DogGone,
Thank-you for your congratulations… I’m not looking forward to the sleep deprivation…
Actually, I shouldn't say that. It really depends on the baby. Is this your first? Our current newborn is #3. She is doing very well with her feedings (gained back all the weight she lost in the hospital), and at times sleeps for stretches of six hours. If this is your first, I don't want to freak you out or anything.. :) I am losing more sleep because I juggle the family with three jobs.
Thank-you, also, for your excellent post. It is certainly working my faculties.
Same here. I have to say that I think I see more clearly where we view things differently.
That is why I mentioned that I had equivocated between a specific item and the category. I’m going to clarify that statement to get at what I mean. Food items normally do conform to the law of demand. Many healthcare items and many healthcare services do not. What do I mean by normally? Normally means absence a general famine. When there is not a famine the substitution effect takes over and reduces quantity. Tomatoes are too expensive so I buy apples. In many, but not all, cases the substitution effect is largely absent from healthcare items and services. If a bone marrow transplant is needed I cannot choose a hip replacement instead.
Ahh, I see what you mean now. And I agree we should stay away from mixing the entire industry (healthcare) and a single product (tomatoes). I'm with you on that. But there are points of disagreement. But first, another point of agreement. I believe we are on the same page in regards to natural disasters, things like a famine due to crop failure or massive storm damage. You asked this of me before, but I don't believe I answered it directly: "In a famine situation demand is inelastic. In a famine, what do you think the government should do? Nothing? Let those who have the money pay for it and get it? In answering this question I'd appreciate knowing how this differs from healthcare."
I feel it is perfectly fine to supply aid to areas and populations at times like these. And I think this position is consistent with a libertarian ideology. But there is a big difference between aiding during times of disaster, and providing ongoing, continuous subsidies each and every day as a matter of policy. But still, any government aid should be structured in a way that it doesn't mess with the free market in the area. That is, any aid should operate within the market itself and it should be focused. I know that is hard for government to do. Otherwise it would send the wrong message - that people shouldn't actually take care to insure their property. People aren't stupid. If they see a bailout all the time, it causes them to adjust their view of risk.
A good example of this would be what most people consider "price gouging" during times of disaster. The price of a good contains a lot of information about supply and demand, and it acts as a signal for both the supplier and the consumer. When its adjusted during times of disaster, that adjustment can cause more problems and suffering than what otherwise would have been. Let me give you an example: I lived in Florida as hurricane Andrew passed through in 1992. I wasn't near the most damaged areas (I was far north of Miami), but we did get a bunch or rain and wind. After it was all over, there were some people selling gasoline for a high price (I think it was $15/gallon, but I can't really remember the exact number). I remember this because it was on the news. We saw long lines of people looking to get some gas for their generators and cars, and they were paying the higher price. But after a while, the police came by and took the men away for price gouging - taking advantage of those poor people in the time of a disaster. As they drove away, the line of people all clapped…… then they went home cold and without the gas they needed to stay warm. Something similar happened just a year a go with hurricane Sandy. Congress did vote for a huge relief package for New Jersey, and the news acted like it would all be OK. But months after the relief package was passed, there were people still without power, and there were still gas shortages within the affected areas. Why? Because the price wasn't allowed to rise on a good with seemingly inelastic demand (the demand didn't stop - they wanted to purchase the same quantity, and they couldn't substitute it with another good, and price wouldn't have been a factor). It should have been allowed to rise with no regulation. Yes, people would have flocked in with their own containers of gas and sold it at very high prices. But that high price would have been a signal to suppliers: "Make lots of money here!! Get gas to this area! We need it!" As the gas became available again, the price would then fall. In the mean time, people get what they need. This is in contrast to the federal goverment throwing money at it, which left people out in the cold (literally).
