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The Free Market Solution to Fixing Health Care

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It's a common assumption that our current health care system is a free market one and that it's broken, thus we should try a government system. However this couldn't be further from the truth, as government is already involved at every level, from licensure and patents, to direct subsidies and provision, to employee mandates and insurance-pooling. This intervention is precisely what accounts for most of the problems people complain about--particularly the high cost. Meanwhile the private dimensions are what account for our systems merits as we are the leading nation when it comes to innovation, coming up with new procedures, medical devices and pharmacueticals that lengthen and improve people's lives.

We are going in the opposite direction of where we should be going: more control instead of more freedom, more spending instead of less, more mandates instead of fewer. The problems we have are being addressed by more of what caused the problems: the patient is being given more poison instead of the proper cure.

Here is the Free Market Solution to fix health care:

  1. Eliminate all licensing requirements for medical schools, hospitals, pharmacies, and medical doctors and other health-care personnel. This would result in a steady increase in supply which would cause prices to fall and the variety of health-care services to increase.

  2. Eliminate the FDA and all government restrictions on the production and sale of pharmacueticals and medical devices. Prices would fall and life-saving products would reach the market much sooner. A free market would allow consumers to assess risks on their own without the government doing it for them. Competition and products liability suits would cause sellers to offer increasingly better product descriptions and guarantees.

  3. Deregulate the health insurance industry. Because a person's health lies increasingly within his own control, many health risks are actually uninsurable. You can't get insurance against suicide or bankruptcy because it is in your own hands to prevent or bring these things about, yet uninsurable risks are covered by government mandate, driving up costs. In addition health insurers cannot discriminate between various groups of people who pose significantly different insurance risks. Hence it is really a system of income redistribution that benefits irresponsible actors and high-risk groups at the expense of responsible individuals and low-risk groups. Because of this, prices continue to balloon.

  4. Eliminate all subsidies to the sick and unhealthy. Subsidies create more of whatever is being subsidized, subsidies for the ill and diseased promote carelessness, indigence, and dependency.

Comments

tbaker 5 years, 2 months ago

Bravo Liberty!

Of course the odds of your proposal happening are pretty long, but they are getting shorter by the day. More and more people are slowly realizing the "big government" solution to things is like Faust's deal with the devil.

People have to be the center of the solution - not government.

It's instructive to read about California. This will be our country's epitaph if we don't wise up and stop the madness. From yesterday's "Observer":

"But the state that was once held up as the epitome of the boundless opportunities of America has collapsed. From its politics to its economy to its environment and way of life, California is like a patient on life support. At the start of summer the state government was so deeply in debt that it began to issue IOUs instead of wages. Its unemployment rate has soared to more than 12%, the highest figure in 70 years. Desperate to pay off a crippling budget deficit, California is slashing spending in education and healthcare, laying off vast numbers of workers and forcing others to take unpaid leave. In a state made up of sprawling suburbs the collapse of the housing bubble has impoverished millions and kicked tens of thousands of families out of their homes. Its political system is locked in paralysis and the two-term rule of former movie star Arnold Schwarzenegger is seen as a disaster – his approval ratings having sunk to levels that would make George W Bush blush. The crisis is so deep that Professor Kevin Starr, who has written an acclaimed history of the state, recently declared: "California is on the verge of becoming the first failed state in America."

meggers 5 years, 2 months ago

Liberty One,

Cool, I guess I can become a neurosurgeon with just a few nightly classes (or none at all!) What a deal!

As for number #4 on your list, I presume you won't mind smelling the stench from the rotting bodies of the disabled and elderly, or stepping over their bodies as you enjoy your utopian "free market" society.

There's a reason libertarianism isn't exactly praised for it's common sense (or humane) approach to policy.

headdoctor 5 years, 2 months ago

meggers (Anonymous) says… There's a reason libertarianism isn't exactly praised for it's common sense (or humane) approach to policy.


What is truly sad is Libertarians have been bastardized with ignorant mentality just as the modern day so called Republicans and many of the far left liberals have been. It is amazing that people who I thought were reasonably intelligent are so ignorant they can't seem to get it that they are being ignorant.

verity 5 years, 2 months ago

This is satire, isn't it?

You had me going there for a minute. Really, really good satire.

headdoctor 5 years, 2 months ago

Liberty_One (Anonymous) says… headdoctor, what is sad is that people have become so used to the idea that the government must provide, they have come to fear and hate the idea that they could, and should, provide for themselves.


You may find this shocking Liberty_One but I agree that we are far to reliant on the Government. Most of the less Government concepts would work great.......If we lived in a perfect world. Sad truth is we don't. With all the control, laws, rules and boundaries we still have situations out of control. The nature of man in general would make things a 100 times worse if we didn't have some control. Just saying can't everyone behave isn't going to work. I know you think that if things were let go the natural order those things would be corrected. There are things in this world that people even in large groups can not fight. Ignorance, greed and the lust for money and power are just a few items that come to mind.

There have been many times what you suggest is very similar to some of the attempts by anarchists. With out exception everyone of those systems failed. There is no way to run and keep a nation intact under any of those type of set ups.

jonas_opines 5 years, 2 months ago

. . . . Meh, what's the point? If you believe that this would work you're not going to listen to anything else anyway.

I had hoped for some level of thought past just "get rid of the evil gub'mint." With nothing else there, beyond simplistic supply/demand models, not much to really comment on.

tbaker 5 years, 2 months ago

Liberty - people have a hard time comprehending a world without the level of government involvement we have today. That equals "normal" to them. You challenge that mental model with your suggestions. A lot of people have grown up absolutely convinced that the ever-growing government involvement in our lives is actually making things better, so less government = lower standard of living. They can't conceive of a paradigm where reducing the role of government in our lives (health care, et all) is actually the solution to our country's problems. They flatly reject it because it invalidates just about every assumption they have about life in America.

Consequently it is going to take a disaster to show people the presumption that the government makes things better is a false one. It's going to take a calamity, much like we're seeing unfold in California, to defeat the statist belief that government makes our country great - not the people. The concept that posits people, unrestrained and empowered by government (not regulated by it), can take control of their own lives and make their own decisions and fix the problems we have is slowly growing as more and more people see the looming disaster. Take comfort in the fact the day the majority of folks realize this is coming and the statists are actually accelerating it's arrival.

So when people call you "insane" just take it with a grain of salt and realize they can't help it. It is very difficult for many of us to let go of failed mental models and embrace new ones. It takes a strong person to admit life-long beliefs are actually wrong.

Gareth Skarka 5 years, 2 months ago

Absolutely, because deregulation has worked so well in the Financial Sector....

Oh, wait.

Well, it resulted in lower prices when they deregulated the telecom industry...

Oh, wait.

Well, deregulation TOTALLY worked out for consumers when it was done to Energy utilities....

Oh, wait.

Walken 5 years, 2 months ago

Liberty -

Perhaps you should review the history of the U.S. and then perhaps you will understand why those controls were enacted in the first place. The late 19th and early 20th century are rife with accounts of quackery, snake oil salesmen and downright deception. Many rathional thinking people such as yourself were taken in and many cases injured or killed poorly or even untrained physicians and pharmacists.

tolawdjk 5 years, 2 months ago

Bah, porch_Person, that document wasn't even written by Americans! Fhur'ners wrote that!

tbaker 5 years, 2 months ago

Consider all the government bureaucracy, control, and regulation we already have and then ask yourself: are the problems we have today caused by not having enough government control and regulation? If this approach works so well, how could we have the problems we have?

There is a very, very long track record of government failure one can point to, but only if one is so inclined. Its clear our problems certainly aren't the consequence of not having enough government involved in our lives. Unfortunately, it is very difficult for a lot of people to accept this because it shatters the belief that government is what makes America great. Giving serious consideration to transferring power from the federal government back to people and/or states, and restraining / removing federal government involvement in American life is not a popular idea with people who refuse to accept the fact that the government involvement we already have is largely to blame for the problems we face today.

Ergo, a calamity is required. Pouring more money we don't have and creating more crippling government bureaucracy we don't need/can't afford is hastening the arrival of said calamity. Its a self-fulfilling prophecy. The statist-version of the federal government we have today simply cannot be sustained and will soon require massive reductions in it's size and scope. Its unavoidable. The country will not accept the level of taxation required to support it.

pace 5 years, 2 months ago

I really hate the ads that say the cure for health care woes are to completely deregulate the Health Care Insurance Corporations. just let them loose on us. While running with the bulls might sound romantic, I would prefer Insurance companies to be held accountable. A reasoned approach to health coverage for everyone is better than the failing mix of government and industrial coverage which is pocked with Health industry favors built over the decades through a congressman or two. We don't need the protection of the Health Insurance Corporations being touted by the ads, we need access to reliable coverage.

