A Four-Step Healthcare Solution
It's true that the US health-care system is a mess, but this demonstrates not market but government failure. To cure the problem requires not different or more government regulations and bureaucracies, as self-serving politicians want us to believe, but the elimination of all existing government controls. It's time to get serious about health-care reform. Tax credits, vouchers, and privatization will go a long way toward decentralizing the system and removing unnecessary burdens from business. But four additional steps must also be taken: FULL ARTICLE
Comments (63)
RWW
It's heartbreaking to imagine how much good would be done by taking these steps.
Published: August 14, 2009 9:18 AM
Theodore Berthelote
As a retired health care provider (dentistry) and a hardcore believer in individualism over collectivism, I heartily agree with Hoppe on his four points. Tragically, I see absolutly zero interest in them by either the "sheeple" or their political "leaders".
Published: August 14, 2009 9:52 AM
Marc
I am bothered by the assumptions in your sweeping "solution", because I think you are serious in trying to fix the problem. Otherwise I would not comment.
Your assumption is that decentralization and increase in personal choice creates competition, which reduces costs and increases quality, as observed with all commercial goods. Fine. That is definitely true in a market where there is choice.
First problem: personal health care is seldom a matter of choice: one does not get sick by choice (though I will grant negligence/self-destructiveness applies in some cases), and frequently the choice of health provider is dictated by urgency/proximity. If you get shot, you are going to call 911, not want to research your options and call a chiropractor by accident (no central accreditation/licensing remember?).
Second problem: Health is not a type goods to be traded and sold. It is not free either, obviously, but if you are going to be pragmatic about it the monetary value of a medicine should be balanced with it's humane value in the society at large (saving lives, reducing health epidemics/pandemics, etc...).
Treating a person's right to live as a disposable/dispensable good is evil.
@TB: If you believe in individualism over collectivism, why are you putting all your faith in the highly regulated collective that is free-market economy? It is regulated by whoever has the highest purchasing-power, FYI. That is probably not you.
Published: August 14, 2009 10:29 AM
HRR
Oh, get serious! Extreme liberterianism is just as silly as the almost socialism we have gotten into. Sure, drop all government credentialing of medical providers. Let anyone who desires hang out a shingle as a healer. But keep enough supervision to assure that an individual calling himself a medical doctor has actually qualified as a medical doctor. Total government control of medical licensing hasn't worked. That is proven by the simple existance of nurse practicioners, physician assistants and chiropractic as government approved caregivers. I have no objection to their practicing - just to the government endorsement. Incidently, osteopathic physicians are no longer beyound the pale. Their training is essentially the same as M.D. training now, with a little manipulation thrown in for good measure, not necessarily a bad thing. By all means, turn back the clock and welcome naturopaths, phrenologists and the many other schools of medicine which existed a hundred years ago.
Free up the insurance companies so they can compete on price and service. Why not? It is ridiculous to demand they accept all comers with pre-existing diseases. The best insurance in the world would be a true, old fashioned mutual company composed of healthy people. You wouldn't even have to charge premiums. Just make your members enter a legal obligation to pay the expenses of a member who falls ill, plus a small fee for clerical staff. The president and the administrative board could be elected to serve without salaries with their reward being the gratitude of their members and a really nice dinner every month or so at board meetings. Property insurance could be handled the same way. As a Florida resident who lives several miles inland why should I be forced to help protect rich people who own oceanfront property.
Just one thing. The government should mandate that once the insurance company has made its bet and accepted a member, they can not have the option of dropping them if they have a loss or two. We still need government, just a lot less. However, I for one, am in favor of the government providing health care, or insurance, to those truly poor or uninsurable. I am not including those who are uninsured by choice. There are many people, especially employed young people, who choose to not buy insurance because they had rather spend their money on more "fun" things, and because they are smart enough to realize there is very little chance of their developing a serious, expensive illness.
