JayB

i have no idea how the pay system would differ - will i be getting paid by how many students i attract? - if so, then i'm basically just gonna get paid for my services as an entertainer and awarder of easy grades, right? how many kids are gonna want to throw their money in to a hard-driving prick who makes you do homework and what not? Oh, c'mon - let's not pretend that students would be the ones driving this train. Schools that want to attract more students will compete for the best teachers, which would likely translate into any variety of incentives that the best teachers responded to. The teachers would determine what those are through their choices. Seems like total spending on admin and other non-essential staff would offer some low-hanging fruit in terms of resources that could be diverted into teacher compensation, but that could well take many other forms. Not being a teacher, it's not clear to me what people working in the field would value most in an environment where the number of competitors for their services increased dramatically.

i don't see this at all - the price tag for a high-faluting private school is way higher than for a public school - sure, give families the amount they threw into the common pot for education back to them to spend how they will, but it's not gonna get poor kids into anything better than what they left. it might make middle class families just capable of affording a posh school by throwing in extra on top of the voucher, but i doubt it. The utopian vision at work here as with other privatization schemes is that with all of this money sloshing around in parents' pockets, saavy capitalist educators will meet the need by building private schools in the areas where they're needed. It didn't happen. Never mind that the failure rate for private schools approaches those for new restaurants. Hey, if that kid from Compton can't find a school in his area, he can always walk to Beverly Hills or Brentwood and cash in his coupons there. You mean like food stamps? Section 8 housing vouchers? Clearly the people who use these public resources would be better off if they were forced to live in homes, and buy food from, monopolies administered by the government.

i don't see this at all - the price tag for a high-faluting private school is way higher than for a public school - sure, give families the amount they threw into the common pot for education back to them to spend how they will, but it's not gonna get poor kids into anything better than what they left. it might make middle class families just capable of affording a posh school by throwing in extra on top of the voucher, but i doubt it. But we're not necessarily talking about high-falutin' schools here. It's clear that there are schools like Lakeside, Phillips Exeter and there ilk that would never participate in a voucher program because their cost structure and their particular market niche for super-premium educational services sold to super-wealthy parents wouldn't permit it. It's one thing to concede that point, it's another to argue that pedagogy, cost-structure, efficiency, discipline policies, etc are fixed in stone and that no school that only consumes as much money per-pupil as public schools do now could possibly deliver a better education. Somehow the folks operating private schools in Sweden, the Netherlands, and elsewhere have managed to get by with funding that's identical to what public schools get, and there's no reason to suggest that they couldn't do the same here. A separate question is why any group should enjoy a monopoly control over funds that the public provides in a situation where it's impossible to argue that it's a technical monopoly that has to be left in the monopoly's hands. Moroever, if you are against vouchers in K-12, why allow them to persist in tertiary education?

yes to the first question as to the second question, i don't like any of the tax exemption bullshit that churches get, though i know the court has upheld it. tax exempt donations to charities is fine, but not charities who wrap it up in buddha/jeebus/mohammed whatever. it's probably just my angry atheism talking i don't know anything of sweden or norway's voucher experiment - enlighten me, if you can in a 1000 words or less - is comparing our giant heterogenous nation to a tiny homogenous one sound? wouldn't the transition to a voucher system dangerously destabilize the current public schools? schools and the infrastructure already built were designed for large populations which could only decline. future planning would be harder w/ potentially giant #'s of students coming in and out of the system. Other than knowing that Sweden has had a voucher system in place since 1992, that schools that accept vouchers can't charge more than public schools, and that enrollment in private schools has increased from 1% to 10% in general, and to 20% in secondary schools since that time - I don't have much to add but there's plenty to Google. With regards to small/homogenous vs large heterogenous question, I think that the proper question is whether or not there are any logically and/or empirically sound arguments that suggest that letting parents control which school get's their child's tuition money will either be impracticable or make the kids worse off than they are now. IMO vouchers that distribute the burden of examining and evaluating the quality of whatever is being bought with them amongst millions of individual parents and families are inherently more cost effective, scalable, and responsive than centralized bureaucracies that are subject to the limitations imposed by informational and public choice constraints. As far as the infrastructure is concerned, I don't think that we necessarily need to make the well-being of educational infrastructure that may or may not be useful for improving education any more than we need to worry about the well-being of the factory that was cranking out Commodore 64 or ColecoVision consoles at one point. Seems like there's plenty of folks that'd be running schools that'd be interested in using the schools in the event that the government-run schools could no longer afford to occupy or maintain them, but if not I'm sure that someone would find a use for them. Ditto for teachers that no school wanted to hire in a system where the money follows the kids. I generally don't like any tax exemptions, for a variety of reasons (spawning waste and corruption being foremost amongst them), and it's hard for me to find a cause that I like the government subsidizing by any mechanism any less than I do religion. Having said that, the reality is that as things stand now, and are likely to for some time - there are several mechanisms such as tax-deductible tithes, grants and subsidized loans for students attending private colleges, etc that are at least as susceptible to 1st Ammendment arguments as the voucher issue. Until and/or unless those get addressed, it seems like the 1st ammendment argument is a bit of a red herring. I suspect that you're a great teacher that'd probably capture a premium, and take home a greater share of the tuition under a completely voucherized funding regime than you do now. Do you disagree?

