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French healthcare vs the NHS
From the Sunday Times:
British people have been infected with the welcome American attitude to competition and customer service. If something isn’t good enough, they complain. In Europe and especially France, people still meekly put up with being sold bad food and bad consumer products and services.
Despite France’s claim to one of the best healthcare services in the world, the only appreciable difference with the NHS appeared to be cleanliness. Instead of the mute mop-draggers, there were armies of cheery diligent cleaners everywhere.
It is not too ridiculous to suggest that while French hospital managers could certainly teach their NHS counterparts about managing a cleaning service, healthcare managers here could teach them a thing or two about concepts of consumer rights. It might help them to treat all their patients with a bit more humanity.
The thurst of the article relates the author’s personal experience of French healthcare. I don’t know how representative it is, but I can imagine the muted and indifferent approach to patient service being true. The author may not have been happy, but what of the French themselves? The system seems to ‘work’ in the sense of delivering good outcomes in aggregate. Do the French focus more on preventative medicine, meaning that less attention is given to the hospital part of the treatment? Do the French take a particularly existential and fatalistic point of view when it comes to health, at the same time reasoning that plush carpets, soft music and an army of nurses wearning synchronised swimmers’ smiles, is unceccessary.
What I do take from this anecdotal story is that you can’t just look at healthcare (at least in the developed world) as a purely economic system that can be exported and bolted on to the infrastructure of another country. Cultural expectations, the prevailing attitude to preventative care, family and other social structures etc. are not independent of the ‘official’ healthcare system in determining outcomes.
Paternalism on a slippery slope?
One of the common complaints against the idea of ‘libertarian paternalism’ - the idea that the state, or indeed the market should help us overcome our biases - is that it’s a slippery slope. Mandate that fruit be served before cakes in the cafeteria (because want people really ‘want’ is to be healthy but their short term desire to binge gets the better of them) will lead to all sorts of increasingly oppressive mandates.
I’m not convinced. The slippery slope argument can be summed up the following way:
Man: Will you sleep with me for a million dollars?
Woman: OK
Man: Actually, how about 10 dollars
Woman: get outta here!
Man: well, you’ve expressed your preferences, now we’re just arguing over price.
In the case of libertarian paternalism, it’s also often forgotten that something as benign as changing the default on a 401(k) is welfare improving, even though I’m sure Richard Thaler would concede that it’s not the optimal policy, in any normative sense. As one commenter at the economist blog points out, perhaps opting out is optimal, if the (absolute) returns are enhanced, but when you’re turning down employer contributions, and returns follow a random walk, that’s a difficult argument to maintain.
Finally, would Professor Rizzo have a problem if the choices under soft paternalism were made through market mechanisms, as in the case of Swedish social security*?
The simple fact is that our brains and psychology are largely wired to prefer short-term pleasure to pleasure in the long-run. But that’s not to say that all short-term choices are poor. I’ve had great fun blowing money on an expensive meal; then regretting it some days later, but still, actually, thinking that “it was worth it”. But at other times, I really do regret it.
That’s the challenge for any sort of paternalistic policy, whether implemented by Government or induced by the market. There are some short term pleasures that we want, but don’t want, but actually, we really do, probably. How do you differentiate these from pleasures that you think you want, but probably don’t?
addendum: confusion over policy may also arise because of the term ‘preference’. In the Samuelson sense, preference equates with choices, but much literature interprets preference as a value, desire, or thought. This needn’t be a problem, in fact multiple interpretations of the word highlight that there may be a wide range of applicable ‘preference’ based approaches, invoking different characteristics of the individual, depending on context. Time may be one such consideration, in combination of irreversability of choices (e.g. at 65, you just can’t decide to get a pension) where we may want to have a different approach to say, choosing the wrong sort of milk.
* Design choices in privatized social security systems: learning from the Swedish experience, Cronqvist, H, Thaler, R. H (2004) AER, Vol 94 (2) pp424-428
Kate Moss - development economist
Personally I can’t understand the excitement of cut price ladies’ clothes range, ghost-designed and modelled by a truculent Croydon superstar whose wealth appears predicated on the ability to look OK and walk, and turn.
I’m even more confused by the thousands who’d queue overnight just to get their hands on this tat. However, it’s their preference, so I can’t complain, unlike the kind of opinion that I’ve been hearing and reading; it goes something like this:
Those people should be ashamed, paying money to an already rich retailer and supermodel. They would do better to give it to the poor of the world.
Or the alternative
What has Kate Moss ever done?
The first point belies a whole lotta confusion. Because most of the money is going to already wealthy people, then that can’t be good. But look, the clothes are probably made in Vietnam or India, so some wages must be flowing back there. If those people hadn’t queued to send money back to poor workers in Asia, then that mone would have found its way into the pockets of Blackpool hoteliers, Croydon barstaff or villa owners in Tuscany. Of course, the bulk of the money is going to Philip Green and Kate Moss but they have talents that can’t be easily replicated.
In fact, the size of the queues should have factory owners in Hyderabad rubbing their hands because it suggests a new trend, especially following Madonna’s foray into fashion with H&M. Other superstars may be tempted, resulting in more work. Now it is true that the returns to madonna and her ilk will increase much faster that those to the garmet-makers, because there’s a limited supply of superstars but presumably quite a lot of slack in the labour markets where these clothes are made. But is that widening inequality such a problem if it lifts more people out of poverty?
As to what Kate Moss has done? Well, amongst other things, she’s proven to be a hugely effective channel for diverting funds to Asia. There’s a great experiment that could;ve been done with the topshop queue. Let’s say that total revenue raised is £1m and let’s assume that £1000 goes back to the Indian workers (that’s 0.1%). Now, how much would’ve been raised if somebody had rattled a charity tin in the face of those eager consumers? Yet Miss Moss magically convinced people to do exactly that. And even better, the workers get the benefit of having a job, rather than receiving charity.
Barack Obama feels like Morrissey
Remember when you were in school and really liked the Smiths and everybody else said how rubbish they were, and that made you feel even more privilged to like them. And then they did ‘Panic’ and it was played at all the discos and so everybody liked them so now you didn’t so much. You thought of reasons why you thought they were now rubbish and had ‘lost it’, even though you secretly thought they were still pretty good?
The point being, concealing your preferences harms your utility, or in more common terms, removing nose from face just to spite said face is a tad illogical. So what do you make of this from the FT?
Black activist websites are debating whether he is really “black” and they are not joking. His mother was white, they complain, and he is not descended from slaves. According to the polls, black voters still prefer Mrs Clinton.
Would black voters really not vote for Obama when it came to the crunch? Perhaps Bryan Caplan is right.