And, finally, why does to government spend so very much money trying to control behavior? Drinking too much, smoking a little dope or even using hard drugs should be a personal, even if stupid, choice. Even that evil weed, tobacco, had its merits. I am sure our medical costs have increased because of the anti-tobacco campaigns. The end of life care for a 55 year old life long smoker dying of lung cancer can't be that much different than the end of like care of an 85 year old dying of whatever. You just save 30 years of maintenance support!
Published: August 14, 2009 10:50 AM
Jero
"First problem: personal health care is seldom a matter of choice: one does not get sick by choice..."
Wrong. Health CARE is a matter of choice. Of course one does not choose to get sick (one does not choose to get hungry, either) but one has choice in determining how to address their illness (as with hunger).
"Second problem: Health is not a type goods to be traded and sold..."
Wrong. Health care is a good like anything else.
"It is not free either, obviously, but if you are going to be pragmatic about it the monetary value of a medicine should be balanced with it's humane value in the society at large.."
How do you propose to measure medicine’s “humane value in the society at large”? How does society value? Society is an abstraction; only persons can value things, so why not allow each person to express how much they value health care on the market. Some people might value insurance covering every possible eventuality. Some people may value the enjoyment of a cigarette over the long-term health effects. People’s values differ, there is no such thing as “society’s values.”
"Treating a person's right to live as a disposable/dispensable good is evil."
Does a person’s right to live include the right to force others to pay for this right? Does this right entail the right to force a doctor to treat my measles at gunpoint? Obviously your conception of justice differs from mine.
Of course, you are free to help someone, but I see no reason why you should be able to force me to do so.
Published: August 14, 2009 10:53 AM
Kenneth Mathews
Mr. Hoppe's four point solution requires a fifth point which Hoppe leaves unstated, but needs to be made explicit. Those who do not have the means temporarily or permanently to provide medical care for themselves should be provided for through free-market/non-government charitable individuals and institutions, and/or through alliances, fraternal organizations, churches, synagogues etc. If this is not stated explicitly it allows socialists to claim falsely that libertarians and/or classical liberals are unconcerned for the needs of the poor and needy. Also the normal function of the market tends to make goods and services (in this case health-related) more available, at increasing quality and specialization, and at decreasing cost over time - this is the best long-term solution for reducing poverty and the often health-related suffering that has afflicted both rich and poor down through history.
Published: August 14, 2009 11:02 AM
Barry Loberfeld
"If you believe in individualism over collectivism, why are you putting all your faith in the highly regulated collective that is free-market economy? It is regulated by whoever has the highest purchasing-power, FYI. That is probably not you."
Whoever it is, he still controls only his own money — not anyone else's. For that, you need the State.
Published: August 14, 2009 11:05 AM
Barry Loberfeld
Marc,
BTW, political individualism does not mean hermitism.
Published: August 14, 2009 11:10 AM
Michael Orlowski(The Orlonater/ChainedOrlo)
HRR,
Before Medicare/Medicaid/SCHIPP, medical malpractice, employer-based insurance, and state mandates medical care was cheap and high quality(for its time).
Published: August 14, 2009 11:16 AM
greg
The problem with healthcare is the insurance. You have to remember where the modern concept of insurance came from. It was the Mafia providing fire insurance and nothing much has changed since. You have a better chance playing craps than you do betting with the insurance company.
We need to stop providing healthcare insurance for everyone. So the employer that pays you $20 an hour plus insurance, now can pay you $27 an hour. If you want insurance, then you have the extra $7 an hour to pay for it. Then and only then will everyone be totally accountable for the insurance they carry.
When you have to write the check, you tend to weigh the alternatives closer. Maybe a higher deductable makes more sense and maybe people won't run to the doctor for everything. And just maybe doctors won't be fast with the countless test that they can just bill the insurance for.
Published: August 14, 2009 11:22 AM
Steve Hogan
I've got a one step program: the total separation of health care and state. To rely on an agency of violence to administer health care for millions of people is beyond laughable.
Published: August 14, 2009 11:29 AM
RWW
[P]ersonal health care is seldom a matter of choice: one does not get sick by choice... and frequently the choice of health provider is dictated by urgency/proximity.
