How should healthcare be rationed?Healthcare is a commodity like any other. Like any other good or service in the material world, there are not enough healthcare resources to satisfy everyone's desire; so it must be rationed. I am of the position that the most equitable, just, and humanitarian rationing system is the price system. The free-market price system is a system of emergent order. This order is arrived at through competition and cooperation, but always voluntarily. This is in contrast to other rationing systems, which require coercive force. These systems are therefore illegitimate in a free society based on Natural Rights. Voluntary action is not good enough for the current administration and they want non-price rationing. What does non-price rationing entail? In the UK for instance, if you need a kidney and are 59 years of age, you can be put on a waiting list, if you are older, you get nothing. If you are blind in one eye and wish to undergo corrective surgery, you may only do so if you lost sight in both eyes. If you want to pay for care, it is prohibited...because that would be unfair to the other, 'less fortunate' person. Here you are, now at the total mercy of another man. You will note further that food is more vital to life that access to healthcare. And yet the free market provisions it quite effectively. In fact, the last time governments attempted to 'guarantee access' to food, it resulted in the deaths of over 20 million people. -- Rand Paul (a doctor) How to deliver healthcare?InsuranceRegarding insurance companies: Most of what people call 'insurance' is more appropriately called an 'income redistribution scheme'. The uncertainty of future events can be viewed as a spectrum with some events being more insurable than others. The main idea of an insurable risk is that 1) the occurence of event in a certain population is known with some degree of reliability AND 2) the likelihood of said event occuring to a particular individual is unkown. Rx Drug use is not insurable. Lung cancer is not insurable. Insurance companies know that 95-98% of people use less than $2000 a year in medical expenses. So they charge you up front for it, if you use less you subsidize the sick person. This is an important point. 5% of the sick consume 50% of the care. Mind you that most of this consumption is for chronic diseases. 75% of Americans die from chronic diseases each year, heart disease, diabetes, and cancer. It is estimated that 2/3 of these deaths are entirely preventable. ie, not insurable risks. The patient has control over the likelihood of the event happening. Sorry, but if you want freedom, you have to live with the consequences of your actions; even the mundane ones you make everyday that have a cumulative effect over your lifetime. Why do insurance companies cover such 'uninsurable' risks in America? If you guessed, 'because the government mandates them to do so', you'd be right. Take a look, as an example, of the history of mental health prescription coverage. They are included in benefit plans because the federal government decreed it. ProvidersOkay how about the provider side: People who were poor used to get adequate personal medical care from 'lodge doctors' . If you've ever seen the Flintstones you now that Fred and Barney were in a club called the 'Water-Buffalo Lodge'. Lodges were mutual aid organizations that pooled resources among those with little to provide essential services like medical care without resorting to charity or government welfare. Medical professionals operate a guild. It is more appropriately called a monopoly. The American Medical Association created the idea of professional licensing. Prior to licensing you became a doctor by studying, working, and apprenticing with a doctor. Licensing was sold as a measure to "ensure the public's safety", but its actual desired effect was to increase doctors' wages. The mechanism to increase salaries was to decrease supply. This was accomplished by a credentialing system whereby the AMA accredited 'legitimate' colleges of medicine. It did so with the power of the legislature. Once this power was secured the AMA promptly began denying accreditation to traditional doctors' apprentices, and in particular women's Colleges of Medicine and black Colleges of Medicine. It did however, have the intended effect, which was to increase doctors wages. Pharmacists also practice a monopoly profession. That is why they get paid so well. PatientsSo where is the patient in all this? I hear the complaint that the patient is getting left behind in our healthcare system all the time. But hey, guess what? The patient doesn't choose the product; the doctor does that. The patient doesn't pay for the product; the employer, the insurance company and the government does that. Why then should it be any wonder why no one listens to the desires of the patient? Issues with healthcare as a social good.Service is substandardWhy do we need a system?