Gareth Skarka 5 years, 2 months ago

Jesus! -- if you actually believe the imaginary crap you're spouting, there's no point in even debating.

puddleglum 5 years, 2 months ago

(laughter)

yes! let's deregulate everything and let everybody do everything they want. Now THAT'S freedom!

(laughter) yet another example of why republicans don't want libertarians in their party.

you almost feel sorry for them.

salad 5 years, 2 months ago

Adam Smith was wrong: markets don't always work. If there's a way that conservatives can get govt. to rig the market with rules or subsidies to give more to the few at the expense of the many, it'll happen. Since markets don't always work, Liberty's satire (it is satire....right?*) is valid.

  • "Free Lunch" by David Cay Johnston ** No one could possibly be so purely evil (not even Cheney....well, maybe Cheney) to seriously suggest such lunacy.

jimmyjms 5 years, 2 months ago

"Doesn't anyone have a dissenting response that isn't based on faulty assumptions or wild hyperbole?"

BWAHAHAHAHA.

Jesus, the irony. It hurts.

tbaker 5 years, 2 months ago

Lets assume for a moment Liberty's entire approach is as insane as many of you claim.

Given government's very, very long history of failure (examples abound) how would you characterize the behavior that continues to pour trillions of borrowed money into programs / bureaucracies that have yet to produce the desired result?

Isn't the definition of insanity repeatedly doing the same thing, but expecting a different outcome each time?

Why not give another approach, one that doesn't cost anything, a try? Whats the harm in that?

Ans: Because it would work.

meggers 5 years, 2 months ago

porch_person,

You're right- last time I checked, I was still an "innie". Good comments...how's your head feeling after pounding it against that brick wall?

I'd love to stick all of the libertarian ideologues on an island and let them be the subjects of their own grand experiment. Sort of like a modern day Lord of the Flies.

tbaker 5 years, 2 months ago

This is really all an academic argument anyway Liberty. The big-government largess we've lived under since WWII cannot sustain itself. It is and will continue to collapse under it's own weight. People will not accept the level of taxation it is soon going to require. Changes that reduce/eliminate current government involvement will be forced upon us by the tyranny of our national debt. Solutions that follow a less costly, people-centered / free-market approaches will end-up being the only viable options left on the table - a bitter lesson Californians are presently learning.

As Darwin said, "It is not the strongest of the species that survives, nor the most intelligent. It is the one that is most adaptable to change."

This change is unavoidable. The recent unprecedented increases in deficit spending are just hastening the day it happens.

salad 5 years, 2 months ago

Liberty_One (Anonymous) says… "salad, contrary to your opinion, what I'm suggesting is the moral choice." I got mine, to heck with everyone else?

"Using the power of the state to violently intervene in people's lives is what is immoral." No...actually, the rest of us got together and decided people like you really ARE crazy and need restrainin'. Sorta like keeping baby gates on the stairs when you have toddlers.

"The “government option” is what is evil, not freedom." Your view of freedom sounds alot like mob-rule. I'm glad I don't have to live next you....I pity the poor soul who does.

tolawdjk 5 years, 2 months ago

"Deregulation does not equal do everything you want. Contracts will still be enforced, malpratice suits will still be brought, fraud will still be against the law etc. "

How? By what standard? There is no regulation, no licensure, no benchmark to base "acceptable" off of. You can't have fraud if there isn't any regulation to say what is done is illegal.

tbaker 5 years, 2 months ago

Tolawdjk / Salad -

Running our country on the principals on which it was founded: one centered on the individual, one of personal freedom and liberty, one of a strictly limited federal government, is in no way implying a form anarchy you suggest. Far from from it.

The trouble is, folks who believe in the sovereignty of our government over that of the individual will react just like you did. Your principal argument, frankly your only argument, is equating a libertarian approach to our problems as nothing short of anarchy. All this does is demonstrate your ignorance of libertarian principals.

Before you condemn this philosophy out of hand you first should acquaint yourself with it a little more than you obviously have, and second, you should consider the options we will soon face as a country. The path we're on is simply unsustainable. We can manage the needed change, or the needed change can manage us.

Though not a member (because I believe organized political parties should be out-lawed) the Libertarian party has been and continues to be the fastest growing political party in the country. The more you learn about it (the philosophy), the more you'll like it. Everywhere it's tried - it works.

meggers 5 years, 2 months ago

tbaker, here's another take on "the fastest growing political party in the country":

http://politeaparty.blogspot.com/2009/07/americas-fastest-growing-third-party.html

And when you say "everywhere it's tried - it works".

Do you have examples of nations that have fully embraced the libertarian philosophy as a matter of public policy?

tbaker 5 years, 2 months ago

Meggers - Whole nations embracing libertarianism? None than I can find. Examples of libertarian approaches to problems working (as opposed to big government). Yes, there are many such examples, but you won't find a "pure" example (just like any other political ideology).

For example, in places where people have a right to private gun ownership, crime is lower. In places where they used to have the right, but it has been taken away (Australia) crime has increased. "People" caused crime rates to drop - not the government. People with a government centered philosophy don't like this. The more individuals are empowered, the less power government possesses.

The country of Estonia's economy is a good example. Studying what happened post-Soviet union, and then studying what happened after they discarded their progressive income tax system (like we have) for a one-rate flat tax is instructive. Same goes for Ireland. Libertarians oppose any form of income tax, but the flat tax leans toward Libertarianism, not away from it.

Without devoting a lot of time to a lengthy tritest on the philosophy itself, consider this the next time you see the "anarchy" card played: People should have the freedom to act according to their desires, but only to the extent that they do not trample on the rights of others. No libertarian I've ever heard of doesn't believe rules and regulations don't need to be established and enforced in order for a free society to exist and safe-guard the rights of the innocent.

Satirical 5 years, 2 months ago

Liberty_One...

First, let me applaud you on your effort to find solutions to the health care problem that doesn’t involve another bureaucratic nightmare whose only goal is to make more people dependent so it can grow; rather than the free market idea of getter bigger by providing better customer service and better quality. Government doesn’t care about customer service once the program is in place.

However, after having recently written a paper on licensing, I don’t think the majority of people will accept your first proposal. I agree that in most instances the requirement to get a license is often a way to increase government coffers under the guise of preventing charlatans. But when it comes to the medical profession, I think you will find most people are willing to pay artificially high prices for greater assurance that their physician has some minimal competency. Also, this peace of mind may in some instances actually increase, rather than reduce, trade.

A similar argument can be made for your second point; the FDA. Additionally, the FDA can argue that it prevents widespread problems which potentially affects more than a single buyer and a single seller. So, while true economic freedom allows no barriers between a willing buyer and seller, if they buyer’s actions impacts society, then it seems fair for society to have a say in the transaction. For example, a new “medicine” which actually starts a plague. Therefore, while it is possible some free market system could replace the FDA, I think you will find in this instance, most individuals willing to pay higher prices for greater peace of mind.

But again, while I think you are moving in the right direction, I respectfully disagree.

Satirical 5 years, 2 months ago

Porch_person's modus operandi when confronting opposing viewpoints:

(Step 1) Quote something completely random the opponent says. It doesn’t have to be a full sentence or more than 5 words.

(Step 2) Claim that quote means s/he supports or is against ‘X’ (X = anything you want, like paving the streets with post-notes. Similar to how porchie claims you say something, even when he quoted your saying the exact opposite. It really doesn't matter what X is, as long as it is ridiculous). Or repeat step 1, and using the two random quotes claim they contradict each other.

(Step 3) Mock opponent for believing ‘X’

(Step 4) When opponent claims s/he didn’t say that, respond by stating that you quoted him/her directly (even though when you paraphrase the statement it isn’t anything close to what s/he actually said)

(Step 5) Insert “(laughter)”

(Step 6) If opponent continues to claim s/he didn’t say ‘X,’ use a specious analogy.

(Step 7) If opponent continue to respond, claim s/he is “in Garfinkel mode” trying to get away from the fact he said ‘X,’ and/or contradicted himself. But never explain how the quote you randomly pulled is anything close to ‘X.’ And never respond to his/her questions.

(Step 8) Insert “(laughter)”

(Step 9) If this does not work engage in personal acts by making up facts about opponent, again using random quotes, as described in Step 1.

(Step 10) Repeat until you have lost all credibility on the issue.

Satirical 5 years, 2 months ago

Correction -

"(Step 9) If this does not work engage in personal (attacks) by making up facts about opponent, again using random quotes, as described in Step 1."

verity 5 years, 2 months ago

Still arguing over Liberty's satire! That means it's really prize-winning, probably on a par with, oh, what's that guys name, the one who wrote about eating babies?

arizonajh 5 years, 2 months ago

What scares us L1 is that you want us to use doctors who may or may not have any training or education for diagnosis, treatment and surgeries. A system that insures those with the least resources or in an emergency will get the least care. If I have little money then I will have to use the cheapest doctor I can find, or if injured will have to use the closest doctor, competent or not and hope he is not a quack. As I understand your position if he kills me because he has no real training or knowledge I can sue from beyond the grave.