Food is seldom a matter of choice: one does not get hungry by choice... and frequently the choice of grocery store is dictated by urgency/proximity.
If you get shot, you are going to call 911, not want to research your options...
Maybe you should have your options researched beforehand.
Health is not a type goods to be traded and sold.
Says you.
...the monetary value of a medicine should be balanced with it's humane value in the society at large...
Are you under the impression that value on the free market is only determined by monetary means?
Treating a person's right to live as a disposable/dispensable good is evil.
The right to life is not a right to be provided for by threat of force. Also, it is not my duty to intervene in the choices of others.
[The free market] is regulated by whoever has the highest purchasing-power, FYI. That is probably not you.
That must be why the only restaurants in Seattle are those that Bill Gates enjoys.
Really, you are being absurd.
Published: August 14, 2009 11:32 AM
RWW
I neglected to refresh and read Jero's comment before posting mine; otherwise I wouldn't have been so redundant. My apologies for that.
Published: August 14, 2009 11:34 AM
RWW
But keep enough supervision to assure that an individual calling himself a medical doctor has actually qualified as a medical doctor.
If he claims to be certified by Company X in medicine, but isn't, he has committed serious fraud and should be penalized. But no one should be forced to be "supervised," if their clients are willing.
Just one thing. The government should mandate that once the insurance company has made its bet and accepted a member, they can not have the option of dropping them if they have a loss or two.
No government mandate is necessary. That provision (or the lack thereof) would be a matter of contract.
However, I for one, am in favor of the government providing health care, or insurance, to those truly poor or uninsurable.
Speak honestly. You are in favor of taking my property, by force if necessary, to "provide" for such people.
Published: August 14, 2009 12:35 PM
Russ
We need to quit dreaming, and realize that most people just won't accept a pure libertarian position regarding health care. Let's look at the four steps, and see what even a liberty-minded Joe on the street would think about them:
1) OK, no licensing required. So a complete quack can open up shop, and I can't tell him from a real doctor. Of course, I could not go to him next time. That's assuming I'm alive next time. Yeah, great idea.
2) So anyone would easily be able to get chloroform, rohypnol, GHB, that stuff that guy Dexter on TV uses on his victims? Anything? Another great idea.
3) I don't think that government should be the insurer, but let's get real here. Insurance agencies sometimes take peoples' money for decades, and then try to use some cheap and dirty legal trick to avoid having to pay out. And the little people just can't compete against insurance company lawyers. Some sort of government oversight is necessary to make sure the insurers live up to their side of deals.
4) I don't know what kind of subsidies you're talking about here. I do know the people who've served our country in the military deserve to be taken care if they were injured in the line of duty. Besides, I don't know about this whole "subsidies create more of what is being subsidized" bit. People don't get sick on purpose.
These four opinions of this hypothetical citizen are, if anything, more libertarian than the average citizen. And even Joe thinks that the extreme libertarian view is nuts. How about we talk about realistic health care reform ideas that actually have a chance in hell of getting passed, instead of this continued insistence on ideological purity that makes us look like nutburgers and effectively creates a big sucking vacuum where a competitor against ObamaCare ought to be.
Published: August 14, 2009 12:51 PM
Jero
Russ,
You're absolutely right. Most people don't reason well, have been indoctrinated in school and wouldn't immediately accept these proposals. Therefore we should give up advancing ideas that would actually work but won't be lapped up upon dissemination.
From now on I am only going to advance ideas that the average rube will immediately support. In fact, I will now endorse only collectivism and war-mongering as the majority seems to see these ideas as just grand.
Thank you for enlightening me.
Okay, but in all seriousness, your hypothetical points would take only minutes to dismantle and the average person would at least be able to understand the responses and give it some thought. I am a case in point as I began my intellectual journey as a typical social-democrat but after many discussions and arguments came to "see the light".
Published: August 14, 2009 1:39 PM
2nd Amendment
Marc,
Why should I pay for your bad health ? It doesn't matter if you didn't choose it !
Most health care problems that were not chosen stem from bad genetics.