Accountability
"Because government pays for much of our health care, it's conveniently argued that any habits or risk-taking that could harm one's health are the prerogative of the government, and are to be regulated by explicit rules to keep medical-care costs down." You no longer are able to make choices for yourself, as you are not fully accountable for your actions. What else does a national health service(NHS) exist for if it's not for treating illness and injury, much of which we bring upon ourselves by our own actions. Should injury caused by football, rugby etc. not be treated by the NHS because we brought the injury on ourselves by indulging in such a dangerous pastime? No free market
Deregulate the market. Why are there so many government mandates to be a doctor and see a doctor? It creates shortages and thus increases prices. Much of the increased costs come from supply restrictions due to arbitrary government mandated regulation and licensing of doctors, medical schools, hospitals, prescription drugs, and other medical goods. The AMA, ADA and FDA are very big reasons for very big health care costs. These are, IMO, the heart of the problem because the active restraint of trade through regulatory barriers to entry. Costs are hidden
The bottom line is that the government and media tell you that the reason health care cost so much is because it is so good. That is completely wrong and opposite to the truth. In a true free market, like in the examples above, prices come down AND the quality goes up due to competition. It's the government involvement in health care and insurance that drives the prices up so high. I'd put money on the fact that as government continues to get involved in health care, that the prices will go up and the quality will go down, which will lead most people to believe that they need more government to help with health care. Perverse outcomes
A doctors rantOn the FDA in the USAThe FDA I am of the opinion that if you want cheaper healthcare in this country, you should advocate a free market. And a free-market is one where government does not grant monopolies. And the FDA is a big enabler of monopolies. I would argue that the FDA does not provide a legitimate service to the public safety. The FDA's best defense for continuing its own existence is invariably “The Thalidomide Tragedy” in which the FDA prevented the severe deformities in fetuses by withholding approval from thalidomide as an approved sedative in pregnant women in the U.S. It should be noted that thalidomide was withheld, not on any suspicion of its potential for causing birth-defects, but rather on concern of potential neurological disturbances. The FDA got lucky. Does luck justify its role? It should be noted that the full safety profile of a drug is not known until it hits the open market. Phase-IV of the drug approval process is called Post-Marketing Surveillance. They're watching to see how many people croak after they've approved it. How is this any different to a market without an FDA? We would still have doctors and pharmacists whose job it was to evaluate treatments for safety and efficacy. Only we would have more choice, not only in Rx drugs, but with medical devices as well. Generally speaking, drug-use is risky for anyone. Who is it for the FDA to decide what risks you or your loved-ones are willing to take with their health and life? It may very well be that benefits of improved quality of life outweigh substantial risks in drug-taking. Consider that the FDA does not require safety and efficacy evidence for dietary supplements. A pharmacy lawyer informed me that the FDA will not do so until such time as someone gets killed by them. These products are largely unregulated, and yet, very few people die. In contrast to pharmaceuticals which are extremely heavily regulated and cause’ two 747s full of people to die everyday’ according to Lyle Bootman at the Institute of Medicine. The attitude I see among many patients is cavalier, frankly, probably, precisely because of the false sense of security the FDA instills. It’s like the SEC trying to convince the public it can regulate the millions of financial transactions that go on each day. It is an impossible task and just instills a false sense of security. Drug-use is risky, with or without, the FDA. What the FDA does well is facilitate this interplay of monopolies, euphemistically referred to as stakeholders. Insurance through employer in the USAThe State The government distorts the medical market in several ways. First and foremost the employer based system of healthcare does. not. work. What else do you buy through your employer? Food? clothing? Car insurance? Why medical insurance? Its origins in fact are with the price and wage controls of WWII. Employers were prohibited in offering salaries they thought necessary to attract the best talent, so took to offering fringe benefits. Medical insurance was one of these. Now last I checked WWII was over and yet we retain the healthcare system of the War State Compulsory employer-based healthcare distorts the market by bidding up the minimum price of healthcare insurance. Making it pricier for those without jobs to purchase healthcare coverage on their own. Monopolies and their perverse effects on the market, cannot exist without the coercive power of the State; and there several monopolies in healthcare. Doctors and pharmacist labor supply is one of them. The solutionHealthcare is not a right it is a luxury. The majority of the world doesn't have healthcare. It is a luxury we as American's enjoy. Just like owning a Mercedes you have to pay for that luxury. The solution: work hard and save. We should be endorsing the ideas of private charity and self reliance. VideosSeptember 14 2007 John Stossel "Sick in America" Good animated video People who are in government, who have tried and failed say we need more government
Ron Paul on Russia Today, talking about healthcare not to be a right.
John Stossel on elderly healthcare (american video)
LinksOrgan donation http://www.bbc.co.uk/news/health-23260057 Whos responsibility is breast feeding http://www.bbc.co.uk/news/health-24900651 |
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