What scares us L1 is that you want the individual to be the determiner of efficacy and safety of chemicals that only the most knowledgeable of chemist and researchers understand completely i.e. "assess risks on their own". Again though if they poison me to the point of death or coma then I can sue them. That is if I can afford to or am still alive.

What scares us L1 is that you (I think though I may have misunderstood your point) are saying that we shouldn't subsidize care for MS, CF, Spina Bifida, etc because it will cause more people to get these diseases. Do you really think that people chose to get MS because they want to sponge off the productive members of society?

If you want to sway me tell me why you think that regulation is the problem in a cause and effect argument instead of just saying intervention is the problem. If you think there are skilled surgeons out there that are being held back by a oppressive system tell me why they can't currently pass the boards and how giving everyone the right to wield a scalpel won't promote a rush to the bottom and cause deaths through incompetence to skyrocket. In fact under your system wouldn't it be a boon for the trial lawyers and therefore be a boon to the Democrats? This vision of yours is not freedom but more like anarchy. The temptation to profit and run would be overwhelming. Say a person had a product that they knew through their own knowledge would be benign for a period of time but it's use over a couple of years would cause liver failure. What stops that person from marketing it for a year and a half, taking the profits and then beating feet to a country with no extradition to the U.S. before people start dropping dead? If you take away protection up front then what recourse do I have in the end in that situation? You claim these regulations are the reason for high cost but offer no proof in the way of statistics or examples. How do you get around the fact that we spend more than countries with total control over their healthcare systems and don't get better outcomes - without saying that the WHO or the CIA just don't know as much as you about the question? Somehow I don't believe flooding the market place with unskilled "doctors" and salesmen hocking every form of snake oil is going to make us a healthier society.

headdoctor 5 years, 2 months ago

This comment was removed by the site staff for violation of the usage agreement.

tbaker 5 years, 2 months ago

Satirical - Nice upgrade to the P2 MO. Good analysis. Should be required reading for everyone on this blog.

headdoctor 5 years, 2 months ago

Liberty_One (Anonymous) says… headdoctor, it is because we don't live in a perfect world that government health care doesn't work. No amount of central planning can be efficient enough to handle the unperfect, complicated world. I don't see how you can say that people are not perfect and subject to bad motivations like greed and then say that we should trust some people with making rules for everyone and spending everyone's money! That doesn't make any sense to me. If people are so untrustworthy, how does appointment to a government position elevate them beyond the muck of human imperfection?


You are looking at my comments and jumping from one end of the spectrum to the other leaving everything out in the middle and in the process are making assumptions about what I think. That is almost like putting words in my mouth. I have stopped debating your posts before for this exact same reason. I thought I would give it another try but it seems you are bound to twist or assume I think a certain way and then run with that idea instead of sticking to what was really said.

I have no choice but to make assumptions on my own about you. You are either naive and or ignorant and really believe this stuff that you post or you are intentionally trolling. If you really believe this stuff that you post here on LJW I would seriously consider complaining to the institutions where you were educated that they ripped you or your parents off.

For the record I do not believe you are a law student either for a variety of reasons to numerous to bother mentioning. If you are, I would seriously consider changing my course of study before you invest any more time. It might help you avoid a miserable failure.

Satirical 5 years, 2 months ago

Arizonajh…

So to sum up your argument…asymmetry of information between the buyer and seller is another hurdle. You are saying that by implementing L1’s free market solution is to shift the burden of verifying competency from licensing boards and/or the government to the individual consumer. This burden shifting will likely leads to indigents and low income consumers getting fewer protections, and more susceptible to charlatans and fraud. Correct? These are legitimate arguments.

However, to offer an opposing argument; couldn’t free markets solutions such as Angie’s List, which provides free consumer ratings be a solution to asymmetry of information? Therefore, a cheap/free alternative may exist to self-regulating and self-serving licensing boards, or costly government bureaucracies to ensure quality care. Additionally, prosecution and publicizing through the media false claims would still occur, so while your argument that frauds would skip the country is possible, it is unlikely in many cases.

Also, wouldn’t the amount or level of care for indigents actually increase? Because, rather than low income earners getting no care, as is currently the case, theoretically costs of doctors would go down, and additionally the consumer could choose to be treated by someone who has the education of a nurses rather than doctors for routine illnesses. Or the consumer could choose to be treated by someone with a great deal of experience, but no formal degree, which currently is illegal.

Satirical 5 years, 2 months ago

Liberty_one… “Drug companies would market their product as being approved by X consumer watchdog organization—particularly for new medicines where the public would be distrustful.”

I think in this instance there would be a conflict of interest if the watchdog organization benefits from approving the product. If there is no benefit to them, then how does a sophisticated watchdog organization (for medical or legal professions) get funding?

I think the public wants an impartial mediator.

Satirical 5 years, 2 months ago

Liberty_One...

Oh, and I forgot to add - I think individuals are also willing to pay higher prices for uniformity in regards to public safeguards.

(To anyone else reading this and my post at 4:38 p.m. - I realize I am countering the arguments I made against arizonajh. I will wait for him to respond before I counter myself again : )

Satirical 5 years, 2 months ago

Liberty_One…

You offer a reasonable response to the concern re: an impartial mediator. However, how many opportunistic CEO’s or fly-by-night companies would be willing to sell their soul for a quick buck? A company that has been trustworthy for 50 years could be under new management who care less about public safety than about making large short-term profits. The side-effects of some drugs may not be know for years; and the cost to society for even one company with changed standards could end up being greater than any potential savings. Therefore, the risk-reward ratio doesn’t favor the risk.

Also, your counter that there really isn’t such a thing as an impartial mediator is unfortunately all too true in some regulatory fields; but I still think in terms of health, individuals are willing to trust the FDA who claims to have standards and at least has public accountability vs. a company which admits to a conflict of interest. But you still make a very valid point.

tolawdjk 5 years, 2 months ago

I trust Angie's List about as much as I trust Wikipedia. Libertarianism is alot like Marxism. Both look good to some, on paper. In practice, it will never work. It would quickly devolve into "those whom have the longest straw" and "those whom have the tastiest milkshake".

akuna 5 years, 2 months ago

Wow. This is is about as stupid as deregulating the energy and financial system ala Enron and Leahman Bros.

Any system without checks and balances is is primed for corruption (and no, a consumer's decision does not provide adequate checks nor balances.) I trust businesses even less than I do government. Business have no reason to inform their consumers nor do the moral thing as long as they make a profit.

Our government and regulations keep us safe. Liberty_one's co-opted ideas are put business first and patient health second.

Satirical 5 years, 2 months ago

Tolawdjk…

My Angie’s List argument was not implying that Angie’s List is a paradigm example of mitigating the asymmetrical information problem. It was simply an example that the private sector can fill voids, and that potentially Government hand-holding isn’t needed for all decisions consumer make.

Also, if you know where I can get a tasty milkshake let me know!

But I might have to check the safety inspection report before I go : )

notajayhawk 5 years, 2 months ago

porch_person (Anonymous) says…

"No, everyone can see what you've posted. Garfinkeling is denying the obvious, hoping that the inertia of fighting the denial will distract from the mistake."

And as usual, poochie, not everyone can understand it.

In his reply to meggers, he clearly stated that you can't be a surgeon without patients, and that people have enough common sense not to let someone cut them open without checking their credentials.

He was wrong about the common sense part - apparently, from your posts, there are people who lack even that much.


Liberty_One (Anonymous) says…

"No, I want you to use your head and think for yourself."

Please remember your audience, Liberty. The prevailing argument against your proposals can pretty much be summed up as 'We're too stupid to think for ourselves so we need the government to take care of us.'


Satirical (Anonymous) says…

"I think in this instance there would be a conflict of interest if the watchdog organization benefits from approving the product. If there is no benefit to them, then how does a sophisticated watchdog organization (for medical or legal professions) get funding?"

Where does UL get their money?

Katara 5 years, 2 months ago

tbaker (Anonymous) says… Though not a member (because I believe organized political parties should be out-lawed) the Libertarian party has been and continues to be the fastest growing political party in the country. The more you learn about it (the philosophy), the more you'll like it. Everywhere it's tried - it works. ~~~~~~~~~~~~~ This should be interesting. Name one society it has worked successfully and is still working.

Jimo 5 years, 2 months ago

I wish someone would write an op-ed reviewing various market-based actions that could be taken to reform health insurance. This piece is not that article.

