The Other McCain

"One should either write ruthlessly what one believes to be the truth, or else shut up." — Arthur Koestler

Has Walter Russell Mead Figured A Way Around The Iron Law?

Posted on | September 17, 2011 | 15 Comments

by Smitty

Maybe he’s explained a way around Pournelle somewhere. I should like to see such an explanation in the context of this:

Ultimately we must either ration health care (death panels and all) or restructure it top to bottom so that it is able to deliver the same or, preferably, much higher levels of care much less expensively. Proponents of a single payer health care system (basically, the kind many European countries and Canada have where the government collects premiums for everyone, sets prices, and pays bills) argue that it is cheaper than our current hybrid (and grossly inefficient and excessively) pricey system.

I agree with the single payer crowd there, but a single payer system only really makes sense under two conditions. The first, as the Spanish are discovering in a very unpleasant way, is that single payer only works if the single payer has plenty of money. If you count on the government to cover your health care, and the cost of health care bankrupts your government so that the health care system goes down as well, it’s hard to call that a success.

The second problem is related to it: single payer would be more feasible if the technology of health care has frozen. That is, if we already knew the best way to treat all diseases, manage hospitals, divide up responsibilities between different types of health care professionals and so on, a single payer approach might make sense.

The Iron Law of Bureaucracy, just to rephrase it for fun, says that homo bureaucratus lacks predators. That is, for all these metrosexual creeps may do nothing useful to add to the population of the country, they sure now how to make an org chart ‘splode.

One huge question here, pertaining to health care and everything else, is: ‘How in the world are we offering feedback to stabilize the size of the bureaucracy and trim it?’ Our first task on the path to sanity is to disabuse ourselves of the notion that the federal government should manage individual health. Yes, some in our society continue to want to make that mistake, but that doesn’t make it any less bloody-minded.


15 Responses to “Has Walter Russell Mead Figured A Way Around The Iron Law?”

  1. Anonymous
    September 17th, 2011 @ 5:13 pm

    The only way around the Iron Law is to take the franchise away from the unproductive citizenry and bureaucrats. Nothing else will work.

  2. JeffS
    September 17th, 2011 @ 5:27 pm

    I have a sign posted at work which states The Iron Law of Bureaucracy.  It’s there because the metrosexuals, empire builders, and their ass kissers*in my organization have turned the old organization chart into a massive, and very hungry, fractal diagram.  I don’t know that people have received the message, but I haven’t been told to take it down.

    Unfortunately, the only real way around the Iron Law is to starve the bureaucracy.  And I say “unfortunately” because said bureaucracy will fight to the death to avoid downsizing, even when their budget can’t cover costs. 

    That’s their version of “fight or flight”.

    *:   Yes, that’s three separate categories.  While related, they are not always mutually dependent for survival.

  3. JeffS
    September 17th, 2011 @ 5:27 pm

    What SDN said.

  4. Matt Lewis
    September 17th, 2011 @ 6:05 pm

    I’ve been saying for a long time that the solution to Medicare is mandatory smoking.  Social Security falls into line, too.

  5. Anonymous
    September 17th, 2011 @ 6:28 pm

    Sometimes I really wonder about Walter Russel Meade, he has grasped the reality that the blue state model is collapsing yet seems to think it’s just a matter of financing. Any attempts by government to control distribution of resources is doomed to fatal inefficiency. All the western societies that have adapted single payer health systems, have also adopted unsustainable nanny state welfare systems. He cites 30% to %40 spent on healthcare but doesn’t add in spending for pensions, government salaries, aid to the unemployed etc. Spanish government spending is 47% of GDP you simply can’t suck that much capital out of an economy and have real prosperity. 

  6. Matt Lewis
    September 17th, 2011 @ 6:46 pm

    I read Meade’s statement regarding single payer supporters as a long winded way to say that those people are full of it, sort of like the Churchill quote about how bad democracy is.

    Basically, he said single payer would be great given two things:

    * We have unlimited funding
    * We have perfect medical technology
    Which pretty much translates to unicorn ribs.

  7. Anonymous
    September 17th, 2011 @ 8:13 pm

    You can’t really take down an established bureaucracy without a revolution (the “kinetic” kind).  What you can do is render it obsolete by two avenues: one is to freeze it and outgrow it, the other is to render it’s more odious aspects moot, as we have done with most “blue laws.”