That's a curious observation, given that the wealthier your parents are, the fewer constraints that the accident of your birth imposes on the education that you'll receive. The real benefit of vouchers accrues to those who are born into families who are too poor to dream of sending their children to private schools. If you consult the literature on the systems in place in Sweden and the Netherlands, you'll notice that both have mechanisms in place to prevent kids that are dependent on vouchers from being priced out of private schools that accept public tuition money. The status quo that you are defending is actually the principal mechanism that forces poor children into schools that resemble the bottom photo, and keeps them out of anything like the institution pictured above it.

So would you support vouchers on the condition that they couldn't have a specific religious charter to advance as part of their mission? Are you sure that there's still a first amendment problem if the parents, rather than the government, determine who gets their money? What differentiates these from tax deductions for donations to churches, in your mind?

Seems like the problem for teachers is monopsony, which is the opposite of monopoly. Eg, monopsony = one and only one buyer, which distorts prices and suffocates competition just as effectively as having a single seller. It's puzzling to me that so many teachers are vehemently opposed to reforms to vouchers, since competition for children would also foster competition for teachers, and likely foster the development of compensation models that'd allow teachers to capture more of the revenue, have more discretion over curriculum, pedagogy, etc. how is there not already competition in education? you can go to private schools - you can move to another public school district - you can home school. there's a first amendment problem w/ many private schools as they're religious in nature. I'd agree that there's already competition, but the deck is clearly stacked in favor of unionized public schools in a manner that it wouldn't be if the money followed the kids. As things stand now, the kids follow the money, and the people who exercise effective control over the public money have every incentive to structure the balance of the benefits that derive from such control on behalf of their own members, and to advance their own interests, whether or not that happens to coincide with improving education. Seniority rules that favor tenure over merit are only exhibit A in a list that would surely exhaust the capacities of the alphabet. This is hardly some radical wing-nut fantasy, unless you consider the Swedes and the Dutch, for example, to be nations of radical wing-nuts. Just listen to this guy: "Per Unckel, Governor of Stockholm and former Minister of Education, sums up the advantages of Swedish system: "Education is so important that you can’t just leave it to one producer. Because we know from monopoly systems that they do not fulfill all wishes".

It's also worth noting that all of the data I've seen suggests that the tendency to believe in all manner of paranormalisms, bogus health modalities, etc actually *increases* with education. The only exception to this trend that I can recall is amongst people who study the natural sciences, and I think that you only really start to see diminishing credulity once people in these fields hit the senior/graduate level. Short summary: -Highly educated, politically liberal people are more likely to believe supernatural claims made outside the context of traditional religions. -People with limited educations and a conservative political outlook are much more likely to believe supernatural claims made in the context of traditional religions. I don't think either generalization offers much hope if the goal is to diminish the country's aggregate credulity. Are we really better off if the atheist sociology post-doc that giggles at creationists simultaneously believes in reiki, homeopathy, and reincarnation? I think you can make an argument that the answer is, on balance, "yes," but it's hard to see it as an unmitigated triumph of education on behalf of science and reason.