For a free market to operate fully consumers would have to be free of compulsion in their choices and possess a reasonable amount of knowledge about their options. While these conditions may exist at acceptable level for toe fungus or acne, they do not operate well in situations involving pancreatic cancer or various forms of trauma such as being impaled.

Of course, a free market also requires basic standards of legal protection that provide adequate remedies for lying, incompetence, carelessness, etc. Unfortunately, few adequate remedies exist for deceitful, misleading, or monopolistic dealing beyond, at best, monetary damages -- which of course are also limited by politicians bought and paid for by insurance lobbyist as "tort reform." I doubt more than one person in a million would consider an award of $10M to be an adequate remedy for death resulting from a lethal infection caused by a doctor not washing his hands. But that's okay because - despite one-off prominent headlines to the contrary - our legal system is exceedingly unlikely to award your heirs anything close to this figure, if anything at all. Unlikely? The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year. Preventable? Easily. Cost? Almost nothing. Progress on reduction? Virtually none - despite regulation, despite lawsuits, despite professionalism. In this "libertarian" proposal to "deregulate," where is the proposal to get politicians out of the courtroom and allow those who are harmed to go to court and sue those who harmed them? This is not "libertarianism" but rather a state of nature, survival of the fittest (or more accurately, luckiest).

Want to "deregulate" health insurance but not be blinded by ideological libertarianism? How about revoking the statutory exemption from anti-trust monopolistic behavior! I can make an exception for baseball, but why do our elected representatives say it's okay to interfere with the normal operation of free markets, which would at least employ market forces to drive out excess profits - to the benefit of consumers? Might bribery have something to do with it?

jonas_opines 5 years, 2 months ago

headdoctor: "You are looking at my comments and jumping from one end of the spectrum to the other leaving everything out in the middle and in the process are making assumptions about what I think."

That's what he does. It might be trolling, but I'm under the suspicion, after probably 10-15 lengthy engagements if I'm right about previous usernames, that it might just be the way he thinks.

lctchr1 5 years, 2 months ago

LO, I understand where you are coming from, but you are overestimating, by a long shot, the intelligence of our society. In your world, everyone would want and have to take care of themselves. Unfortunately, this will never be the case. Our society would crumble, without regulation and checks, because, quite frankly, a large percentage of our population are sheep, slowly being herded to the slaughterhouse. Our government prefers it this way. They will keep the sheep at pasture, to support their cause and keep the peace, but no progress will ever be made. The sheep are blinded by wild ideology and fear. The sheep have taken their eyes off "the wolf". Good luck!

jonas_opines 5 years, 2 months ago

Meh, if by presiding forum moderator you mean having a rather long and studied notion of where everybody, including L1, generally stand on subjects, and occasionally feeling the need to inform others, for instance, that certain posters have no conception of anything other than absolutes, then I guess I can be, as long as its an unofficial title. Personally, I still like the Devil's Avocado, myself.

Regardless, you haven't made me mad in quite some time, and in general the only ones that question my general moderate-ness (?) are the recognized forum extremists, such as yourself.

jonas_opines 5 years, 2 months ago

I would admit, though, to a good deal of frustration on a number of occasion, when it seemed like rather than listen you were only waiting to demean opposing viewpoints. Then it occurred to me that rather than listen you were only waiting to demean opposing viewpoints, and since then I've found it more amusing to simply mock you and your impotency of cause. From a practical aspect, both are probably equally productive.

headdoctor 5 years, 2 months ago

jonas_opines (Anonymous) says… headdoctor: “You are looking at my comments and jumping from one end of the spectrum to the other leaving everything out in the middle and in the process are making assumptions about what I think.”


That's what he does. It might be trolling, but I'm under the suspicion, after probably 10-15 lengthy engagements if I'm right about previous usernames, that it might just be the way he thinks.


I think the problem is solved for me. Liberty-One now joins a real short list of who I will no longer engage. I might post on his thread/blog to other posts, but not to his. He doesn't want to debate on a clear playing field and apparently is pretty sensitive when you poke a stick at his ignorance. I suffer fools very little and when the parameters keep changing or the issue gets sidetracked with an assumption to create deflection I lose my patience pretty quickly.

jenniflip 5 years, 2 months ago

I am really tired of hearing about what we shouldn't be doing instead of a solution.

reticent_irreverent says:

"With insurance paying health care expenses, we become less involved in making decisions, because someone else is paying the bill. Comprehensive health insurance is different than any other type of insurance. Health insurance is the primary payment method not just for expenses that are unexpected and large, but for nearly all health care expenses. Does you auto insurance pay for gas? Does your homeowner insurance pay for your electric bill? Most pregnancies are planned, and delivery can be forecast 9 months in advance, yet we pay for these using tyhe same way we fix our car after a wreck - by filing an insurance claim."

Ok,

a. We are, as consumers of health care, and those who are fortunate enough to have health insurance, all responsible for being proactive in the insurance claims process.

b. To state that someone "else" is footing the bill is claiming ignorance in the system... have you never heard of premiums, deductibles, copays, or coinsurance? I pay almost $300/month for my family. I have large ($7500) deductible, of which my employer pays the first ($1500) and I can set up a health savings account to offset the rest of the out of pocket expenses. No one "else" is footing the bill. As a matter of fact, it is October and no one in my family has been to the doctor ONCE this year. I have paid a lot of money for health care I have not and hopefully will not require. I would say that when and if we do, we will be very "involved" in where that money goes.

c. I am not a car. So, yes, my insurance is different than auto insurance. If my car runs out of gas, it stops running. The nice man at AAA can come and give me more fuel and my children still get a mother. I am a human being and my body can react unpredictable ways. Reminder, I PAY for my health insurance and that includes preventive maintenance of my body. Do I do my part? I try really, really hard. Do you?

d. Are you really equating human reproduction with a car wreck? I guess (hopefully) most pregnancies are planned, but you argue they should not be paid by insurance? First, once again, you are admitting your ignorance of the health care industry by equating it with other kinds of liability insurance. I pay PREMIUMS (not free, once again) and my child is a future contributor to the economy. To have a child that is a drain on society due to birth defects or poor prenatal care is counterintuitive.

notajayhawk 5 years, 2 months ago

porch_person (Anonymous) says…

"I pointed out the contradiction earlier. You must not have read it. You submit Liberty_One's argument again!!"

There is no more contradiction in Liberty's posts than there was when you tried to 'contradict' my poll numbers on single-payer by posting poll numbers on public option. But then, I guess you really don't know the difference, do you? Kind of points out what a buffoon you are trying to debate healthcare policy.

Liberty never said meggers could not put up a shingle offering her services as a neurosurgeon. He pointed out that it would be foolish of her to do so, as no one (at least no one who isn't named porch_person) would be stupid enough to let an un-credentialed neurosurgeon cut into them.

"How do potential patients for Dr. Meggers “check her credentials” when Liberty_One has abolished them?"

Gee, poochie - perhaps if you could get a third grader to read for you?

Let's see - how to explain to a mindless troll without using words too big to understand - someone who quotes Sesame Street in his arguments - what to do, what to do.

I know - how about if you had just read Liberty's posts before making an even bigger a** of yourself than usual?

"that's where private accreditation comes in."

Maybe when you get out of primary school, poochie, you'll realize that most schools are accredited by non-government entities - why not medical schools? Maybe some day you'll also be able to understand that credentialing is a term that encompasses more than licensing, which is all Liberty suggested doing away with (after quoting him - twice - it's too bad you didn't have the mental capacity to figure that out). There are actually professions that have various agencies issuing credentials that have nothing to do with a license issued by a government agency.

You're always amusing, pooch - but please do try to keep up. Who knows - you keep hanging around, maybe someday you'll figure out the difference between single-payer and public option.

notajayhawk 5 years, 2 months ago

jenniflip (Anonymous) says…

"To state that someone “else” is footing the bill is claiming ignorance in the system… have you never heard of premiums, deductibles, copays, or coinsurance? I pay almost $300/month for my family."

Wow! That much?

Of course, the healthcare costs for the average person in this country are about $700 per person per month. Who's paying the rest?

That is part of the problem - when you have insurance, you have no idea that ER visit cost more than a car, or that fairly commonplace medical procedure cost more than your family's annual income. When your obligation is capped at, say, $300/month, then you don't have much incentive to try to hold costs down, do you? Even with a $6,000 deductible, would you bother to even call different hospitals to see if they maybe charge $80K for the same operation that your hospital charges $100K for?

"I am not a car. So, yes, my insurance is different than auto insurance."

No, it isn't. And this is another part of the problem. Insurance is insurance. It is a financial arrangement - insurance companies provide a service, financial risk management, for a fee. They do not provide healthcare, any more than AAA sells gas (AAA pays an independent road service company to come out and bring you gas). Or any more than your homeowner's insurance salesman is going to roll up his sleeves and come out to replace your roof. It's that emotional, knee-jerk reaction that associates health insurance with health care that leads people to believe that they are somehow different in nature.