    The path to freezing out single-payer intentions is for every conservative to learn this fact: medical care keeps getting more expensive because we want it, and will pay for it.

    That’s also an iron law and it is only limited by the potential ability to achieve immortality.

  8. Anonymous
    September 17th, 2011 @ 9:13 pm

    But he neglects to point that out. If you read his series on the blue state model wherein he states the blue state model no longer works and that liberals are basically being reactionary in their attempts to sustain it. He doesn’t seem to grasp that the blue state model never worked but merely received funding. All of the social safety net programs were designed to solve problems to “cure the disease” of poverty or urban blight, education and unemployment. None of these programs succeeded, but at best treated the symptoms. Some were more successful at this than others but none of them “cured the ills” they were designed to do.

     The discussion of the efficacy of these programs has only gotten traction at the point where it’s become impossible to fund them. The two sides on each of these programs are still arguing about if and how they should be funded and it took reaching the edge of utter catastrophe to get there. Our side and more importantly the supposed leaders of our side oppose increasing funding for education through the DoE. Very few openly call to abolish it. I heard a pundit on the tele the other day (a lefty) state that only 25% of Americans favor abolishing the Dept of Education. I’ve no doubt that figure is roughly accurate. That departments complete failure to improve education by any objective measure is the simplest most straight forward case to make, yet the argument for it’s abolishment receives little discussion among policy makers.

  9. Joe
    September 17th, 2011 @ 11:40 pm

    Matt:  Unfortunately smokers don’t tend to die fast enough.  While a few die right away, most smoking related cancers tend to start in their sixties or even later.  Even the heart cases tend to live longer now.  And they tend to linger, with very expensive treatments. 

    Now meth works really well.  It takes them out fast (if they start young they are dead by their forties) and they do not even bother getting dental work even when their teeth are falling out of their mouths.  Win Win. 

  10. Joe
    September 17th, 2011 @ 11:44 pm

    This may sound crazy, but I would not mind a sales tax that paid for emergency room visits.  A sales tax would capture the illegals and destitute who take advantage of such treatment and never pay for it.    We are already paying for it now through those outrageous bills to those of us who do pay (I mean seriously, $2500 for stitches on a weekend?).  We have universal health care now (do you see people dying in the streets?).  We just have a very inefficient way of paying for it. 

  11. Steve in TN
    September 18th, 2011 @ 12:01 am

    I seem to recall that Americans pay many times the global average for medicine because we bear almost the full brunt of research costs.  What would paying our rates to do Canada and other full ride socialist medical systems?

  12. Anonymous
    September 18th, 2011 @ 12:16 am

    Your absolutely right it sounds crazy. There is no possible justification for ANY new form of taxation that doesn’t leave the IRS rotting in a crows cage.

  13. Anonymous
    September 18th, 2011 @ 12:27 am

    Canada forces the drug companies to negotiate prices in competition with each other. The prices we pay in effect subsidise their drug costs by being the most significant payers of R&D costs. If medicare and large private insurers had more organization to drug company negotiations this might reduce costs and/or stifle the search for new medications. That wouldn’t be an entirely bad thing. Have you noticed how many of the latest and greatest drug breakthroughs advertised five or ten years ago are now featured in ads for call 1-800-bad-drug now?

  14. Bob Belvedere
    September 18th, 2011 @ 12:36 am

    You’ve inspired me to put the Law up in my office.

  15. Adjoran
    September 18th, 2011 @ 2:57 am

    No, Canada and European national health plans pretty much tell the manufacturers what they will pay.  The drug companies have little choice, as if they refuse those countries will declare the drug a necessity and stop honoring the patent, which costs the companies even more.  So they end up selling for marginal cost plus a small mark-up, leaving it profitable but not lucrative.

    If we didn’t fund the R&D here, it wouldn’t get done.  In 1970, half of all new drugs were discovered in the US, most of the other half in UK and Europe.  Now over 90% are found here, and most of the rest in Asia.  The Europeans have converted to generic manufacturing only because their national plans won’t allow the true costs of R&D to be recouped.

    99% of all the “bad drug” litigation is just slimy trial lawyers like John Edwards or Sokolove trolling for class actions to force settlements because our system costs too much to defend yourself, and stupid juries of Obama voters just vote against the “corporations” anyway without regard to evidence.