Going to be an increasingly heavy millstone around the Republican party's neck in the future. I'm hoping that they'll escape from this trap somewhat by redefining the scope of "Big Government" to include state interventions to prohibit things that consenting adults do to themselves or others in private, but I'm not terribly optimistic.

Just to get things back on topic. "Cash-short county inks raises for unions." http://www.seattlepi.com/local/410379_county22.html If you're tempted to claim that public employees with equivalent qualifications are undercompensated (wages plus benefits, including the costs of their pensions and health-care in retirement) to their private sector counterparts, I hope that you'll furnish the data that supports that contention.

Seems like the problem for teachers is monopsony, which is the opposite of monopoly. Eg, monopsony = one and only one buyer, which distorts prices and suffocates competition just as effectively as having a single seller. It's puzzling to me that so many teachers are vehemently opposed to reforms to vouchers, since competition for children would also foster competition for teachers, and likely foster the development of compensation models that'd allow teachers to capture more of the revenue, have more discretion over curriculum, pedagogy, etc.

Another factor that confounds international comparisons is that in quite a few countries kids are separated into vocational and academic tracks at a fairly young age. Are all of the kids in those systems subject to the testing that's used a basis for constructing those transnational comparisons? I seem to recall hearing or reading that they aren't, but I can't recall precisely where. If that's true, then that's introducing a bias into the data that's potentially making the performance of US schools worse than they are. I think longitudinal studies of performance in the US would be more revealing, but even there it's difficult since I suspect that the content and format of most standardized tests has changed over time.

1. If another employer is offering a better deal, it's clear that negotiating with their existing employer isn't the only option that they have for securing better pay, wages, etc. If no one else anywhere is offering a better deal, that's a sign that you're being payed the maximal price for what your skillset is worth. If the public sees that people with skillset X aren't making much money, and want to boost their income, a negative income tax like the EIC is a superior mechanism for doing so than collective bargaining, as it neither prices the employee out of a job or his employer out of a market, and you can calibrate the magnitude of the benefit more precisely. The problem for the folks that work building planes for Boeing is that they know that the second they step out the door they're looking at an immediate and substantial pay-cut in virtually all cases since they're being paid above market rates for their skillset, and even if they accept lower wages elsewhere they'll still be at wage levels above which the public is likely to feel moved to cough up tax money to supplement their incomes. 2. See above.

okay fine, but did adam smith really foresee just how far and with what force industrial corporations would thrust their vast thorny cocks up the ass of the working man? how would that oft-raped class be a single bit better had unions been broken in their infancy? Given that he was alive during during an age when the dwindling embers of feudalism were still glowing in pockets here and there, and the hereditary aristocracy played a meaningful role in society, it's difficult to argue that he was unacquainted with what happened to people when they had no mechanism with which to hinder the exercise of arbitrary economic power. Given the proliferation of guilds in Europe at the time, it's reasonable to conclude that he had a fair opportunity to evaluate the extent to which they furthered the public interest as well. I don't think the quote above is indicative of any particular disdain that Smith had for tradesmen who were attempting to increase prices for whatever they were selling by restricting competition and preventing the public from buying similar wares at a lower price from someone else. He was simply pointing out the reality that by doing so they were imposing excess costs on the public with the intention of accruing the benefits of doing so in their own hands. This was part of a larger discussion about the aggregate effects that partitioning the economy into a collection of state sanctioned cartels would invariably have on the overall level of prosperity in a given country. He seemed fundamentally Madisonian in his distrust of any particular group's capacity to use exclusive commercial powers or privileges they'd been granted on another group's behalf, particularly in order to benefit that other group or advance their interest. I think that was in part because he doubted whether or not it was actually possible for them to reliably know what was in another's true interest, much less put their interests on par with their own when the two were in conflict. There are probably other quotes out there that make the point better than these, but it's clear in his work that he didn't think that groups of tradesmen were uniquely flawed in this respect: "It is the highest impertinence and presumption, therefore, in kings and ministers to pretend to watch over the economy of private people, and to restrain their expense. They are themselves always, and without any exception, the greatest spendthrifts in the society. Let them look well after their own expense, and they may safely trust private people with theirs." "This total exemption from trouble and from risk, beyond a limited sum, encourages many people to become adventurers in joint stock companies who would, upon no account, hazard their own fortunes in any private copartnery. The directors of such companies, however, being the managers rather of other people's money than their own, it cannot well be expected that they should watch over it with the same anxious vigilance with which the partners in a private copartnery frequently watch over their own." With respect to modern-day unions, it's not like they're unique in attempting to forcibly extract wealth from the public by eliminating or restricting competition. Virtually every commercial enterprise large enough to lobby any level of government is engaged in efforts to get the government to rig the game on their behalf, and at the public's expense. It's one thing to recognize that, it's another to acquiesce to it, much less applaud it when you're the one being forced to pay more than you would otherwise. With respect to the role of unions in the past, even if you accept all of the claims about unions and unions alone being responsible for getting various worker rights and protections signed into law, it doesn't follow that the public should be forced to pay royalties in perpetuity to present day union members for whatever services they may have rendered in the past. With commercial unions in the present, most of the time there's are some competitors out there, no matter how hobbled which limits their capacity to forcibly extract wealth from consumers. This is why any union that imposes costs on employers that exceed whatever (hypothetical) increase in output that union members generate relative to their non-union counterparts are doomed to extinction unless they somehow manage to secure legislation that bans competition outright. Even a hobbled competitor is often sufficient to put the likes of GM under, and if not innovation and/or substitution will. In the case of public sector unions, there's are no constraints imposed by competition, and the public is materially worse of for every dollar of excess compensation that the public sector unions, or unions contracts funded with public money, secure over and above what they'd get under competitive conditions. The public could either get the same output with lower taxes, or get more output for the same level of taxes. That's true whether you're talking about bridges or file clerks at the DMV. It's clear how this benefits public sector unions and unions that depend on public sector contracts, or legislation that restricts competition, but it's not clear how it benefits the public.* Before anyone chimes in with the shopworn fallacies about unions, rather than productivity, increasing real wages, or paying workers "enough to buy the product" it's worth noting that somehow the guys making yachts and lear-jets manage to get by with salaries that are far less than necessary to own either, and to observe that there's no shortage of countries in the world where the workers are both dirt poor and heavily unionized.

