No. I’m quoting from the WHO rankings of health care systems. They are indeed looking at the entire system.

And it is dogmatism when if think the word _actually_ in that sentence adds any value. As you said, there are arbitrary assumptions about how the system works that come before the choices people make. The choices people make given one set of arbitrary assumptions are not the choices people would make under other assumptions.

For example, if the US system was more free market than it is, people could have the property right to sell their kidneys to pay for an operation, cash in their health insurance and spend the money on TV, and so on. Are the choices they would make in that cyberpunk dystopia somehow more ‘actual’ than the ones under the 2009 system, the 1979 system, or any other variant of the system?

Property-right systems are kind of an inherent monopoly – at least I have never heard of any proposal to mix them in the same society.

If the property-rights system arbitrarily decides that everyone needs to have one eye plucked out to save money on glasses, you will probably get a revealed preference for it being the left eye. Inside the system you you can’t say any more: you have to take some kind of paternalistic liberal elitist view to come to the conclusion that that is maybe not the right set of choices to be offering.

Yes, but only for the few. Most of the US poor have only one form of healthcare: through ER. Most of the middle classes have to wait until they get the permission from their insurance company before they get the treatment. The rich few can get treatment immediately since they can pay on the nail.

When you look at US healthcare as a whole – rather than for the privileged few – they are not much more responsive than the NHS.

As an American commentator in the FT put it a few months back:

“Why does it cost the US about $7,000 per person annually for our incomplete national healthcare system, while other major economic competitors provide universal coverage for about half that?”
http://www.ft.com/cms/s/0/4049dac4-8d05-11de-a540-00144feabdc0.html?nclick_check=1

For a comparison of average life expectancy at birth in OECD countries:
http://oberon.sourceoecd.org/vl=1780725/cl=41/nw=1/rpsv/factbook2009/11/01/01/11-01-01-g1.htm

Say for example.. if MANY die from GANG violence — THAT would be included.

If they die from CAR CRASHES — that would have NOTHING to do with it

Tim W: funny how you suddenly measure ‘responsiveness’ over efficiency now. For spending that much money you’d expect something to be extra, if not value for money!

But funny how your priorities keep changing.

Cassidy: How Markets Fail, is not particularly about healthcare market failures but about the array of reasons why market fail and presented in an accessible way, with contemporary examples, for general readers, unlike much recent professional literature, which is highly abstract and awash with (often degree level) mathematics.

The rhetoric of Free market champions seldom mentions market failure despite the origins in a professional literature going back to Pigou and Marshall, around the beginnings of the last century, or even, arguably, to Adam Smith in the 18th century and he was the original apostle for the benefits of the invisible hand of the market.

Francis Bator’s survey: The Anatomy of Market Failure takes us back to the state of the art 50 years ago: http://instruct1.cit.cornell.edu/courses/econ335/out/bator_qje.pdf

My guess is that most readers will be hanging on with their finger tips attempting that.

Then along came Coase in 1960, who argued that externalities could be left to private bargaining, without government intervention, providing the costs of bargaining were sufficiently small – which is hardly true of climate change or a host of other causes of failure in which there are many polluters and/or many adversely affected by pollution:
http://www.sfu.ca/~allen/CoaseJLE1960.pdf

And that literature took no account of failure mechanisms inherent in financial markets. Keynes and Nobel laureates Joe Stiglitz and George Akerlof deserve credits for that.

Unfortunately, many of us have to put up with Free Market champions who are mostly just ignorant.

I agree that both sets of rights are artificial. But it’s hardly market dogmatism (Paul Samuelson who came up with the idea of revealed preferences was hardly a market dogmatic) to point out that if we observe people with the choice to get what they want we’ll find out what it is that people actually want.

Whereas if we observe people who do not have that choice, it being made by others, then we’ll not observe the individuals getting what they want: they’ll be getting what those making the decisions think they should want.

I’d also agree that there are indeed times when people shouldn’t be getting what they want but what they ought to, by some other standard than personal desire, want. More aircraft carriers and less homeopathy perhaps?

The US health market delivers ‘responsiveness’, at the cost of both overall outcomes and inequality. This comes down to doing whatever the patient/customer pays for: typically screening and diagnostics on the healthy.

That’s a pretty natural market outcome, given a certain pattern of property rights. You’d get something similar if geologists worked for landowners instead of oil companies: they would search for oil in the areas their employees owned, rather than where-ever the oil was most likely to be.

The market dogmatism comes when you define the logical consequence of that particular set of property rights (i.e. individual ownership of a health insurance plans, versus national-level citizenship rights) as inherently ‘natural’ or ‘modern’, telling you something universal about what people want, rather than just a consequence of explicit political decisions.

Although part of this is artifact of the question. The US has a strong pro-Life movement and they count every dead baby as a dead baby. A lot of other countries do not. The country I am most familiar with, Germany, does not count a dead baby as part of its infant mortality unless the baby lives about two weeks. Needless to say this keeps their figures low. Cuba probably does the same as does most of Europe. In turn this drives the average life expectancy down in America. It does not take many dead babies to lower that average a lot.

“The Netherlands win the 2009 Euro Health Consumer Index (EHCI), for the second year in a row – the first time this happens since the EHCI started in 2005 – and with an outstanding margin. Nevertheless, Denmark keeps its runner-up position from last year. Besides the Dutch and Danish system there is a small group of strong performers: Iceland, Austria and Switzerland. Luxembourg leaves the top league, losing 5 positions. Estonia, “the wonder boy” of the EHCI, drops significantly but anyhow delivers value for money healthcare.”
http://www.healthpowerhouse.com/files/EHCI-2009-general-Press-release-final.pdf