"To have a child that is a drain on society due to birth defects or poor prenatal care is counterintuitive."

To believe that lack of insurance is the cause of these things is not too intuitive, either.

esteshawk 5 years, 2 months ago

Dr. Nick Riviera, neurosurgeon. With Lionel Hutz as his legal counsel. Then you can go see Dr. Marvin Monroe for psychological counseling.

Satirical 5 years, 2 months ago

Children....

Can we please try to offer opposing viewpoints without resorting to sophmoric name calling?

I disagree with Liberty_One, but am able to engage in a civil discussion with him without claiming he is ignorant. (Actually his arguments are valid as to most fields requiring licensing, which are a barrier to entry and often adversely affect minorities and the poor. I simply disagree as it pertains to the medical field.)

I welcome opposing viewpoints because they allow me to (1) question what I currently understand as "truth," and either (2) Refine my argument and reinforce it, or (3) Require me to abandon my pre-conceptions. Either way, it is a win-win to engage in a discussion/debate. I don't argue for anyone's sake but my own.

When you resort to name-calling and ad hominem attacks, you are aren't proving anything about the person you are attacking, you are only proving something about yourself.

tbaker 5 years, 2 months ago

I just read where the senate finance committee defeated an amendment that would require the final health care bill to be posted on-line for at least 72 hours before they vote on it.

What could possibly be wrong with doing that?

There is a trend here folks. This lack of transparency is whats driving the voter outrage:

House energy and global warming bill, passed June 26, 2009. 1,200 pages. Available online 15 hours before vote.

$789 billion stimulus bill, passed Feb. 14, 2009. 1,100 pages. Available online 13 hours before debate.

$700 billion financial sector rescue package, passed Oct. 3, 2008. 169 pages. Available online 29 hours before vote.

USA Patriot domestic surveillance bill, passed Oct. 23, 2001. Unavailable to the public before debate.

denak 5 years, 2 months ago

"....Gonna have a tough time suing someone for malpractice when there was no license to have violated. You don't realize that...."

At the risk of someone thinking I am defending or worst agreeing with Liberty_One, I do have to take exception to this statement. I don't think it is totally accurate.

Granted, if L1 believes that there should be nostandards in existence, then this is probably correct.

However, if there are duty of care practices in place, a "doctor" or medical personnel could still be sued for malpractice if that doctor breaches his or her duty of care.

I think there are actually cases where hospitals or individuals have been sued for malpractice because that individual impersonated a doctor. There was no liscense but that "doctor" and by extension, the hospital, is still liable for malpractice.

Correct me if I am wrong.....or if you think I missed the point completey. :)

Dena

P.S. About this statement, " You can't get insurance against suicide or bankruptcy.." This is not exactly correct. Life insurance policies do pay out for suicide. The only restriction in most life insurance policies is that the suicide does not occur within two years from the start of the policy.

notajayhawk 5 years, 2 months ago

Thank you, pooch-person, for demonstrating once agin your boundless ignorance, this time with a complete lack of understanding of the difference between licensing and credentialing. But then, what else would we expect from someone who doesn't know the difference between public option and single payer.

camper 5 years, 2 months ago

Unfortunately the free market system cannot be applied as a "one size fits all" remedy for all of our personal and societal needs. I simply do not believe that certain institutions fit the the free market model. Health care is one example.

Of course free markets and Capitalism are preferred, but a balance of regulation and government must also be struck. Without it, you have chaos and anarchy. Almost like a return to the days of the wild west or something like a lot of third world countries I can think of.

headdoctor 5 years, 2 months ago

Satirical (Anonymous) says… Children…. Can we please try to offer opposing viewpoints without resorting to sophmoric name calling?


No. Not when it involves Liberty_One and in most cases Notajayhawk. In order for a debate or civil discussion to occur, both sides need to state their view with some sort of real support and then you can discuss back and forth. It also helps if the one discussing have some credibility of which in the case of these two doesn't exist. It is impossible to debate someone who is constantly making assumptions, altering the parameters of the discussion, or changing the direction of the discussion by deflection because they have nothing else to make their case.

This thread should have been dead ten posts after it was started and if common sense was used the thread shouldn't have even been started. This whole thread is about pipe dreams and or utopia. The concept behind this thread would result in chaos and at no time in the history of man has this type of system ever worked and it sure wont work now. For anyone to think that things will work out on their own without some laws and enforcement is utter stupidity.

The humorous part about this is most people who believe in this type of thing think or want you to think they are supporting true freedom when there really is a very ugly hidden agenda. A good hint is it usually starts with the survival of the fittest. Does that ring any bells for you people? What is even more funny is the people who support this type of concept think they are smarter and better than anyone else but in reality those strong idealistic people are the first to be taken out by the chaos.

Satirical 5 years, 2 months ago

Liberty_One...

I looked up the word "malpractice" and the word "license" isn't used anywhere. http://www.answers.com/topic/malpractice

So, to me at least, it is clear that removing a licensing requirement is NOT taking away all standards for everyone and creating anarchy. Otherwise any job which doesn't require a license would be "anarchy."

This of course does not mean that I agree with all of your proposals, but I think it is clear for anyone to read that absence of licensing doesn't mean standards and accountability still don't exist; and anyone who claims otherwise is simply being disingenuous.

camper 5 years, 2 months ago

Liberty, I think of free economics in terms of wants and needs from willing participants. While health care certainly qualifies as a need, much of this need is beyond ones control. Providing health care and taking care of those who are sick is also a moral issue....going far beyond simple economics.

Satirical 5 years, 2 months ago

Liberty_One... "It wouldn't because the two aren't connected. Licensing is a statutorily-created regulation and malpractice (or professional negligence) is a common law tort."

I know ; )

(Just trying to spell it out for those who continue to cling to this failed argument so we can move this discussion along. Also, you think you don't like licensing requirements now...just wait until you have to submit all the paperwork for your Bar application : )

tbaker 5 years, 2 months ago

Headdoctor - Let me tell you about a pipe dream. It is to insist that we must proceed from the predicate assumption that our health care problems are so big, so bad, and so complex that ONLY the federal government can fix them; that there is only a token roll for individual people and the free market to play, that we simply must have yet another expensive government entitlement program we cannot afford.

Since the late 1930s, our country has operated with a decided bias towards the aforementioned predicate assumption, and it has failed by any objective measure. Our big entitlement programs are bankrupt or quickly headed that way. We face nearly $60 trillion dollars in unfunded federal liabilities. 43 cents out of every dollar being spent by the federal government today is borrowed.

Reasonable, clear-thinking people know this situation is unsustainable. If the true motive is to reduce cost and improve access to health care, then alternatives that do not require new entitlement programs we cannot afford simply must receive serious consideration. Dismissing them by implying a people/market centered approach to our health care problems is nothing but pure anarchy is disingenuous hyperbole that ignores this fact.

Satirical 5 years, 2 months ago

Some arguments against licensing (occupational regulation) in general:

Occupational licensing harms the public principally by restricting entry to the occupational group. “Within an occupation, the employment growth rate is approximately 20 % higher in states that do not require licensing, but impacts differ widely based on the methods of occupations.” Theoretically fewer professionals in a trade lead to decreased supply, decreased consumer choice, higher prices, and higher incomes for existing practitioners. Higher prices tend to reduce the service's availability to poor people. “Licensing drives up prices, and the overall wage effect relative to unlicensed occupations is 10-12 percent, however it should be noted the impacts differ widely based on methods, occupations, and toughness restrictions.” Also, “occupational licensing tends to reduce minority employment prospects because these groups often are less able to meet the entry standards it imposes.”

Some of the perceived advantages of occupational licensing are arguably dubious. The role of the government and professional associations as unbiased gatekeepers and enforcers is questionable. Licensing’s entry restrictions often create undesirable monopoly rents through greater barriers to entry. Because licensees per capita stakes in the licensing controversy are so much greater than those of consumers, crucial licensing decisions that can affect the public are often made with little or no input from the public. “If such a process serves the public interest, it is only by happenstance.” Friedman argues that licensing systems are almost always run by and for incumbents, so that gatekeepers and enforcers are self-interested. “Their vested interests lead them to not only create monopoly rents through restrictions on entry but also to limit complaints and disciplinary procedures against most incumbents.”

If consumer protection is the main objective then it is questionable whether occupational licensing is succeeding. In fact one report shows, “there is no overall quality benefit of licensing to consumers, using generally available sources such as regulatory boards, malpractice insurance rates, and other direct quality measures.”

Satirical 5 years, 2 months ago

Cont'd

Because of the higher costs, and the lack of supply as mentioned earlier, some consumers, resort to do-it-yourself methods, which in some occupations has led to lower overall quality and less safety than if there were no licensing.