"People of the same trade seldom meet together, even for merriment and diversion, but the conversation ends in a conspiracy against the public, or in some contrivance to raise prices."

Yes. The panel of physicians who have spent careers working in the NHS, and specialize in end of life care wrote that letter because they're vehemently opposed to...hospice care. If we use the conventional meaning of each of the words contained in this passage below at face value: "In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death. Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn. As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others. “Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong." It's clear that what they are all implacably opposed to the very notion of...hospice care.

Mighty harsh thing to say about Ted Kennedy so shortly after his demise. Without his efforts in the senate, the deregulation of large swaths of the transportation sector might not have ever happened! Anyone that opposes granting the government the power to fix prices, dispense patronage via tarriffs, subsidies, and other impediments to competition that might displace the cartels run by their favorites must be a madman. It's also clear that legislation governing commerce is good - irrespective of its effects. Legislation that created the modern FNMA and GNMA, the mortgage-interest deduction, the capital gains exemption for homeowners, the CLA, etc, etc had no effect on the genesis or magnitude of the housing bubble. 'Kay.

Great! Be sure to listen to the Nassim Taleb podcast while you're doing your background research. Fasinating stuff! http://www.econtalk.org/archives/2007/04/taleb_on_black.html

Love the Econtalk podcasts he hosts. Isn't he dead? Like his ideas? Maybe you guys should ban him from school curricula - hell, burn his books. I prefer to use them for TP at bivis, but I guess they coul also work for emergency fire starter. In my experience, the level of loathing one has for Friedman is inversely proportional to the number of pages of his that one has actually read. The rare leftist that actually reads his work will typically find some common ground with his philosophy on issues like his opposition to the draft, his advocacy of the Earned Income Credit (negative income tax) as a poverty fighting tool, his antipathy towards the War on Drugs, etc. "Paige: Let us deal first with the issue of legalization of drugs. How do you see America changing for the better under that system? Friedman: I see America with half the number of prisons, half the number of prisoners, ten thousand fewer homicides a year, inner cities in which there's a chance for these poor people to live without being afraid for their lives, citizens who might be respectable who are now addicts not being subject to becoming criminals in order to get their drug, being able to get drugs for which they're sure of the quality. You know, the same thing happened under prohibition of alcohol as is happening now. Under prohibition of alcohol, deaths from alcohol poisoning, from poisoning by things that were mixed in with the bootleg alcohol, went up sharply. Similarly, under drug prohibition, deaths from overdose, from adulterations, from adulterated substances have gone up."