Bad genetics could be screened before birth and before conception and could be corrected, fixed or the foetus could be discarded.
This would fix a lot of unchosen problems at very low costs.
Published: August 14, 2009 2:02 PM
2nd Amendment
HRR,
I am appalled that you think it is "extreme" and silly for someone to want to keep and decide what he will do with the fruits of his labor.
Obama's central takeover and vast taxation (robbery) is what qualifies as extreme and silly in my book.
"Oh, get serious! Extreme liberterianism is just as silly as the almost socialism we have gotten into."
Published: August 14, 2009 2:05 PM
2nd Amendment
Step 5, Abolish Forced Psychiatry.
Psychiatry, like all other medical fields, should be 100% voluntary and follow the same contractual principles.
Published: August 14, 2009 2:07 PM
EnEm
"Because of legal restrictions on the health insurers' right of refusal — to exclude any individual risk as uninsurable — the present health-insurance system is only partly concerned with insurance. The industry cannot discriminate freely among different groups' risks.
As a result, health insurers cover a multitude of uninsurable risks, alongside, and pooled with, genuine insurance risks".
________________________________________________________________________________
A family member who had existing health insurance became ill with heart disease and the health insurer refused to insure her any longer because she is/was now a heart patient. Heart disease is genetic, so the question of not being responsible for her own health does not arise. No health insurance company (including the frigging hypocritical AARP with its motherhood and apple pie, goody-two shoes demeanor) wanted to go anywhere near her unless she paid a ridiculous monthly premium. And she's unemployed. She was not granted workers comp after a fatal injury at work because the employer exploited a loophole in the law. She finally had to buy health insurance at $1000 per month. She was also refused insurance by her husband's insurance company.
She had to undergo triple-bypass surgery. Now guess what her surgery bill amounted to? $160,000 !! And that's just for the surgery! All other expenses will easily put the amount well over $200,000! Yes, there really are five zeroes in that number. This is the sort of thing that gives socialist agendas a good name, 'cause milking the public also happens on a Republican watch.
What the thugs running the health care industry (blessed by the other gang of thugs on Capitol Hill) need to understand is that they have to suffer the loss and eat it and NOT increase health care premiums just because they are in this for the money. Insurance is risky business and that risk should NOT be carried by the Insured, but by the Insurer.
Published: August 14, 2009 2:09 PM
2nd Amendment
Steve,
"To rely on an agency of violence to administer health care for millions of people is beyond laughable."
It's like asking a sadistical murderer to care for other people's lives by first robbing them of their own money at gun point to pay for such care. LOL !
"give me your money so I can save your life or else I will shoot" LOL !
It's really not about saving lives nor caring for us, it's about growing government and grabbing power and nothing else.
Published: August 14, 2009 2:18 PM
Nick
En Em,
I'm not real sure about the point of your story. Did the existing health insurer have a clause in the contract that allowed them to drop her?
If this is the case, and I'm guessing that it was, then it should be self-evident that de-regulating the health insurance industry would help.
If one was able to purchase insurance a la carte - and choose their levels of coverage and what clauses they approve of based on how much they were willing to pay, then she could have made sure she had a policy that contained no "heart patient" clause.
In other words, put the choice - and the *responsibility* - back into the hands of the individual.
Published: August 14, 2009 2:33 PM
Reggie Greene / The Logistician
At this point, although the debate and spin continue, this bill is essentially dead from an emotional and mandate perspective, even if some version gets passed. Whether it ultimately proves to be of any benefit to society, or a detriment, will take years, if not decades, to appreciate.
This bill, and virtually anything that might be done to improve our healthcare system, involves too much complexity with which we are emotionally motivated to deal.
There's been too much arguing about the details. People can not describe in 2 or 3 sentences the conceptual parameters of the effort and what it is supposed to accomplish. Unfortunately, people can describe how they feel about it in 1 or 2 words, and that's not good.
If either side of the debate has to work this hard arguing about something which theoretically should improve the lives of the masses of people, there's a big problem.
