X-Message-Number: 5080
From:  (David Stodolsky)
Subject: Re: Non-cryonics issues, Stodolsky, anti-big-government, etc
Date: Tue, 31 Oct 95 16:59:11 +0100

In Regards to your letter <>:
> I have to put in my 2 cents' worth.  Bear with me, it touches on cryonics 
> issues in the end!  Stodolsky wrote:
> > 
> > For comparison, in Denmark the doctors are, for the most part, organized
> > in a Union which bargains directly with the Association of Counties over
> > salary, etc. There is virtually no involvement of lawyers, including those
> > associated with insurance companies, etc. in medical affairs. The
> > elimination of this type of overhead results in about twice as much
> > medical care per unit of expenditure. 
> > 
> This in itself is an argument in favor of government involvement and 
> regulation.  I've also lived in Denmark for five years, and am familiar 

This is not quite accurate. Both the Doctors' Union and the Association
of Counties are voluntary non-governmental organizations (even thought
one of them is composed of local governments.) Certainly, the State
has helped set up the playing field, and provides financial support
to a mediation service, which helps the system to function, but direct 
State involvement is not regarded as as appropriate in labor - management 
negotiations/disputes. 

I would characterize people's attitude toward government in Denmark
as "healthy disrespect". A democratic system can be more or less anarchistic,
and Denmark is currently at the anarchistic extreme. There is even
a "Free City" within Copenhagen, where taxes are not collected. A
recent academic study of the administration of this "Free City", gave it
high marks, as compared to the ponderous Copenhagen Municipal bureaucracy.

This is the flip side of the coin. If people don't want big government,
then they organize their own institutions. The idea that the market
can solve all problems has never been widely accepted in Denmark.
The attitude is that if power has to be centralized, then set up as
many checks and balances as possible, so that power is almost, but
not quite, impossible to exercise. Any move by the State to force
anybody to do anything is generally regarded as a sign of government
incompetence.

The exceptions to this are those services seen as essential. Health
care for all is seen as such a service. This means the government has to
provide the money to pay doctors, to educate new doctors, etc. The
actually delivery of services can be private, but it is the government
that has the responsibility to see that services are delivered. 

The health care crisis in the USA can be seen as a result of a failure
of "industrial policy". The whole idea of industrial policy has been
rejected in the USA. The effect of this has been that development
has been directed by market forces and unaccountable power blocks,
in this case the American Medical Association. When it comes to the
education of professionals, which may take ten years or more, market
forces can be unwieldy, thought they are theoretically adequate.
The argument presented earlier is that the AMA in attempting
to maximize economic gains, precipitated a situation detrimental to
the profession and patients. 

This has been exacerbated by a health care system structured in a
way which led to no one being interested in controlling costs. Insurance
companies were happy with higher costs, doctors were happy with higher
costs, and patients, who didn't pay directly, were also not cost sensitive.
This meant an inevitable cost spiral. Since it is "cost" as opposed to 
"care" that is controllable in this type of system, it is the patient 
that has to suffer when the crunch comes.

dss

David S. Stodolsky      Euromath Center     University of Copenhagen
   Tel.: +45 38 33 03 30   Fax: +45 38 33 88 80 (C)


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