This is a good transition into healthcare - back into the law of demand. I agree that for some goods and services, you can substitute with something else, and for others you cannot. However, I don't feel it makes the market "special". In the example of my wife, seeking a chiropractor, you mentioned that the demand from our perspective was inelastic - that is we were still going to seek out the services no matter what. But that's when a market is needed the most. Yes, it really may be the case that we can not substitute a chiropractor treatment with some other alternative, but we can substitute providers! My wife needed that treatment, but even though she was in pain, she (not me) made the decision to get the heck out of there and seek out a competitor. Now let's assume for a moment that we went home and found no other competitor with a cheaper price. What do we do then? Do we throw up our hands and declare that the market just failed? No, the price, as it does with gasoline during a hurricane, holds important information. It is telling would-be providers of chiropractic services, "Make money here! Come provide this service!" The result would be, over the long term, more chiropractors and a lower price with more real availability to care of that sort.
That is why I was bringing up monopolies in my previous post. In the cases of products that are not subject to substitution, and products that are needed, rather than wanted, and therefore would seem like the law of demand is suspended, there is only a real problem if there is the customer can't go somewhere else to get the product.
In summary, I don't think inelastic demand really is a problem as long as there is competition. It underscores the importance of a real market. It also cuts to the core of my issue with ACA and single payer - it eliminates the competitive forces. For competition to really work you need 1) competitors, and 2) consumers that discriminate between competitors on price.
It really is a special market. Many items and many services have highly inflexible demand and are not subject to the substitution effect. I’m not going to try to argue all the factors of why it is so high… I’m nowhere near knowledgeable enough to engage that debate. I’m arguing, though, that it is a special market. Government involvement can have favorable or unfavorable effects on the allocation of services, on pricing, and on quality of delivery. However, government involvement does not change the fundamentals I’m referring to. It can be a countervailing force, however.
I don't think I should repeat too much. Many of the things I wrote in the previous section apply here. For those goods or services that view as inelastic, with no substitution, can a consumer get the good or service elsewhere?
Curious: how do you feel about car parts? If I want a new alternator for my 2004 Mitsubishi Outlander, I certainly can't substitute that part with a carburetor. I can't even substitute it with other alternators. I need one made for my car only. But its a good thing that I don't need to get it from the manufacturer. There are substitute providers, and so I pay less.
Upon reading and rereading your post, I think that after giving an excellent explanation of inelastic demand you then fail to use it correctly. When economists routinely write about inelastic demand they are referring, as you noted, to “where the demand doesn’t change so much in relation to price.” Inelasticity of demand has an effect on market fundamentals and it doesn’t have to approach perfect inelasticity for this effect to be dramatic.
Hmmmm.. Perhaps I did use it incorrectly. I wouldn't be surprised if I messed it up a bit. It was 3 AM after all. It'll happen to you too soon…ooops.. never mind, I shouldn't say that… don't want to freak you out. :)
Can you expand on what you mean by "market fundamentals"? - it is an overused term and I'm not sure what you mean by it. What effects are you referring to? Higher price?
I agree that a monopoly distorts the market effect, of course, as you note in your illustration of the desert town. (A strange town legislature that would grant a monopoly to an essential service but fail to regulate it). It is convenient to your argument that the desert town suffered a monopoly due to government interference. However, it does not have to be so. Let’s take this same town with no government interfering in the control and distribution of the water supply. An individual puts the capital into digging the well. He then creates the distribution network to deliver the water. He has a natural monopoly due to being first to market and to the high barrier to entry for any competitor. It is not perfectly inelastic at any price point as people would, at extreme prices, take tankers to other towns, walk miles to get water, etc. Nevertheless, the market forces are distorted because there are no easy substitutes, the demand is highly inelastic. After all, in the free market this entrepreneur should and will charge what he or she can.