Even more so than how something is done, people are interested in results, not the details. And once again, as is frequently the case with much of human processing, the facts don't really matter. How people view the world, what they value, and what they want, matters.
And there is nothing collaborative in nature about that. Factor in the strong individualistic American DNA, and this effort is emotionally toast.
Published: August 14, 2009 2:36 PM
FarSide
EnEm -
Your final comment makes no sense whatsoever.
Why, exactly, does a business have "to understand... that they have to suffer the loss and eat it and NOT increase health care premiums just because they are in this for the money" ?
Why would an insurance company bother to exist, if they didn't want to make money? If they "suffer a loss and eat it" all the time, how will they have any money to pay out to their claimants? (Oh, I know, it's because some board of super-intelligent aliens who can see into the future will set the proper prices)
Secondly, I am sorry to hear of the heart trouble. However, pre-existing conditions is the #1 emotional tactic that is being used right now to advance this thing. But the bottom line is, health insurance is NOT a right, and you can't force a business to give you something for free.
If I want fire insurance, I can't buy it after my house burned down.
Yes, this sounds callous, especially to someone who has been at the bad end of the stick in this regard. However, I would submit that without much of the current red tape you would find some insurance companies would appear that would be better suited to address this sort of thing with people, at better prices than is currently possible.
Published: August 14, 2009 3:27 PM
2nd Amendment
Reggie,
So funny of you to dismiss as "emotional" those of us who disagree with this health care reform. Typical liberal tactic.
Did it ever occur to you that most of us who disagree with this health care reform do so on a logical and analytical basis based on how much wealth and opportunities will be lost ?
"which theoretically should improve the lives of the masses of people,"
You and your big government are the problem. Why not let the masses improve their own lives ? Why can't the masses improve their own lives by themselves ? Could it be that government is in the way and that explains why ?
Oh yes, I'm "emotional" so my opinion doesn't count, only "logical" people like yourself agree with the reform.
Published: August 14, 2009 3:29 PM
bernardpalmer
Excerpt from 'What is the Primary Fundamental Right?'
"Getting governments out of health care should greatly reduce costs and improve services. Except for the scrapping of Medicare and Medicaid probably the best situation would be for young people to abandon medical insurance en masse or get their employers to give them the cash instead of the health cover. This could have the biggest effect in forcing down health care costs and putting medical attention in reach of far more people. At the moment about 1 person in 6 in the US has no medical cover. This probably needs to be closer to 1 in 2 to break the doctors and dentists monopoly.
Medical insurance, both government and private, is probably the single biggest burden forced onto any society because it generally stops competition. Doctors and dentists through their guilds and their esteemed place in western society often control the amount of people allowed to become professional health carers, thereby assuring little or no competition between their members."
Published: August 14, 2009 4:10 PM
Marc
2nd amendment:
"Bad genetics could be screened before birth and before conception and could be corrected, fixed or the fetus could be discarded."
That has been tried, and though it is effective, what you are talking about leads to ultimately killing off the weak. Beyond the moral questions, there is a practical question: who decides who is strong enough to live? If the Chinese tomorrow decide to kill off Americans because they see us as weak, and they have the power to do it, is it your opinion that this is justified and acceptable?
Yes, being emotional can invalidate your argument, but only if it blinds you to the rational argument. It's the difference between Passion and Obsession.
RWW,
Marc: "[The free market] is regulated by whoever has the highest purchasing-power, FYI. That is probably not you."
RWW: "That must be why the only restaurants in Seattle are those that Bill Gates enjoys."
Real example: Microsoft gets to set the typical price of an OS because they control the largest market share, and buy the most programming talent from the population. It's not bad or anything, I am just making the point that the free market is not solely driven by individuals, and therefore libertarian free-market capitalism is an oxymoron.
Barry,
fair enough. You are right.
Jero,
"People’s values differ, there is no such thing as “society’s values.”"