“The incidence of rabies is higher, for example, where there are strict limits on veterinary practice, and as Sidney Carroll and Robert Gaston documented, rates of electrocution are higher in states with the most restrictive licensing laws for electricians. Apparently, consumers often do their own electrical work in highly restrictive states rather than pay artificially high rates for professionals, with predictably tragic results. Carroll and Gaston also found, using data on retail sales of plumbing equipment, that plumbing restrictions increase the extent of do-it-yourself work.”

Denying the right to earn a living is a direct deterrent to both personal and economic potential. In addition, regulations that restrict entry into the profession may disserve the public interest by increasing costs and protecting the incompetent.

While some requirements of occupational licensing aren’t universally inherent to all licenses, empirical and anecdotal evidence can provide meaningful insight into what the court should look at in determining whether potential burdens are recognized and avoided by the drafter of the regulation to determine whether the regulation “fits” or is “substantially related.” Some requirements are not based on the levels of knowledge, skill, ability, and other traits truly necessary to ensure adequate service. Apprenticeship requirements, for example, do not always bear direct relation to the actual amount of time needed to acquire minimum competence. “Until the courts called a halt to it, for example, it took longer in Illinois for an apprentice to become a master plumber than for a newly graduated physician to become a Fellow of the American College of Surgeons.” This barrier of entry also provides a problem for rehabilitating previously convicted felons. “In some states virtually the only ‘profession’ open to a once-convicted felon is that of a burglar…” While the purported public benefit of licensing exams is determining the fitness of candidates, if the exam isn’t regularly updated then it may have little or nothing to do with what is currently considered good practice.

Satirical 5 years, 2 months ago

Cont'd:

Additionally, some occupational regulations impermissibly discriminate according to the values of egalitarianism and social justice. Licensing tests, if administered solely in English, as often is the case, make it more difficult for foreign language speaking citizens. The burden of paying tuition to professional schools or undergoing prolonged periods of apprenticeship is particularly difficult for the indigent. Moreover, economists have found correlated evidence that exam grading standards have sometimes been manipulated to reduce the number of applicants who pass the tests during tough economic times, thus proving greater job security those who are already licensed members of the profession.

Local licensing also has lead to decreased mobility. Licenses are sometimes enforced by cities. Outsiders, no matter how skilled or experienced, are barred by reason of not being able to claim a narrowly localized experience. While arguably the right to earn a living doesn’t also include the right to live where ever one pleases, Americans have historically held the belief that mobility leads to new ideas and new techniques, aka the “melting pot” paradigm.

“Occupational regulation has limited consumer choice, raised consumer costs, increased practitioner income, limited practitioner mobility, and deprived the poor of adequate services—all without demonstrated improvements in the quality or safety of the licensed activities.” Additionally, some of the perceived benefits of occupational licensing are questionable. And finally, occupational licensing left unchecked may lead to undesirable and possibly unconstitutional consequences, such as decreased mobility and unlawful discrimination.

Satirical 5 years, 2 months ago

If anyone wants the arguments in favor of occupational licensing, please let me know.

Satirical 5 years, 2 months ago

Porch_person....

I love your imagination. On what basis do you claim I am an attorney?

Satirical 5 years, 2 months ago

porch_person.. "Satirical, that was only an hour ago…"

Since I have knowledge of the Bar application process it automatically means I am an attorney? Couldn't it also be possible that I know of someone who went through the process? If you want to continue to call me an attorney will such lack of evidence, then be my guest.

"Still haven't read any snappy comebacks on Bolam…" - porch_person

Haven't I told you enough times that I am not going to argue with a person who won't admit 'A' is different than 'B'?

Satirical 5 years, 2 months ago

porch_person...

Why would I reveal any personal information about myself, which would simply serve as a distraction from my arguments, and allow individuals who know nothing of my job/occupation/career/profession to fallaciously criticize my argument in order to stroke their own ego?

"Always feels good to have bested an attorney and a third year on a point of law." - porch_person

You can speculate about me all you want porch_person.

Satirical 5 years, 2 months ago

Liberty_One...

You have allowed porch_person to hijack your blog with his predictable traits. Regain control by ignoring him.

denak 5 years, 2 months ago

What I think is interesting is that L1 is proposing the abolition of licensing when the free market would make it so that hospitals would demand licensing.

In order to compete, not only for the best staff but for patients, the hospital would need some kind of proof for the general public that the hospital is sound.

People are not going to go to a doctor (or lawyer) that has not proven via school and testing and licensing that he or she is competent. Hospitals will not hire someone who isn't licensed. Hospitals need prestige in order to remain fiscally viable and licensing is one way they would prove to the general public and shareholders that they are.

Contray to what some suggest, licensing does not prohibit the most qualified from becoming a doctor, lawyer etc. It prohibits those that are least qualified.

The crux of the matter is that when one is dealing with someone's life, the general public and the individual professions demand licensing in order to protect the public. Doctors, nurses, lawyers, social workers need to be licensed in order to insure the quality of care and advice given to their patients and clients. In fact, it is my opinion that our country is moving towards more licensing rather than less. There is a movement to require paralegals to become licensed. And in my opinon, given the fact that paralegals are taking on more and more responsibilities, they should in fact be licensed.

The public, the legal establishment nor the medical establishment will ever go for a free market solution.

Dena

llama726 5 years, 2 months ago

I'm not going to read all eleventy billion comments, but Liberty, you seem to keep saying:

"malpratice suits will still be brought"

How? If we've deregulated physicians to the point where they don't have to meet a universal standard to graduate from a medical school and we've deregulated laws governing health care, where do you take your malpractice suit and what laws do you use?

jonas_opines 5 years, 2 months ago

Dena: I think the answer would be, if the free market does the same thing as the government does in the long run, it's just not evil because the free market did it and not the government. That might not make much sense, but that might be because you don't start your philosophical base with the version of Cogito Ergo Sum that simply states: "Government is Evil."

llama726 5 years, 2 months ago

"People are not going to go to a doctor (or lawyer) that has not proven via school and testing and licensing that he or she is competent. Hospitals will not hire someone who isn't licensed. Hospitals need prestige in order to remain fiscally viable and licensing is one way they would prove to the general public and shareholders that they are."

The inherent flaw in your argument is your assumption we have a choice of emergency practitioners. We have one hospital in Lawrence and most communities, you will only have access to one or maybe two hospitals within reasonable distance in the event of an emergency. Given those circumstances, you don't get to choose who your emergency doctor is. Often, you don't get much of a choice in who any of your doctors are, especially in an emergency scenario - you may need a surgeon immediately and the only providing hospital doesn't bother to certify anyone.

I know what you'll say - well, someone else will start a hospital. Fantastic. It's too bad that in the six months it takes someone to get up and running with this, people will be dying needlessly or getting treated improperly.

Unlike a cheeseburger stand or a clothing company or an gadget maker, hospitals provide a service that many people need and that many people have their health and well-being affected by. To remove regulation and standards from these and allow the market to decide them is folly. The market typically arrives at the conclusion that the superior product is the one marketed better and the one that costs the least.

I appreciate your fanatical devotion to your theory. I really do. It's time that we stop acting as if any extreme can be applied to every situation. Communism doesn't work in practice and unrestrained, free market capitalism will suffer the same flaws. The free market cannot solve the problem of health care. The problem of heath care is the fact that everyone needs it and not everyone can afford it. Like it or not, lowering standards and removing safety nets for people who aren't taken care of when they slip through the cracks isn't a solution.

frank mcguinness 5 years, 2 months ago

This has to be the most POS blog ever written.

This joke of a blog almost makes marion's blog sound sane.

This article reeks of ignorance beyond belief.

Get off the moonshine dude.

llama726 5 years, 2 months ago

"A malpractice suit is just what we call it when we sue a professional for negligence. It's a common law tort claim that pre-exists medical licensing in the US. The standard by which the doctor would be judged would be established by expert witnesses—simply other doctors."

So we remove the requirement for doctors to have any certifiable training. Then, we place those doctors in the field where other un-certified doctors can be called upon as witnesses to defend their colleagues from being found guilty of wrongdoing.

Why not just keep the certification requirements in place? It doesn't make sense why we would abolish the guarantee that every doctor meets a certain standard, preserving malpractice suits for cases when the doctors lapse, with the hope that the free market comes up with an idea that it's good for all doctors to have a baseline set of skills measured by... certification.

llama726 5 years, 2 months ago

So let me get this straight. I can't go to school to become a doctor if I so decide?

Wait. I can. Turns out I wouldn't have much problem, either, as long as I can make the academic requirements.

llama726 5 years, 2 months ago

And turn around and get paid $150,000 to $200,000 per year. Yes.