Now, I’m not creating a straw man here, I know you weren’t arguing that monopolies are only caused by governments. I merely wanted to illustrate where government interference is required in a market distorted by highly inelastic demand. (Note: we should not confuse inelastic demand and inelastic need. It does not have to be a need, as in our discussion, to distort the market)
Like I said, I like to use illustrations, but I know each illustration has its limits. They never correspond to reality in every way, but rather just a few ways. But I am glad the illustration didn't blow up on me. I have you to thank for that because you didn't take it too far beyond what it was meant to illustrate. I agree with your point that there might be high start-up costs for a new well owner. Nevertheless, the barrier will be broken quite easily when the price rises. It will send a signal to others to risk the cost to start another well, or take out a loan for start-up resources. The only way to prevent that from occurring is to legally prohibit it. Up to that point I think the illustration is sound. But if you go too much farther, it starts to unravel. For example, you might say that it seems odd a legislature would do such a thing, seeing that they would be voted out next election cycle and replaced with people that would lift the drilling monopoly. I think my main reason for bringing that into the illustration is that we have now, in our current US economy, a whole heck of a lot of companies in bed with the government. They go to the government to ask for special privileges usually under the guise of "helping the middle class". In reality, its just to try to get law to step in and limit competition.
Your monopoly illustration is analogous, as you suggest, to drug companies with patents on life saving medicine. (Side point: monopolies cause price distortions which cost the consumer more. However a monopsony can reduce prices as is widely seen in state run healthcare.)
I am very skeptical of that last statement. In the case of a monopsony in healthcare, the state declares it is the only payer. All the providers need to come to the table and give a good deal! No state contract for those providers that do not give a good deal. This works for a while, but those companies that are outbid will soon go away (there is only one payer after all). Effectively, the competition is eliminated and a monopoly is created. The last company standing then can raise prices.
But, all of this is beside the point. The inelasticity of the demand (quantity) presents a strong resistance to natural free market forces. It does not require a monopoly and does not require a lack of supplier choice for a given service or item. What is requires is a poor elasticity in the QUANTITY demanded despite any given price for a specific service or item. This is where I believe you err: “I would say you are right only because government subsidies necessarily discourage people from the activities that would make it elastic.” I agree that government subsidies discourage people from making sensible market driven decisions about healthcare which further compound the problem. Your story about your wife’s need is illustrative of the value of deductibles and copays in helping shape efficient consumer behavior. We are not as far apart as you might think.
However, although you made a smart price decision your wife’s demand was highly inelastic. At the end of the day, the demand was still 1. You had a choice of suppliers and a choice of prices. That did not mean you had elastic demand. Of course, given an inelastic demand you will still make a smart price choice. But, the quantity was not affected. You were not able to say, well, at that price I will just get a drug instead (see, I’ve learned about the restrictions on drugs for pregnant ladies!). I believe you are mistaking consumer choice in a given buying situation among prices and suppliers with the demand itself.
The central question is not whether we can ensure that there are market forces at play to ensure consumers make better price decisions (I believe the ACA encourages copays and deductibles???) but whether the market is special because, as I claim, it is subject to highly inelastic demand.
Inelastic demand is an effect even when there are choices of suppliers and prices. If you did not find a less pricy chiropractic service, in fact, if you found that all the others were 10% HIGHER you would go back to that practice and get the procedure. The sticker shock would be the same. Your power to negotiate a better price for the product would not be.
And here is where you need to flesh it out. When you say, it "does not require a lack of supplier choice" - for that statement specifically, please give the economic "why" and "how". Step through it for me. Remember, we are trying to answer whether or not a product with inelastic demand makes it "special" so that it needs to be socialized. You write about it a little bit above. You said, "I believe you are mistaking consumer choice in a given buying situation among prices and suppliers with the demand itself." I don't think I am confusing them; rather, I am saying the consumer choice matters. The pure existence of a product with inelastic demand doesn't mean its "special" and requires government takeover.
Your last sentence there: "If you did not find a less pricy chiropractic service, in fact, if you found that all the others were 10% HIGHER you would go back to that practice and get the procedure. The sticker shock would be the same. Your power to negotiate a better price for the product would not be." - I addressed this in the first section. Yes, you are right. At that moment, for my case, I would go with the cheapest price (the original one). But since chiropractors have been working in this area for decades, we had choice through competition, and a lower price was paid. When the consumer is removed from the cost, however, it has the opposite effect - and that's what I want to avoid.
