On One Hand

July 8, 2009

The Free Market Healthcare-Rationing Basketball Tournament!

Filed under: Uncategorized — ononehand @ 6:17 pm
Tags: ,

I’m hearing economic conservatives talk about “rationing” healthcare, saying that healthcare is a scarce resource, and the best, most equitable way supply it is based on a person’s ability to pay. That system may not be perfect, they’ll argue, but they think it’s still pretty awesome. Any other form of rationing using the influence of government is worse, because government is clumsy, ineffecient, and caught up in liberal interests like “equality.”

I already have them beat: how about rationing medical based on who is going to die if they don’t get treatment.

(Economic conservatives hate this idea because it is exactly the same as saying “as according to need,” which is something Karl Marx said, therefore evil. I hope Marx didn’t like basketball!!)


You can tell I am a bit of a contrarian when I mingle in economically conservative circles. I happen to be of the beleif that, on the slim chance that there is such a limited supply of healthcare that paying more people to become doctors would never work, it just doesn’t make sense to have one person on a plan that gives him six referrals a month for acupuncture and a chiropractor because of his achy back, when the next person, who can’t afford that plan, has leukemia that she will ultimately die of because of her medical circumstsances. Lets say she does have insurance, but her plan is only useful for catastrophic emergencies because of a hugely unaffordable annual deductable, so she, being a good budget-conscious person, doesn’t get checkups, and didn’t go to the doctor until she was showing bad symptoms. It turned out to be late in the course of the disease there’s a 75% chance that she will die now even with expensive treatment.

I think a lot of people are in denial that this kind of thing even happens, and secondarily they’ll argue that if it does it’s impossible to change things for the better. First they’re not paying attention, and second they’re being painfully uncreative. But that’s because their position doesn’t really come from observations or pragmatism, it comes from a certain ideological perspective on how everything in society ought to be run.

That is: economic conservatives are very attached to the idea of free market capitalism. But in a culture inundated with capitalism’s messags it is easy to lose perspective on what the free market actually is and what it isn’t. We live in a post-industrial society, and the market isn’t based on “labor” and “capital” in the old-fashioned sense; most of our stuff is made in Asia or Latin America, and our economy is based on services, a more abstract category of goods (like intellectual property) and on investing. Investing is key because it requires surplus income and good luck, and virtually everyone needs to do it to retire.

Many will have you think the way the economy works is to give the most money to those most willing to work hard. Now I won’t argue that hard work is a valuable thing to be doing. Unfortunately, we happen to live in a world where people go to college and get a degree so that they’ll have to work less hard in their lives (I sure as hell hoped for that when I went to school), and as much as we want to beleive that only the most deserving people make it, that’s not how things shake out.

People don’t put moral character and determination on their resume. You can write it in, but what employers want to know is what you’ve done and where you’ve been. A little fib here and there, though unscrupulous, turns out to be helpful, though not as helpful as knowing someone in high places – something that depends a lot on the community you were born into. In America, income is not based on work. The people you see at bus stops at 4 in the morning to clean the hotel beds or sweeping our streets – the most uncomfortable and inconvenient jobs – are poor, not rich. I bet the vast majority of people in this country making between $30,000 and $50,000 a year would love to accept a 60-hour workweek for a few years if they were guaranteed a six-figure income, if only they could land that job or its training. I bet the vast majority of people in this country would love to be an invester or be offered a million dollars by inheritance even if they weren’t allowed to spend a penny of that – not even a penny – but simply they invested it, doubled their money in 25 years, and then had to pay the original million dollars back.

Unfortunately our world doesn’t work that way. More often than not the people who make the most money had something other than willingness to work going for them: they had elusive skills beyond their ardent toil and suffering. They were savvy. Innately confident. They had a high IQ. They were able-bodied. They had an expensive education – starting in private elementary schools. They had private tutors. They knew the language of power and business. They got positive feedback to keep them going. They were “cool.” They had friends or family members who knew people. They had a reputable family name. An the end, while few rich people have all those qualities, the mixture of those qualities they had paid off for them. They started out lucky and got lucky breaks.

Capitalism is, in the end, a game. It is your ability to play the game correctly, along with your natural-born talent, that gets you ahead.

Now I am willing to concede that capitalism is all we have to progress in the free world. Communism doesn’t work, and people are ultimately happier and more secure if they have their own private property with the autonomy to do what they want with it. They want the control to determine their immediate surroundings, to choose their job, and if they believe the government or the community mismanages its resources, they are entitled to their own separate savings account or sphere of wealth and to do what they want with most of what they earn. I concede that capitalism is necessary, and even good.

But it’s still a game, that requires natural-born talent, an able body and mind, and a few luky rolls of the dice. Some things are okay to ration as according to that game; the size of the house you live in, the fanciness of your car, the tennis court, the swimming pool, the number of rooms in it can all be rationed that way, I suppose because there’s not much of a better way to do it.

But not life or death. Life or death should not be dolled out so tenuously. So in its place I propose a fairer game, the Free-Market Medical-Treatment Basketball Tournament for Economic Liberty, Market-Based Distribution and Freedom!!!.

Everybody can don their fancy basketball shorts and a tank-top, and it’s onto the court to play!

First thing we do is put everyone in the country onto teams of 6 (five players one alternate) with people who have their same ability level, which will be judged in the pregame period. You get a couple (free!!!) training sessions – you can choose whether or not you go – then other players vote on how good they think you are, and choose what team to put you on. If you drop the ball a few times it might not be good for your placement.