We also have student loans (gasp) and horrific federal grants from the government which help people go to school. They're so awful. If we reformed the health care system, you wouldn't need those loans! Anyone could learn to be a doctor and it'd only take 2 years and $3000, right? Please. You're telling me the cost is impractical. The amount of information a med student (I know several) ingests TAKES them the amount of time they spend on it.

Who will teach medical students? How long should the training be? What medical background do you have to determine all this? What will the content of training be? What will you cut out in the abridged certification process? How do you specifically cut the costs associated with someone becoming a physician? How do you attract someone to teach other physicians to be if it is not lucrative to teach what they know?

Easy there, Tiger. I know your answers. De-regulate everything and let the market sort it out. So helpful! Meanwhile, if the market doesn't solve the problem, then it will just... be ignored?

llama726 5 years, 2 months ago

Liberty, I am having a really hard time with this. You think that education costs too much so you want to privatize it, making it less accessible for people who already can't afford it. Then you want to make it take less time? And you tell us this with a serious tone?

jafs 5 years, 2 months ago

LO,

The problem with your model is that it doesn't have any mechanism to prevent damage/harm.

It only allows for lawsuits after injury has been done.

What prevents an individual/business from simply operating in a harmful manner and then paying whatever fines they accrue?

Most of us would rather know that our doctor, mechanic, etc. has to operate at a certain level of competence so as to prevent injury.

Most of us don't want to have family members killed, maimed, etc. and then have to engage in lengthy and expensive lawsuits.

Regulation is an attempt to prevent injury by requiring demonstrable competence in a field in order to practice in it. It's not perfect, and of course varies with the competence/integrity of the regulators, but it's better than nothing.

gogoplata 5 years, 2 months ago

Regulation can also be taken care of by the free market.

Gareth Skarka 5 years, 2 months ago

Aw, isn't it cute? Somebody just read "Atlas Shrugged."

Another Ayn Rand fanboy, spouting the wacko Libertarian BS....

llama726 5 years, 2 months ago

"Yup, you're right. Only a licensed doctor could possibly be able to treat scratches and minor cuts, perform CPR, set a splint on a broken bone, diagnose althete's foot or pinkeye, construct a weight loss program or deliver a baby."

Scratches and minor cuts can be treated by first aid. Most people don't go to an ER for a scratch or a minor cut not requiring stitches.

CPR is performed daily by people who are trained in first aid. No one is claiming only a doctor can do this.

Athlete's Foot can be treated with over-the-counter medication.

Pink Eye... okay... So because I can tell I have pink eye, I should be able to write my own script?

We have nutritionists (bachelor's degree requirement) and dietitians for weight loss programs.

The only thing you've included that a doctor is primarily involved in is Pink Eye and childbirth. You're really stretching.

llama726 5 years, 2 months ago

Not to mention, nurse practitioners and RNs do a lot of the treating you're describing here. I'm sorry. You're never going to persuade me that we should lower the bar academically. We should make it more accessible financially, sure. But the free market decides prices, and the free market wants it to be so cost-exclusive.

PS, there are more doctors than presidents, and becoming a doctor involves educating yourself, not winning an election. Please try harder for a more appropriate metaphor.

jafs 5 years, 2 months ago

If you simply increase the supply of incompetent doctors, it will not decrease the prices that competent doctors can charge, if consumers are in fact doing their homework.

If practicing without a license is a jailable offense, then yes, it's more of a deterrent than a simple monetary judgement.

The point again, which you completely ignore, is that most people don't have the time/energy/resources to pursue legal action, and would prefer the prevention of injury to the compensation for it after-the-fact.

jafs 5 years, 2 months ago

I'll give up after this one.

Licensing and regulating various occupations is done in order to attempt to ensure that practicioners possess a certain level of competence in order to practice.

Someone who has demonstrated via tests (both written and practical) that they have an understanding of their profession is a bit more likely to be good at it than the average joe.

Anyone can be greedy of course - that's a given.

And, I believe that it might be a bit easier/less expensive to simply report someone to the correct authority for practicing without a license (for example) than it is to bring a lawsuit.

Then the licensing board does the investigation and arrives at the outcome.

jafs 5 years, 2 months ago

We'll have to continue this at another time.

Bottom line:

I think both the private and the public sectors need improvement.

My response to the problems of incompetence and greed is more/better regulation that is enforced better.

You seem to have a rather large faith in the private sector and the court system which I don't share.

gogoplata 5 years, 2 months ago

You seem to have a rather large faith in government regulation that I don't share.

jafs 5 years, 2 months ago

I already said I think both sectors can/should be improved.

jafs 5 years, 2 months ago

However,

Federal guidelines and regulation are the only way to create/maintain consistent standards throughout the country.

gogoplata 5 years, 2 months ago

No they are the only way to force them. Guidelines and regulation can be handled by the free market.

jafs 5 years, 2 months ago

gogo,

Then the standards will change from place to place, hence not be consistent.

Liberty,

Courts are administered by the government and paid for by taxpayers - why would they be any better?

jafs 5 years, 2 months ago

Let's take just one example of an industry that is not federally regulated - auto repair.

Have you tried to find a decent mechanic recently?

The private (voluntary) attempt to maintain some standards (ie. AAA approval) is woefully inadequate - I have had poor experiences with a number of AAA approved shops.

Since we are not all generally experts on automobiles, it is hard to judge the competence/honesty of auto mechanics.

The only recourse is to file a lawsuit if you believe you have been ripped off (the recourse you'd like to see for problems with doctors).

However, the burden is then on you to prove that in court, which may be difficult - professionals are generally wary of criticizing other professionals, especially in affadavits which will be used in court.

All of the above would be true of doctors and other health care professionals.

In addition, if we removed the licensing and other requirements, the phrase "ordinary doctor" would likely lose all meaning, since anyone could become a doctor.

I understand that you don't like the federal government.

I don't understand why you think that patients/consumers should bear large burdens when trying to go about their daily lives.

MyName 5 years, 2 months ago

This is dumb.

1) Regarding removal of licensing requirements: Have you hever heard of John R. Brinkley? (http://en.wikipedia.org/wiki/John_R._... ) This just opens the door for xenotransplantation of goat glands as a "legitimate" form of treatment. And you don't gain anything. Lowering some of the requirements so that Nurses or other health care professionals can do more, may be helpful, but eliminating all of the is dumb.

2) All removal of the FDA testing does, is open the door for a non-profit or other private organization that does the same thing (and charges the same amounts). The FDA performs a useful and necessary function and so the market would eventually come up with the same thing on its own (though without the force of law). See Underwriters Laboratory, the IEEE, and many other standards and testing organizations. How is this going to save us megabucks? And what will it do to prevent xenotransplantation?

3) Again you're opening the door to repeats of the mistakes of the past. While I think removing some of the regulations may be helpful. Removing all of them just opens the door to complex forms of fraud (think Bernie Madoff, only in insurance), or insurance companies selling policies that are so full of riders that you can never actually collect on them.

4) "Eliminate all subsidies to the sick and unhealthy." What the heck does this even mean? Are you talking about removing SSI, and the tax breaks for being blind or what? And given the percentage of people who collect this stuff, compared to the actual costs that are driving up the price of health care, this really won't solve anything.

So again, none of this stuff will do anything to solve the actual problem, but I guess it would make you feel better about have a "more libertarian" society, even as everyone continues to enjoy higher insurance and health care costs.

gogoplata 5 years, 2 months ago

You can still have consistency if that is what you want. You could have a private organization with a set of consistent standards that have to be met for approval like the BBB. So if you this was important to an individual they could seek out an office that has been approved my this private organization.

jafs 5 years, 2 months ago

gogo,

And if none, or very few, businesses chose to affiliate, then you'd have a very limited choice.

Liberty,

Again, the point is that licensing (and other forms of regulation) attempt to ensure that consumers will generally not have to file lawsuits, and simply be able to count on a certain standard of care.

It doesn't work perfectly - I agree. Perhaps the standards are too low. Perhaps they are not enforced adequately.

Your system would also not work perfectly - I have pointed out a number of reasons/explanations for that.

The "actual" problem with our health care system is not a simple one - there are many facets.

It is too expensive. It is too difficult for patients to navigate. It is too complex. The level of care received is often lower than I'd like. It is inefficient.

That's just off the top of my head.

Do you think most people actually (and should have to) research past lawsuits/kill rates when finding a doctor?

In your ideal system, I assume the lawyers will also not be regulated/licensed in any way - so again we have the same argument there.

jafs 5 years, 2 months ago

And, you didn't respond at all to the auto mechanic issue.

I submit that under your scenario, doctors/health care practicioners would become much like auto mechanics.

It seems to me that would be a lowering of the current level of care, which is already lower than I'd like in many cases.

gogoplata 5 years, 2 months ago

gogo,

And if none, or very few, businesses chose to affiliate, then you'd have a very limited choice.