Love the Econtalk podcasts he hosts. Isn't he dead? Like his ideas? Russ Roberts is very much alive! You should listen to some of his podcasts. Start with his interview of Hitchens, on his book on George Orwell: http://www.econtalk.org/archives/2009/08/hitchens_on_orw.html You might also find the Alan Wolfe interview interesting: http://www.econtalk.org/archives/2009/05/wolfe_on_libera.html

BTW - not worried about the president's address to schoolchildren. I'm much more concerned by legislators that make liberal use of "the children" as a pretext for whatever legislative agenda they're trying to promote. "[shout]Keep the sugar tariff's in place...for the children....[whisper]And the heavily subsidized HFCS lobby, and the sugar-beet lobby! And...[/whisper]" As last refuge's for the scoundrel go, children are often much more effective than patriotism.

The left wing eagerly marches towards totalitarianism - their preferred state of being. Where was your outrage at a totalitarian Bush regime stripping the nation of constintutional and consumer protections, intruding on private citizens at will, snatching people off the streets and torturing them with no due process, and establishing an imperial executive? Are you a complete fucking moron? Strange to see such profound distrust of government manifesting in a passionate zeal for a single-payer system, particularly one that will invariably be run by these same totalitarians at some point in the future.

Love the Econtalk podcasts he hosts.