Sure there is. It is called the law. It is the consensus agreement of what we consider unacceptable behavior, and how to punish it, and prevent it, though clearly it can be misused. You may not like "Big Government", but it developed in part to defend people like you from people like me who think that yes, you SHOULD be forced to help someone when they need it, and punished if you don't. It is a compromise which pragmatically I think works to keep the peace, and make this debate possible.
Published: August 14, 2009 4:34 PM
Mark Davis
It is heartbreaking RWW. This application of free-market principles to health care will certainly fall on deaf ears; just as it does when they are applied to security, roads, banking and any other service or good the state "must provide" due to the "failure" of the market to bring about Utopia. The limited ability of most people to see the long term benefits of assuming responsibility for their own lives is overwhelmed by a lifetime of state imposed nannyism. What can be gained from these exercises in "theoretical purity" is providing a basis for future understanding and debate. The state is crumbling of its own weight and its days are numbered. When that number is up the remnant must be prepared to step forward to do intellectual battle with the "law and order" totalitarians who will rush in to fill the void among a fearful, ignorant populace. Dr. Hoppe is a treasure chest of ideas for lovers of liberty.
Published: August 14, 2009 5:17 PM
Jero
Marc,
""People’s values differ, there is no such thing as “society’s values.”"
Sure there is. It is called the law. It is the consensus agreement of what we consider unacceptable behavior, and how to punish it, and prevent it, though clearly it can be misused."
No, you are wrong again. Law is certainly not based on 'consensus agreement.' Where would you get such an idea?
It is a fact that society CANNOT VALUE. Society is not an entity that acts or that can have ends, only acting man can do so. Thus my point that people’s valuations differ – some people value the instant pleasure of cigarettes and alcohol over the long-term benefits of abstinence, some people value comprehensive insurance while others value that money in their pocket. There is no way to formulate a universal system that takes into account the various valuations of all people. Thus, in a universal system, most people do not get what they want, what they value.
"You may not like "Big Government", but it developed in part to defend people like you from people like me who think that yes, you SHOULD be forced to help someone when they need it, and punished if you don't."
Again, you are wrong. Government certainly did not develop to protect people like me from people like you (you don't scare me ;) ). Do you have any evidence for holding such a view, or are you just regurgitating middle-school civics class bs?
Published: August 14, 2009 5:43 PM
EnEm
It really is terrible to hear about your family members condition, but it sounds like they got a pretty good deal. You said that they found an insurance plan that was $1,000 a month right? And that the total cost of her treatment for heart disease was 360,000 dollars? If those statistics are right your family member got quite the deal, she would have to be on that said plan for 30 years and incur no other costs to the insurer other than what it cost them to pay for the triple bypass for that company to recoup their loses. In short lets say your family member lives another 20 years and is on this plan the whole time, that means they will pay the insurance company $240,000 which seems like a lot, but it is actually a whole lot less than they would have paid with out insurance ($360,000 for just the triple bypass) paying at least $120,000 less for something is a pretty good deal in my book.
Published: August 14, 2009 6:33 PM
Andy von Guerard
Woops ^ that post right there where it says EnEm it should be my name, I messed up gahh.
Published: August 14, 2009 6:36 PM
Tim
From what I take, anyone who's not in explicit approval of Hoppe's suggestions runs a risk of being branded a statist liberal collectivist by some of the people here. Even steering off from the discussion a tiny bit to mention some other unrelated point will make you in their eyes, the enemy of freedom. It's precisely this kind of absurd behavior which alienates public attention from our perspective and ends up hurting our cause.
The problem isn't that Hoppe's suggestions are invalid, it's just that they're very hard for the average man to swallow outright. Every point would require a lengthy justification of how individual responsibility would compare to the token notion of social egalitarianism. In that extent, what Logistician wrote earlier was very much relevant. The concept of individual liberty is not something you can explain in a single sentence.
Take the recent interview of Peter Schiff by MSNBC. Throughout the interview, the host spewed an endless stream of accusations and distorted his stance without letting him throw as much as a word in between, let alone explain or articulate his positions. His goal wasn't to debate, but to make Schiff look like a right-wingnut who doesn't care about the poor and generally wants to eat babies. The host succeeded only in making an disgrace out of himself and his channel.
