiful, so no one pays for it.  Pure Oxygen is scarcer (it must be harvested) so people actually pay for it.   Medical care items (be they objects or services) are scarce (arguably more scarce then need be) and thus a market exists for these items.

A market is rationing.  This must be agreed upon before a conversation on why the market form of rationing is superior to centralized rationing.

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Before I begin, I must beg your forgiveness.  It is late and this idea has been rattling around in my skull.  I must let it out before it pulverizes itself into a puff of dust and logic.  I apologize in advance for any typo’s, errors, and omissions in this rant.  I am going to scribble down as if it were crayon on a cave wall and then go back to bed without so much as a second glance.

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For a long time I have taken a very primitive view of health care and tried to apply it to the modern condition.  I reasoned that until very recently in our collective history people worked and played in very consistent groups.  These groups had three types of people: harvesters, traders, and servicers.  The harvesters were the people who farmed or mined.  They- like their modern counterparts in Eve, WoW, or LOTRO- brought forth the raw materials from the Earth.  Tradesmen bartered for these raw materials with refined items their talents had created.  Industrialists of all kinds are the modern equivalent.  Whether a person is making the widget or selling it, they are a tradesman.   The servicers didn’t manipulate the Earth or materials directly, they provided a secure and stable environment for these more basic market activities to occur.  Servicers included everyone from chieftain and shamans, priests and pastors, police and firemen, entertainers and scholars, garbage men and doctors.

While the primitive world may have had chieftain farming crops in addition to being old school community organizers, the larger the community became the less time the chief had for farming.  The modern world has brought us the double edged sword of being so specialized that we forget our basic nature; and people in service forget the meaning of service.

It is decidedly unfair to say that servicers are a drain, because the market tells us otherwise.  But there is something easily forgotten: overspecialization leads to inefficiency and waste.  One does not have to think too hard about bureaucracy to see this is true.  Image your daily life where perhaps you can do something yourself in half an hour at a cost to you of $50 or you can give it to another person to do in an hour at a cost of $40.   While you have lost time in the transaction you have gained capital, but what happens if the second person take two hours and costs you $80?   This is a very oversimplified example of problems we face in the real world everyday.  Given the example above, you would not have the second person do the task, unless you had a guarantee that the work would take less then an hour and fifteen minutes.  But in the modern world, the reality is seldom that transparent. (more…)