Health Care Reform --- Behemoth Bureaucracy vs. Nimble Entrepreneur

|Peter Boettke|

How do you want to fight disease and promote better health among yourself, your family, your friends and your neighbors?*

 

HT: David Hebert

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*You can learn a lot about the "vision" conflict evident in this policy reform by revisiting the municipalities debate where Vincent and Elinor Ostrom began their research program in institutional analysis and development.  See part 1 of Challenging Institutional Analysis and Development --- I am linking to the Kindle Edition which is less than $20 and you can join the e-book revolution.  Anyway, there is indeed an "intellectual crisis" in America public administration and public policy analysis, namely the lingering legacy of the 'progressives'.

Comments

[acuvue oasys]

Umm, after viewing that chart, I'd say just eat more spinach and whole grain. That's going to be a lot easier and make more sense from that piece of incoherent mush.

[Stephan]

Context matters. How did the picture look like before Healthcare Reform?

[Daniel Kuehn]

I don't know - I think these displays provided limited insights.

You could provide an equally complex map of a private company if you wanted to. You just need to write down everyone involved in the work, and any organization of sufficient size can get you a mess like this.

Notice who produced this - Republicans on the JEC. In an attempt to debunk politicians you're playing right into another politician's narrative.

Complexity alone I don't think tells us much of anything about an institution - public or private.

[Bill Stepp]

Daniel Kuehn,

The chart probably masks more than it reveals, but that's a key point. No corporation in the world has an org chart anywhere near as nasty as that of Obama"care".
An important point made by Murray Rothbard in his book _Power and Market: Government and the Economy_ (it's the best book ever written on the criminal entity known as the State) is the fatal split between payment and receipt of service when the State provides a service. This doesn't happen on the market.
The cekatS violates the principal-agent relationship that is the foundation of a free market transaction.
The defn. of the cekatS is an organization that arrogates a legalized monopoly of coercive force over an arbitrarily circumscribed geographical territory, and that gains its revenue mainly by theft.
To understand the cekats better, read Rothbard's book, and his three essays "Justice and Property Rights," "The Anatomy of the State," and "War, Peace, and the State."

I still remember the instant I became a libertarian--halfway through the first paragraph of "The Anatomy of the State." At that moment I realized I'd been lied to my whole life by all my teachers.
Government is not "We the People"--it's a criminal entity.
Obama"care" is just the latest variation on the Amerikan cekatS.

[Boonton]

"The chart probably masks more than it reveals, but that's a key point. No corporation in the world has an org chart anywhere near as nasty as that of Obama"care"

But if you were to produce a chart of, say, the entire cell phone market you'd produce something equally as nasty with squares and circles for all the internal departments of cell phone makers, providers, regulators, retailers etc.....everything from the local zoning board who approves a new cell phone tower to the street vendor who hawks prepaid phones.

The question is, though, why would you want such a chart? A company's org chart is useful because it helps you know whose the ultimate boss, whose in charge of marketing, whose in charge of HR etc. Does this chart say anything useful? Would a pharma executive use it to understand where reimbursement rates will head in the next year? Would an unemployed woman who just found a lump in her breast use it to know where she should seek insurance or even whether she should talk to a doctor least she be documented with a 'pre-existing condition'? No not at all. Like the recent chart on the Afghan war or my hypothetical 'cell phone industry' chart, visual stunts like this aren't very informative at all unless the information is that human interaction is highly complicated. But then that shouldn't be news to anyone.

[Boonton]

And, of course, I could just as easily recreate the chart by making Patients, Doctors and Insurance companies really big, make all the gov't boxes really small & eliminate some of the stupid boxes (for example there's a box in the lower right hand corner that just says "Only Medical Expenses above 10% of Income are tax deductible" as if individual sentences were now government agencies by themselves).

That restyled box would be more accurate in the sense that the bulk of individuals are going to see little or no change in their health coverage making the complicated lines little more than background noise.....like the wiring harness in your car that is nicely tucked behind the dashboard.

[Niko]

Probably if you torture the numbers enough, they'll look as you please.

@Boonton:
You skipped this from Bill:
"is the fatal split between payment and receipt of service when the State provides a service."

[Current]

I've designed components for cellphones, it certainly is a complex industry. But, most of my interactions are local. There are many organisations and people involved overall, but generally each group need not communicate with very many of the others at once.

As computer programmers would say... It's not the size of the entity relationship diagram that matters its the degree of coupling.

[Lode Cossaer]

The difference is between this chart and the cell phone industry is very simple: you pay and you get the service. What happens with the money; you don't care.

But this chart is you get the service, someone else checks wether or not you are allowed to get the service, someone else pays, etc.

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Oh God. I read almost the whole thing til I realized it was a joke.

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The difference is between this chart and the cell phone industry is very simple: you pay and you get the service. What happens with the money; you don't care.

But this chart is you get the service, someone else checks wether or not you are allowed to get the service, someone else pays, etc.

I have the same views, thank you! While each person's point of view is different, but I think he did and I have a lot in common.

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Great job here. I really enjoyed what you had to say. Keep going because you definitely bring a new voice to this subject. Not many people would say what you’ve said and still make it interesting. Well, at least I’m interested. Cant wait to see more of this from you.