To fix our health care system, we need only set up a planned economy

“Instead of Work Requirements, Why Not a Jobs Guarantee?” (Atlantic) is kind of fun. The author recognizes that the centrally planned Medicaid system now consumes more money than Americans want to spend (though many are unaware of it!). The proposed solution is a fully planned economy for a subset of Americans in which the government provides a job for anyone whom private industry doesn’t want to hire (e.g., at the new $15/hour minimum wage?).

[Separately, the January 19, 2018 issue of The Week carries an article about the UK’s National Health Service running out of cash, space, etc. It quotes some Brits saying that the NHS was designed for a country of hard-working laborers who died young and now is dealing with “sedentary workers who eat too much and exercise too little” and then keep living more or less indefinitely.]

12 thoughts on “To fix our health care system, we need only set up a planned economy

  1. Philip, what do you think of the New Deal, particularly the WPA? I learned about in in school as a “ make work” program similar to what this Atlantic article proposed. But some of the results of the “make work” programs, such as trails in national parks, still benefit people. So maybe this isn’t the worst idea out there.

  2. Obviously there are some awesome things that were built as part of the WPA, but a WSJ reporter argues fairly persuasively that the expansion of the Federal government during the Great Depression slowed the recovery. See

    (a few months after I wrote those, the U.S. melted down, the government expanded, and we had another painfully slow recovery!)

  3. It doesn’t seem as though there is as much demand for low-skill labor as there was in the 1930s. But maybe that is simply because (a) labor costs are much higher, and (b) the option to collect welfare is much more attractive than it was. So perhaps there could just be a flower-planting and weed-pulling project! Certainly right now it is not possible to find anyone to do this in the Boston area for less than $25/hour.

  4. That stuff about the New Deal is sort of religious belief that people enjoy believing.

    Also, most Britons appear to think that the NHS is doing a great job, delivers great value for the cost and just needs more funding. The NHS is probably the most popular institution in Britain, just as Medicare is in America The statistics do show that similar countries like France, Germany and the Netherlands spend a bit more per capita.

  5. “It doesn’t seem as though there is as much demand for low-skill labor as there was in the 1930s. ”

    It’s because unlike in the 1930s, most of the low-skilled labor would be domestic or administrative and Americans have longstanding historical issues with domestic labor. And on the administrative end, people would rather be exploited doing lower-skill administrative work for corporations at part-time hours and often barely above minimum wages (the “pink collar ghetto” was a phrase that you used to see a fair bit) than do clerical work for household employers at higher wages.

  6. Interesting. Is there a counterexample somewhere of a country having an analogous depression but recovering more rapidly as a result of not expanding its government in the way the US has done?

  7. > So perhaps there could just be a flower-planting and weed-pulling project!

    Someone agrees:

    From about 125 million people employed in the US (, 14 million are employed directly or via grant/contact by the Feds ( Another 16 million by state and local governments ( No idea how many contractors they employ… That’s at least 30 million people, or about 1/4 of the employed workforce. Which consumes 40% of GDP. What fraction of GDP originates from the take-home pay of these 30 million (and non-take-home pay in the form of medical insurance payments and retirement plan contributions)? What does that leave? Less than half of GDP not *directly* controlled by the government. But certainly influenced by it in myriad ways. Farmers and agriculture are not “directly” controlled by the government, but regulations sure seem to greatly influence what is grown, where it is grown, how it is priced, etc. How many of the half-million CPAs are needed only to comply with tax collection?

    Looks a lot like we already have a planned economy, masquerading as free-market capitalism. Just the medicaid bit was a bad plan, and now needs a new plan. Everything is fine, carry on.


    Got your attention? Good. Because it is absolutely true!

    For Healthcare to be affordable some people must do without it and some of them MUST DIE! Sounds harsh? That’s the unfiltered truth if you can handle it! Why? Because IF THERE IS ALWAYS AN ABILITY AND WILLINGNESS TO BUY SOMETHING REGARDLESS OF PRICE, IT’LL NEVER BE CHEAP. Will I sell a car for $10,000 if government will find a way to buy it for everyone at $1,000,000? If society will find a way to pay for Healthcare regardless of the costs, healthcare will NEVER be affordable. It doesn’t matter whether you are making the rich pick up the tab for the poor, the young pick up the tab for the old, or the government pick up the tab for everyone. As long as somebody always pick up the tab and you have just ensured that there will be no effective price competition and it’ll be unaffordable (overall) for society. It’s that simple.

    Ask you doctor how much that test is going to cost or how much the prescription is. If his answer is “I don’t know” and to look at the back of your insurance card for the co-payment, you can be 100% sure Healthcare costs will remain out of control. If one day, you see $29.99 and $24.95 signs come up in front of competing clinics and hospitals advertising $24,995 flat fee with $1000 get well cash back for Heart Surgeries, you can be 100% sure Healthcare costs will no longer be an issue!

    ● Healthcare Reform shouldn’t be about covering more people with Insurance.
    ● Healthcare Reform should be about LOWERING HEALTHCARE PRICES, period.
    ● There must be effective and robust price competition in healthcare.
    ● Day-to-day use of Healthcare services MUST be an individual responsibility.
    ● Insurance MUST only be for the bank breaking events not routine benefits.
    ● Instead of free stuff, repayable Healthcare Loans should be the safety net.
    ● All healthcare expenses should be tax deductible.
    ● Make Medical School (MD) should an undergraduate program
    ● Clinical malpractice and frivolous lawsuits must be reigned in

  9. Why can’t we stop making fake wars and sending our young kids to die? If we can even save 30% of the money we are spending on our weapon collection, a lot can be solved.


    That’s not a problem. People die every day and that will never end.

  11. If you want to go socialism, you need to go all the way. Problem with guaranteed jobs with fixed salary is that it encourage people to work as little as possible without getting into trouble. East Germany had the same problem, and found a solution: they’d put people who refused to hit its (admittedly very low) productivity criteria into jail.

  12. “Demand for low skill labor” …. a few months ago we had a BLS statistician give a talk. She was very excited, they were allowed to develop a new dataset (related to greatly increased SS disability payments). Anyway, she had some great slides.

    One of my favorites broke all US jobs down by training time needed. Basically minutes/days/years. Another breakdown was by salary. Forty five per cent of current jobs have a training time of about 20 minutes, combined with a salary of $8 to $12/hour.

    Seems like there is still considerable demand for low skills labor. Maybe not in Boston?

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