But if many chose to you'd have a large choice.

MyName 5 years, 2 months ago

If my responses were so dumb, then why did you have nothing to counter them? Removing all regulation of the medical industry will lead to quack medicine where people who claim to be doctors pretend to do helpful medicine that ends up looking shameful if not completely crazy 50 years after the fact.

Your belief that somehow the market will magically fix this stuff without regulation goes against the fact that this type of guy really was in business and was one of the reasons we have such strict regulation in the first place.

And good job ignoring my other three points about how legislating the FDA out of existence won't eliminate the need for an organization that does the same job; removing all regulation from the insurance industry will lead to a "buyer beware" situation that always tilts the table in favor of the guys with the money and the lawyers (which would not be the consumer); and that your last "solution" is trying to legislatively trying to "fix" a problem that has little to no effect on the actual costs of insurance.

So again, this "solution" is dumb and in defensible. But it's ideologically pure so will make you feel more libertarian. Which makes you just as smart as the liberal who thinks that a government takeover of healthcare will fix everything.

MyName 5 years, 2 months ago

There was nothing outrageous about any of my statements so the fact that the best you can come up with is "it's a conspiracy to eliminate competition" shows how dumb your idea is.

The end result of eliminating the regulations is not an increase in competent physicians, but rather an increase in the number of people who claim to be competent physicians and who provide dodgy fake cures. Or are people going to suddenly learn the same amount of knowledge it takes to be considered competent without the 10 years of study just because you passed a law?

And while you failed to provide a source for the doctor-patient ratio you spouted off, so I can't verify that, maybe the reason the ratio has gone down is because: 1) people aren't as sick as they were in the 1800s and 2) technology has allowed doctors to be more efficient and treat more people.

And the proof that your tariff idea is ridiculous is the fact that, while there is a barrier to entry in the profession, it doesn't prevent 18K new doctors from being trained and certified each year with over 90% passing the exam on the first try (http://www.usmle.org/Scores_Transcripts/performance/2008.html ). This would seem to be a highly ineffective "tariff". A more effective idea would be to simply limit the number of licenses allowed each year (which doesn't happen either).

While I will admit that there may be some merit in allowing people with lesser qualifications to do some of the work that a fully qualified doctor does today, that isn't your proposal.

At this point, I'm assuming you've already conceded that I'm right about the other three parts of your "plan" since you've failed to address my points about them at all. Since there is no conspiracy to limit the number of people who can become a doctor, that leaves you with basically nothing but an ideologically pure, worthless idea.

Have a good weekend.

Richard Heckler 5 years, 2 months ago

http://www.pbs.org/moyers/journal/blog/2009/10/bill_moyers_michael_winship_in.html#more

If you’ve been watching the Senate Finance Committee’s markup sessions, maybe you’ve noticed a woman sitting behind Committee Chairman Max Baucus. Her name is Liz Fowler.

Fowler used to work for WellPoint, the largest health insurer in the country. She was its vice president of public policy. Baucus’ office failed to mention this in the press release announcing her appointment as senior counsel in February 2008, even though it went on at length about her expertise in “health care policy.”

Now she’s working for the very committee with the most power to give her old company and the entire industry exactly what they want – higher profits – and no competition from alternative non-profit coverage that could lower costs and premiums.

A veteran of the revolving door, Fowler had a previous stint working for Senator Baucus – before her time at WellPoint. But wait, there’s more. The person who was Baucus top health advisor before he brought back Liz Fowler? Her name is Michelle Easton. And why did she leave the staff of the committee? To go to work – surprise – at a firm representing the same company for which Liz Fowler worked – WellPoint. As a lobbyist.

You can’t tell the players without a scorecard in the old Washington shell game. Lobbyist out, lobbyist in. It’s why they always win. They’ve been plowing this ground for years, but with the broad legislative agenda of the Obama White House – health care, energy, financial reform, the Employee Free Choice Act and more – the soil has never been so fertile.

The health care industry alone has six lobbyists for every member of Congress and more than 500 of them are former Congressional staff members, according to the Public Accountability Initiative’s LittleSis database.

Just to be certain Congress sticks with the program, the industry has been showering megabucks all over Capitol Hill. From the beginning, they wanted to make sure that whatever bill comes out of the Finance Committee puts for-profit insurance companies first -- by forcing the uninsured to buy medical policies from them. Money not only talks, it writes the prescriptions.

In just the last few months, the health care industry has spent $380 million on lobbying, advertising and campaign contributions. And -- don’t bother holding onto your socks -- a million and a half of it went to Finance Committee Chairman Baucus, the man who said he saw “a lot to like” in the two public option amendments proposed by Senators Rockefeller and Schumer, but voted no anyway.

The people in favor of a public alternative can’t scrape up the millions of dollars Baucus has received from the health sector during his political career. In fact, over the last two decades, the current members of the entire finance committee have collected nearly $50 million from the health sector, a long-term investment that’s now paying off like a busted slot machine

Richard Heckler 5 years, 2 months ago

Smart National Health Insurance Improves Our Quality of Life, our wallets and our expendable cash availability! Yes more for birthdays,Christmas, vacations, home improvements,home purchasing or investments.

National Health Insurance does not remove competition from the actual health care industry. It will be alive and well. Profits will be based on customer service and clinic performance based on the clients experience. This is my perception of competition.

How many of the vocal minority out there supporting the most expensive medical insurance in the world are employees and/or shareholders?

How many are receiving corrupt campaign dollars?

Some of our reps on all sides of the aisle say “Let's slow down a bit”. I say consumers have been waiting for more than 60 years for fiscal responsible medical insurance how much slower can it go?

What could possibly be more american? Providing americans with the choice of National Health Insurance.

Shouldn't taxpayers have the choice of National Insurance For All? Absolutely!

HR 676 would cover every person for all necessary medical care including: long term care such that cancer demands prescription drugs hospital surgical outpatient services primary and preventive care emergency services dental mental health home health physical therapy rehabilitation (including for substance abuse) vision care hearing services including hearing aids chiropractic durable medical equipment palliative care long term care.

A family of four making the median income of $56,200 would pay about $2,700 annually for all health care costs.

HR 676 ends deductibles and co-payments. HR 676 would save $350 billions annuall by eliminating the high overhead and profits of the private health insurance industry and HMOs according to the CBO.

National Health Insurance http://www.healthcare-now.org/

Doctors for Single Payer http://www.pnhp.org/

Unions for HR 676 http://unionsforsinglepayerhr676.org/union_endorsers

Organizations and Government Bodies Endorsing HR 676 http://www.pnhp.org/action/organizations_and_government_bodies_endorsing_hr_676.php

Health Care In the USA http://www.dollarsandsense.org/healthcare.html

jafs 5 years, 2 months ago

LO,

Yes, I believe that regulations/licensing requirements exist in order to maintain a certain standard for professions.

I would have no problem with people being allowed to self-diagnose and self-medicate as you suggested, if that's your real goal, as long as you're willing to suffer the consequences if you get it wrong.

That's quite different from allowing anyone to practice medicine on other people.

The end result of licensing auto mechanics might be an overall drop in numbers, but a rise in quality. That's better to me than a lot of bad mechanics.

By the way, although licensing might be a state issue, I'm pretty sure that most licensing boards (especially in medicine) require graduation from a nationally accredited school (as part of the requirement).

I think your system would work for folks who have lots of free time/energy/resources/money who are willing to do exhaustive research on many aspects of their day-to-day lives, and glad to go to court a lot when things don't work out.

The rest of us wouldn't be well served by it.

And, the fact that it's already hard to find a good doctor, even with the licensing, suggests to me it would be even harder without it.

jafs 5 years, 2 months ago

Finally,

The current system may rest on the competence/integrity of regulators, but your system would rest on the competence/integrity of judges (politically appointed), lawyers (without any regulation/licensing I would imagine), and jurors (most of whom just want to get home quickly).

I'm not at all sure why you think that's better.

Richard Heckler 5 years, 2 months ago

This is something to never forget. It is the private medical insurance industry that cancels YOUR medical insurance AFTER taking YOUR MONEY for years.

This could never happen with National Health Insurance

Filing bankruptcy due to medical care would never happen with National Health Insurance

jafs 5 years, 2 months ago

LO,

Are you suggesting that we have to either believe or disbelieve everything any politician says?

That's a little black-and-white for me.

This has been fun, but I think we've worn it out.

I find libertarian philosophy interesting and entertaining, but ultimately seriously flawed.

By the way, if you're really looking to save money, you can find low-cost health care at the Leo Center in Lawrence - you won't have to spend anything like $200 to see a doctor. And there are programs to help with costs of medication as well.

See you around, I'm sure.

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