Malthusian me?

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In the comments below in regards to eugenics I made an argument that rationing is going to be inevitable in national health care systems as the information we have about the propensity (or inevitability) of diseases outruns the ability to treat those diseases. In particular, I believe that it may come to the point where though one can treat something in theory with medical technology the costs may simply be prohibitive. The argument I’m making smells a lot like Malthusianism, insofar as I believe that genomic diagnostic technologies will decrease in price in a manner that scales downward to a far greater extent then the treatments for those diagnosed probabilities for the total sample space of possibilities. But of course, we know how Malthusianism worked out when it came to the argument about population & food production, so I’m not sure about this. We (humans) have a tendency not to account for future innovation. In the near-term (less than 20 years) what do those who know about the costs of medicine think?



  1. The mistake of Malthusian thinking was that it didn’t take into account the power of smarts+markets to come up with ways of increasing productivity. But the combination of both is what’s necessary to escape the Malthusian trap. If socialized healthcare becomes the reality, you’ll be absolutely right.

  2. but most national health care systems have optional private sectors from what i know. so wealthy people can get extra value care, right?

  3. Yeah, but that doesn’t have much of an effect on the overal structure of health care provision — it’s analogous to allowing private schools along with public ones. The important thing is how strong the incentives are to innovate and bring costs down on the supply side. If the government basically says “we’ll take care of all the costs out of the public purse”, then that goes out the window. You already see this to a lesser degree with employer-paid healthcare — the reason the US spends more on health care than fully socialist systems is because pretty much nobody feels the costs of their medical expenses and thus feel free to get more (and more expensive) care at the margins. With a socialist system the costs become more centralized and thus there’s more incentive to keep accounting costs down (this is where your original point comes in), but society pays for that in all the off-paper costs that inevitably come with socialism.

  4. There’s a lot of nonsense out there about Malthus. He did not fail to account for human ingenuity – if he had, he would have said that food supplies remain constant with time, when in fact he said that they rise arithmetically. You guys are thinking of Paul Ehrlich.

  5. He did not fail to account for human ingenuity – if he had, he would have said that food supplies remain constant with time, when in fact he said that they rise arithmetically.  
    that’s a pedantic point. the issue is that he (along with adam smith and david ricardo) did not anticipate the extent to which technological innovation would result in increased productivity.

  6. No, he didn’t, but that really doesn’t matter. That’s not the main reason why “SSBBW” is becoming a recognizable acronym and we’re not eating 1200 calories/day. The demographic transition is. 
    Malthus claimed, based on the behavior of Americans, that human populations doubled every 25 years in the presence of abundant food. So here’s his projection of what would happen if world food supplies could be increased at the rate of X every 25 years, where X is the amount of food produced in his time: 
    “…supposing the present population equal to a thousand millions, the human species would increase as the numbers, 1, 2, 4, 8, 16, 32, 64, 128, 256, and subsistence as 1, 2, 3, 4, 5, 6, 7, 8, 9. In two centuries the population would be to the means of subsistence as 256 to 9 ; in three centuries as 4096 to 13, and in two thousand years the difference would be almost incalculable.” 
    Projected food supplies now would be about what they actually are. Granted, this was a reduction to the absurd, and he didn’t believe that we could really achieve this, but the point was that even if we could, it wouldn’t keep up with projected population growth. Human ingenuity was almost irrelevant to his theory.  
    Most of us would be near starvation, and nobody would know what “SSBBW” stood for, because there wouldn’t be any, outside of some very rich families who would still use corpulence as a status marker. We would need some serious sci-fi tech to feed 100+ billion people, which is where we’d be now, and far more human ingenuity than we’ve shown. 
    But population growth didn’t come close to keeping up with his projection, and it points to the real weak spot in his theory. Yet hardly anybody talks about the great importance of family planning, at least not compared to the relative hordes of libertarian Julian Simon fans who’d rather talk about GM crops. 
    I know this has little to do with the real point of your post. Just a pet peeve of mine.

  7. c23, thanks for the clarification. something to think about.

  8. Malthus isn’t necessary to justify this diagnosis. The true underlying problem is pure, uncontroversial, first week introductory microeconomics. When government pays for health care, those who use health care face a price of, essentially, zero. A casual look at supply and demand curves find an equilibrium at quantity where marginal benefit(following the demand curve) is equal to marginal cost(the supply curve) If price paid by the user is too low relative to supplier cost and ability to produce, the quantity demanded will, in virtually every real-world situation, exceed quantity supplied. Thus shortages and rationing. (Think Nintendos the first week they are released, gasoline in the ’70s and in some places after Katrina, etc.)  
    In this case, if families bore the full burden of their choices, they would either test cheaply, and abort expensive fetuses, or pay for their decision to have the costly offspring, themselves. In the case of nationalized health care, they don’t bear the financial costs, (though they do the emotional ones) so they will tend to overutilize expensive healthcare and underutilize the less socially costly alternative – in this case, abortion. (From their perspective, the financial cost of testing and aborting are the same as those of treating after birth, while the real financial costs are very different.)

  9. An example to study in this regard might be the Indian Health Service, which exists to respond to the Treaty obligation to provide universal health care for all Indians. Because it is persistently and continuously underfunded, it constantly does unacknowledged triage. More sympathetic people get better care. Local public drives to help finance private medical care for local children work pretty well, but not for adults. Major joint replacements are postponed for years which means that the patients endure much pain, limited movement, and resultant diabetes or alcoholism. Patients who come in with results of bad behavior such as trauma from fights, alcoholism or drug addiction are sometimes treated badly because of being “expendable” and they come to represent the whole Indian population thus justifying constant shortages of medical infrastructure: medicines, bandages, cleaning supplies, sufficient staff, weak or confused protocols, and so on. (Most people think of medicine in terms of doctors. Volunteer doctors who come in from “outside” often complain about 3rd World budgets and disorganization.) 
    Prairie Mary

  10. “No, he didn’t, but that really doesn’t matter.” 
    Um, yes he did. 
    “Human ingenuity was almost irrelevant to his theory.” 
    Um, that’s the point. That is, he developed a theory which described the next several centuries exceedingly poorly because he ignored the effect of human ingenuity. In one sentence you claim that he didn’t under-estimate the effect of technology on production and in the next you plainly state “human ingenuity was almost irrelevant to his theory.”  
    You say Malthus over-estimated population increases (and perhaps he did) but he also under-estimated the effect of technology on our ability to increase food production (indeed, according to you, technology was “irrelevant” to his theory).