This game is played like every other basketball tournament, and through the tournament’s play, all teams will be ranked against the other teams. They will be ranked from the best players, to the worst. All people regardless of age, weight and physical disability must play. If you’re in a wheelchair – gonna be tough for you buddy! – but this is no less fair than how we ration resources or jobs in the real world. For example if you were born with Down’s Syndrome and your IQ is 60 you’re going to get a banking job, so you just have to try to cut it as well as you can. If you have poor motor skills, also too bad. Those with poor social skills don’t get a handicap at work; they have to find a lower-paying job that suits them. Those with no training in basketball are, similarly, shit outta luck. That was your choice to not get trained there, buddy! Either that or you weren’t good enough to make it to advanced classes. Those without college degrees don’t get a pay bonus to compensate for their lack of knowledge!

But hey – you may say – really old people are at a total natural disadvantage over young people! They were once young, too, one could argue, but even so, you argue; this basketball tournament is a one time deal, and it’s not their fault for the year they were born!

Tsk tsk sir. It’s not a person’s fault for the income level/community he/she was born into either. Some old people might be in good enough shape to hold their own – just as lots of poor people hold their own and get ahead. But we don’t give you automatic pay raises or promotions because of where you were born.

Okay okay, fine, we can throw in a “minority scholarship” for middle-aged folks. They get a few free classes to get them up to speed, and we’ll try to place the ones who give the most effort on teams with younger players who are a little better than they are, so that they are pushed a little harder to get in shape. (The younger players will howl and whine about the “unfairness” of it till our ears bleed. You know, that’s affirmative action, which is racist. So we won’t do it often; just on a few select occasions.)

You say men have an advantage over women? Ah, you already know how we’re likely to handle that.

After the first round of games, we do some 1-on-1 games to see if there are a few individual shooting stars out there who were weighed down by their team, for some additional shakeup.

Okay everybody! Lets play some basketball!

The people who score in the highest 30% of the tournament are our winners. Clearly the most deserving and determined people in our competition – Unlimited healthcare! They get their life-threatening conditions treated, obviously, and if they get tendonitis or shin splints well let them see some physical therapists to work on that, too. They get to see a psychiatrist or psychologist if they need one, and get whatever medication they want. Need an acupuncturist? Go for it! Need some massage work done? We’ll provide that too. Hey — YOU EARNED IT!!!

The people in the middle 40% can get whatever’s left. We’ll try to give them care for the most serious conditions, but if somebody in the top category is having his slipped disc looked at, you aren’t exactly our top priority for that swollen ankle. Sure it looks bad but it’s not gonna kill you, is it? Unless it’s broken, you’re gonna have to wait in line.

Those in the bottom 30% get nothing. Unless it’s, you know, life threatening, like you’re bleeding to death, then you can go to a hospital; but you have to prove it to us. You don’t get regular physicals or screenings.

Sound fair?
Confident you’d do well in the competition?
It’s at least as fair as things are with a totally market-based approach to healthcare. See in our society, we think the best players in the game of life have the liberty to do what they want with their success.

Fair enough for most things, maybe – BUT NOT FOR HEALTHCARE. Call your local representative and ask them to support a Public Health Insurance Option if you want something better for America.



  1. I’d be okay with a public option on the condition that all restraints on private companies be abolished, including community ratings, gold-plated coverage requirements, enrollment “holidays,” premium caps, cross-subsidies in hospital billing to Medicare and Medicaid from private-care patients, state disproportionate taxation of insurance companies, licensing laws that prevent nurse-practitioners from seeing routine-injury patients, and inequitable taxation of self-purchased health care.

    Then I think we’d see which system really does a better job taking care of people in all parameters, but everyone would have an option if the other failed.

    Would you take that deal?

    Comment by jdhenchman — July 9, 2009 @ 11:45 pm | Reply

    • I’d have to know more about what those programs are and what they intend to do, but I don’t see any red flags.

      I wasn’t aware that you were charged any tax whatsoever for self-purchasing health insurance. That would really surprise me!

      However, if some of those changes turn out to be politically unfeasible, I would still support a public option. I wasn’t aware that the federal government had power to change whether or not states disproportionately tax health insurance companies!

      Comment by ononehand — July 10, 2009 @ 6:07 am | Reply

      • One must pay taxes on dollars used to buy health insurance. That isn’t that problematic, except for the fact that employers don’t pay taxes on dollars used to buy health plans for employees. This tax difference (stemming from World War II price controls) is the main reason that our system today is (problematically) employer-centric.

        The federal law that grants states the power to tax out-of-state companies disproportionately is the McCarran-Ferguson Act of 1945.

        Comment by jdhenchman — July 10, 2009 @ 9:19 pm

      • Well I’m with you on that, which you may have already noticed:


        Though I have to say, I don’t have any problem with employers providing health benefits (they’re usually much better than individual plans) as long as its easy to get insured if your employer doesn’t buy in or you are unemployed.

        Also, I think that if there is too much of a political barrier to peel back that tax inequality, it isn’t a substantial enough argument to derail healthcare reform entirely. This can be a compromise to make the package more palatable to economic conservatives, but I would still support a public option if the compromise turns out to be unfeasible.

        Comment by ononehand — July 27, 2009 @ 5:41 pm

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