Michael Sandel

Apparently cash incentives do not always work….in the sense of bringing about the desired result.

Excellent, so let us continue to study this question and use such cash incentives where they do work and not where they don\’t.

My suspicion (OK, call it what it is, prejudice) is that they do work in many fields where current society says they do not or should not.

In China, the business of paying people to queue has become routine at top hospitals. There, the market reforms of the last two decades have resulted in funding cuts for public hospitals and clinics, especially in rural areas. So patients from the countryside now journey to the major public hospitals in Beijing, creating long waits in registration halls. They queue overnight, sometimes for days, to get an appointment ticket to see a doctor.

The appointment tickets are a bargain – only 14 yuan (about £1.20) – but it isn\’t easy to get one. Rather than camp out for days and nights, some patients, desperate for an appointment, buy tickets from touts. The touts hire people to queue for appointment tickets and then resell them for hundreds of pounds – more than a typical peasant makes in months.

There is something distasteful about touting tickets to see a doctor. For one thing, the system rewards unsavoury middlemen rather than those who provide the care. Doctors could well ask why, if appointments are worth so much, most of the money should go to touts rather than to them, or to the hospitals. Economists might agree and advise hospitals to raise their prices. In fact, some Beijing hospitals have added special ticket windows, where the appointments are more expensive and the queues much shorter.

For example, why shouldn\’t there be a reasonable co-paymnet for seeing a doctor? As there is in various European medical systems but not in the NHS?

I\’ve no problem with hte idea that all markets all the time cash markets does not a perfect society make. But I do, as above, have a very strong feeling that proper study of this particular point would lead to more cash markets than we currently have.

8 thoughts on “Michael Sandel”

  1. Our Lord (no not you Tim) said:
    “It is easier for a camel to go through the eye of the needle than for a rich man to enter the Kingdom of Heaven.”

    What they never taught me in Sunday School is the corollary. If the rich man gets rid of his money he stands a chance. So you CAN buy your way into Heaven.

    Between an extra baggage allowance and Eternal Life there may be fewer non-cash examples than we think.

  2. If the ticket sells for more than a peasant earns in a month, it isn’t the peasant who will pay that instead of queuing for a couple of days.
    What this actually demonstrates is the *hidden* corruption that provides a surplus of hospital services in Beijing where most of those bureaucrats who determine funding live and a shortage of hospitals in rural areas.

  3. Sorry to be still worrying this bone, but…

    That money isn’t everything is too trivial an observation to be worthy of comment. You can’t fuck it, sleep in it or eat it. But…

    You can use it to get things you do want, shorter queues, longer creches, whaddever.

    The question of Wolfshit commune is a bit more complicated. People were given the option of social cohesion without the intervening inconvenience of money. 51% of them took it. Note that there are no price signals in having a nuclear dump at the bottom of the garden, so it is not a great surprise that when the price is signalled by an outsider the vote changes.

    Does Sandel seriously expect us to believe that, having taken a vote to accept a nuclear waste dump, the town council would still charge nothing to the dumper?

  4. @ blokeinfrance
    When the locals were told that it was a question of being paid to take a nuclear waste site because other people didn’t want it and were willing to pay someone else to take it the question changed dramatically from the previous one which was “We have to have a site, will you as part of our equal community accept it?”
    About forty years ago, someone suggested a nuclear waste site near my home town with a whole array of arguments as to why it was harmless and could not affect the water table (rather better than most frackers propose today) so I was initially puzzled why my father objected – he did not put forward any scientific arguments using his two Oxford Chemistry degrees: he just said “Why aren’t those civil servants willing to have it in Surrey where they live?”
    The chalk underlying Surrey would have been more geologically suitable.

  5. So Much For Subtlety

    For example, why shouldn’t there be a reasonable co-paymnet for seeing a doctor? As there is in various European medical systems but not in the NHS?

    In China virtually nothing is free. This may be going on in public hospitals, but they are not public in the sense European hospitals are some times public. After all, the Chinese tax system is a bottom-up one, i.e. everyone has to kick some cash back up to the senior levels of government. Everyone means everyone. These hospitals will have to do it too I expect (although I don’t know for sure).

    Which means they pay to see a doctor. Not a co-payment. They will have to pay the full cost. There have been some insurance schemes to help peasants pay but they are still rudimentary.

    Which makes all this doubly stupid. The public hospitals could tap this revenue stream. Which means rich urban people would get to see a doctor immediately while poor peasants would sleep a few extra days in the hospital lobby waiting for an appointment. Not a medically good outcome as no one goes to an expensive city and waits for a few days to see a doctor unless they really have to see a doctor. Or they could ban it and see people on an actual medical-needs basis.

  6. I’ve often wondered why there was not some scheme to expedited waiting to see specialists in Australia.
    A cash payment works but many people who need the big stuff – joint replacement etc – are pensioners and may have to wait many months on assorted waiting lists.

  7. The two standard problem cases are poor grannies (the sort who can’t afford to heat their home, so wear 15 layers of clothes and blankets in the winter) and poor-any-dysfunctional parents of children.

    The grannies couldn’t afford a 10 quid co-pay, say – 10 quid is several days food, and tend to be the sort who don’t want to trouble the doctor with their problems anyway. We need to not dissuade them from getting medical help.

    The poor, dysfunctional parents probably have more income than the grannies, but don’t do very well at prioritizing spending. These are the families who routinely send their kids to school hungry because they don’t manage to provide food. Parents who can’t manage to put a meal on the table aren’t going to produce 10 quid for the doctor either – they’re just going to wait until the kid is sick enough for A&E. This is also bad.

    I don’t know how to make a copay not do harm in these cases.

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