The whole point of free speech is not to make ideas exempt from criticism but to expose them to it.

Monday, August 24, 2009

The Free Market and Health

It is said that the price of medical care has increased at about five times the rate of general inflation since 1965, when Medicare was effected. Medicaid came along and expanded the opportunity for exploitation by patient and physician alike. That fits with the conservative mantra that if you subsidize something, you get more of it.

There once was a time when families had a family physician who knew them and their peccadilloes, and who gave them medication and care (often including counseling) based on that knowledge of their lives and lifestyles. Often that relationship was exploited unethically to augment the physician's lifestyle.

That scenario is largely gone from the American scene. Now a family's medical care largely comes from a variety of specialists, few of whom know anything of their patients' lives and lifestyles. Often those relationships are exploited unethically to augment the specialists' lifestyles.

In the first scenario, the exploitation was governed by the amount the exploiter could extract from the available income of the exploited. In the latter scenario, the exploitation is governed by that plus whatever the exploiter can extract from the health care "plan" owned by the patient, which, more and more often, is only provided by taxpayers. That makes the opportunities for exploitation virtually limitless. As "mental health" becomes more and more a factor covered by governmentally financed plans, the opportunities expand exponentially.

The libertarian view of this is that while medical care, especially for traumatic cases (injuries, primarily), has improved dramatically over the past 40 years, the expenses to the general public who fund a great deal of the care have increased unsustainably. Expansion of government involvement will create a financial disaster and, ultimately, destroy the doctor-patient relationship entirely.

It is frustrating to argue this in the context of a partial government-funded medical care system. Those on the other side of the argument from us libertarians point at the status quo as a given in which we must try to plug the holes. We say that the status quo is evidence that there is no possibility of plugging the holes.

We do not believe there is any evidence to suggest that "health care" is a right. We also suggest that if government were not involved in medical care, that private charities and insurance companies (under the supervision of a somewhat "just" justice system) would provide better health care.

As a topic, this is getting too long now, so maybe we can continue it after we see how badly my basic premises are shredded.


caheidelberger said...

The rest of the world is finding that government involvement in health care increases liberty. I'm listening to Fresh Aire on SDPB right now. TR Reid is talking about his new book on health care and his experiences with other countries' health care. Among the details:

--Germans have 200 different health insurers they can choose. If they don't like their current policy, they can drop it and buy another, and the new insurer can't jack up the premium. Germans thus have more choice of health insurance.

--France requires insurers to pay doctors within three days. Doctors thus get their money faster and can run their businesses better.

--Switzerland: if the insurer doesn't pay your doctor within five days, your next month's insurance premium is free (more efficient payment, occasionally more money back in your pocket)

France, Germany, and Japan: you can go to any doctor, chiropractor, clinic, whatever, and your insurance will pay for it (no American private insurer offers such choice).

Small examples, but important. Sometimes government action actually increases everyone's net liberty.

caheidelberger said...

And, says Reid, no other country in the world says, "Gee, I wish we had an American-style health insurance system."

Bob Newland said...

Boy, I can believe that, Cory. I doubt that the insurance companies allowed to practice in most countries are allowed to so diligently use the insured's money to so diligently fight paying benefits to the insured.