We still may differ in reference to copays. I don't think copays do anything. I could go to the expensive doctor and pay $30. Or I can go to the cheap one and pay $30. Deductibles are good because for a portion of the policy, the consumer is directly connected to the cost. I think everyone should have just a catastrophic plan - although I am not saying it should be forced on anyone.
Market prices also drive the input costs. At the macro level, I believe the demand elasticity has a particularly strong effect on highly specialized inputs. I can’t pay my employees too much or the market will not bear the cost of our services. However, if the market was less elastic I could. I need my specialized team and so do my competitors. Wage costs could go up until this class of specialized folks were paid the most the market can bear. That occurs in efficient market dynamics too, but in a market distorted by inelastic demand for a highly specialized service (skill) or product that ceiling is much higher. It illustrates why the free market is not enough to produce efficient pricing when the forces are out of balance.
Hmm, but I don't see it that way. I see a highly specialized team getting paid a lot of money. That price signals the future producers of that labor (students looking to find a career) to invest in education so that they too can earn a lot of money meeting the obvious demand for those skills.
I disagree. You might want to say “unless you price fix by law OR ration care”.… Even still, those nations with the most socialized healthcare frequently provide better outcomes for less cost per patient (or by GDP) than the US. Monopsonies are highly effective against natural monopolies and are also a counter weight to inelastic demand (IMHO).
Yes, I concede I should have said "OR"… actually, on second thought we both messed up. It should be "AND/OR". It could be one or the other or both. I need to come back and re-address this statement at another time, maybe tonight or tomorrow. You say "better outcomes" - how can you be so sure? How do you define "better"? Monopsonies tend to make artificial monopolies…
I think you made a mistake there. A glut of services will cause a decrease in price. I think you meant that price fixing causes a decrease in services. We have seen this in Canada where some specialists move to the US where they can make more money and operate with greater freedom. Your point is valid. It is a good argument against a single “invisible” payer. I take your point. However, I counter that the argument that prices will naturally fall in a free market is incorrect due to the forces discussed above. In multi-decade live examples in country after country central price negotiations and fee schedules have NOT lead to poor outcomes.
The moral argument is that when there is scarcity of supply of something critical to live and limb the market is not a suitable moral arbiter for the allocation of products and services. It works for ipods not for heart transplants. I argue that morally, those with more money should not be the first entitled to healthcare. Of course, wealthy baby boomers will get plenty of hip replacements in a market driven system. However, the underprivileged child will not necessarily receive the needed treatment. I believe the moral duty is to remove "not" from that last sentence and it takes collective action to make that possible.
DogGone does not have all the answers. But, would you agree that this is a special market? Maybe, you do not like the options of a single payer, single insurer, individual mandate, etc; However, do you still feel the free market, absent government interference, will lead to reduced prices for items and services across the board in healthcare the way it does in fast food and home electronics?
Ahh, but I don't think I made a mistake. But I would say that I was severely unclear, LOL. I said, "you can see it will cause a glut in services and an increase in price". The glut of services is caused by the distorted price from a single payer, but there is no downward force on the price. A single payer will make it look like, from the perspective of the consumer, that the cost is low (zero). They will flood into the doctor. The doctor will start to raise prices, and most likely expand. After all, from the perspective of the doctor, its a huge increase in demand (looks like healthcare might be responding to the law of demand :)). New doctors will come into the market to get in on the boom. But, the consumer is not connected to the cost, so there is no downward pressure on the price. No doctor will have any reason to lower the actual price of their servies, only increase. It will continue to rise and the boom will continue - that is until the benefactor, the single payer, can't maintain the cost. Then comes the price controls AND/OR rationing.
I have enjoyed these posts!
MMM