[video:youtube]grbSQ6O6kbs "Dying patients A group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death. Published: 4:08PM BST 03 Sep 2009 SIR – The Patients Association has done well to expose the poor treatment of elderly patients in some parts of the NHS (report, August 27). We would like to draw attention to the new “gold standard” treatment of those categorised as “dying”. Forecasting death is an inexact science. Just as, in the financial world, so-called algorithmic banking has caused problems by blindly following a computer model, so a similar tick-box approach to the management of death is causing a national crisis in care. The Government is rolling out a new treatment pattern of palliative care into hospitals, nursing and residential homes. It is based on experience in a Liverpool hospice. If you tick all the right boxes in the Liverpool Care Pathway, the inevitable outcome of the consequent treatment is death. As a result, a nationwide wave of discontent is building up, as family and friends witness the denial of fluids and food to patients. Syringe drivers are being used to give continuous terminal sedation, without regard to the fact that the diagnosis could be wrong. It is disturbing that in the year 2007-2008, 16.5 per cent of deaths came aboutafter terminal sedation. Experienced doctors know that sometimes, when all but essential drugs are stopped, “dying” patients get better. P. H. Millard Emeritus Professor of Geriatrics University of London Dr Anthony Cole Chairman, Medical Ethics Alliance Dr Peter Hargreaves Consultant in Palliative Medicine Dr David Hill Fellow of the Faculty of Anaesthetists of the Royal College of Surgeons Dr Elizabeth Negus Lecturer, Barking University Dowager Lady Salisbury Chairman, Choose Life " http://www.telegraph.co.uk/comment/letters/6133157/Dying-patients.html In a letter to The Daily Telegraph, a group of experts who care for the terminally ill claim that some patients are being wrongly judged as close to death. Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away. But this approach can also mask the signs that their condition is improving, the experts warn. As a result the scheme is causing a “national crisis” in patient care, the letter states. It has been signed palliative care experts including Professor Peter Millard, Emeritus Professor of Geriatrics, University of London, Dr Peter Hargreaves, a consultant in Palliative Medicine at St Luke’s cancer centre in Guildford, and four others. “Forecasting death is an inexact science,”they say. Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong. “As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients." The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS. The scheme, called the Liverpool Care Pathway (LCP), was designed to reduce patient suffering in their final hours. Developed by Marie Curie, the cancer charity, in a Liverpool hospice it was initially developed for cancer patients but now includes other life threatening conditions. It was recommended as a model by the National Institute for Health and Clinical Excellence (Nice), the Government’s health scrutiny body, in 2004. It has been gradually adopted nationwide and more than 300 hospitals, 130 hospices and 560 care homes in England currently use the system. Under the guidelines the decision to diagnose that a patient is close to death is made by the entire medical team treating them, including a senior doctor. They look for signs that a patient is approaching their final hours, which can include if patients have lost consciousness or whether they are having difficulty swallowing medication. However, doctors warn that these signs can point to other medical problems. Patients can become semi-conscious and confused as a side effect of pain-killing drugs such as morphine if they are also dehydrated, for instance. When a decision has been made to place a patient on the pathway doctors are then recommended to consider removing medication or invasive procedures, such as intravenous drips, which are no longer of benefit. If a patient is judged to still be able to eat or drink food and water will still be offered to them, as this is considered nursing care rather than medical intervention. Dr Hargreaves said that this depended, however, on constant assessment of a patient’s condition. He added that some patients were being “wrongly” put on the pathway, which created a “self-fulfilling prophecy” that they would die. He said: “I have been practising palliative medicine for more than 20 years and I am getting more concerned about this “death pathway” that is coming in. “It is supposed to let people die with dignity but it can become a self-fulfilling prophecy. “Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway.” He added: “What they are trying to do is stop people being overtreated as they are dying. “It is a very laudable idea. But the concern is that it is tick box medicine that stops people thinking.” He said that he had personally taken patients off the pathway who went on to live for “significant” amounts of time and warned that many doctors were not checking the progress of patients enough to notice improvement in their condition. Prof Millard said that it was “worrying” that patients were being “terminally” sedated, using syringe drivers, which continually empty their contents into a patient over the course of 24 hours. In 2007-08 16.5 per cent of deaths in Britain came about after continuous deep sedation, according to researchers at the Barts and the London School of Medicine and Dentistry, twice as many as in Belgium and the Netherlands. “If they are sedated it is much harder to see that a patient is getting better,” Prof Millard said. Katherine Murphy, director of the Patients Association, said: “Even the tiniest things that happen towards the end of a patient’s life can have a huge and lasting affect on patients and their families feelings about their care. “Guidelines like the LCP can be very helpful but healthcare professionals always need to keep in mind the individual needs of patients. “There is no one size fits all approach.” A spokesman for Marie Curie said: “The letter highlights some complex issues related to care of the dying. “The Liverpool Care Pathway for the Dying Patient was developed in response to a societal need to transfer best practice of care of the dying from the hospice to other care settings. “The LCP is not the answer to all the complex elements of this area of health care but we believe it is a step in the right direction.” The pathway also includes advice on the spiritual care of the patient and their family both before and after the death. It has also been used in 800 instances outside care homes, hospices and hospitals, including for people who have died in their own homes. The letter has also been signed by Dr Anthony Cole, the chairman of the Medical Ethics Alliance, Dr David Hill, an anaesthetist, Dowager Lady Salisbury, chairman of the Choose Life campaign and Dr Elizabeth Negus a lecturer in English at Barking University. A spokesman for the Department of Health said: “People coming to the end of their lives should have a right to high quality, compassionate and dignified care. "The Liverpool Care Pathway (LCP) is an established and recommended tool that provides clinicians with an evidence-based framework to help delivery of high quality care for people at the end of their lives. "Many people receive excellent care at the end of their lives. We are investing £286 million over the two years to 2011 to support implementation of the End of Life Care Strategy to help improve end of life care for all adults, regardless of where they live.”

The major unstated premise here seems to be that, even under conditions of open competition, profits can only be realized by cheating consumers. you're going to the extreme there jay. its not "cheating consumers" its "maximizing share holder value". you see, it isn't all bad...because someone is winning! the shareholder. that why the corporation exists. I'll repeat what I said earlier. I'm all good with a doctor making a good salary and benefits - they earned it. Ditto for his/her nurses, administrative staff, etc. But I'm not good with a corporate hierarchy (or governmental one) telling the doctor how much he can/should charge to maximize profits (or implement price controls), stating what treatments are allowed and when (to control costs), etc, etc. All the more reason to develop mechanisms that keep insurers and government out of such decisions as much as possible IMO. Whether it's students or patients, the best way to insure that the incentives are structured around their interest is to let them control as much of the money spent on their behalf as possible. Catastophic+HSA plans with income indexed vouchers would eliminate these conflicts of interest as well as anything that I've heard proposed thus far.