This moral stance which the leftists rely on is strongly ingrained in the public's mind. Critics of Hoppe's solution would immediately scoff at the very idea of suggesting that people should hold personal responsibility for their life's choices. To them it will sound as if Hoppe's advocating cruel and careless measures which will undoubtedly determine the access and quality of care to the amount of wealth of an individual. Most people would buy into it because of the apparently evident infallibility of such a position. Moreover, their moral argument is that EVERYONE, regardless of the level of risk, MUST have their health care costs leveraged by the rest of society. Indeed it's the Christian concept of turning none away, how could you argue against it?
What most people fail to realize is that what sounds the most morally acceptable isn't necessarily the best solution for everyone in reality. As Hazlitt said, "the art of economics consists in looking not merely at the immediate but at the longer effects of any act or policy; it consists in tracing the consequences of that policy not merely for one group but for all groups." And the art of economics is precisely what affects our health and wellbeing in the long run.
Published: August 14, 2009 6:57 PM
RWW
Microsoft gets to set the typical price of an OS because they control the largest market share, and buy the most programming talent from the population.
And yet there are other great OSes, some of them free. I'm no computer expert, but I use Linux at home and work. Harmful monopolies are infeasible in a free market, unless backed-up by government force (which Microsoft is, to some extent, though it's pretty far from a monopoly).
I am just making the point that the free market is not solely driven by individuals, and therefore libertarian free-market capitalism is an oxymoron.
How do the words "libertarian," "free-market," and "capitalism" contradict each other? And what is the market driven by, if not individuals? And what alternative would be more individual-driven?
...yes, you SHOULD be forced to help someone when they need it, and punished if you don't.
Your views are utterly inhumane. I wish you would stop bullying people.
Published: August 14, 2009 8:01 PM
Jack's Pipe
"What most people fail to realize is that what sounds the most morally acceptable isn't necessarily the best solution for everyone in reality."
Well then, what do you suggest be done? These seem to me a backbone on which any real reform needs to rest. Say someone goes to a doctor complaining that are heavy. The doctor prescribes diet and exercise. The patient responds, "That's not reasonable and I don't want to do it." Well, that's the solution. Either you accept a solution or you don't.
The idea that Microsoft sets prices doesn't obligate me to pay that price. The fact that the OS costs more than people want to pay is why many people are still using XP instead of Vista, why some have adopted Linux, or perhaps they bought a computer where the software add-on was cheaper.
Published: August 14, 2009 9:24 PM
thomas williams
does anyone know of any good/systematic austrian/free-market analysis of the actual obama healhcare bill, vs. standard arguments against gov health care or pro free market?
Published: August 14, 2009 9:52 PM
J. Cuttance
After someone such as Marc presents a prima facie argument, it always comes as such as a relief when someone like Jero shoots him down.
Not schooled enough to pick out Marc's flaws myself, I can only lend moral support to those who can.
Go to it guys!
Published: August 15, 2009 6:42 AM
Ron
Logical but politically impossible points.
Obama is mixing the human desire of safety in mass with a socialistic coup over the American system based on freedom and liberty. His binding health care needs with a socialist take over, will in fact give power of government over the people not for the people. He knows that.
A better argument would be to expose the failings of socialism and the political wills that want to crush liberty, freedom and choice from the hands of the masses they seemed to have duped into believing they are the cure over risk.
All systems have risk and socialisms are well defined. We need people defending our constitutions base on freedom of enterprise and liberty which involves personal choice and risk coupled with the rewards of an advanced society. The risks are smaller with self destiny, choice and economic power to reject service rendered and flee from inadequate care and governing principles.
Socialism forcefully binds individuals to a system with no avenue of pressure, escape or financial denial. Thus socialism gives power to the very people that have caused the situation to grow so financially unsound in the first place.
Politicians that use its mass appeal to blind people by cloaking feel good messages based on misconceptions should be exposed as the Marxist terrorists that they are. The argument should be on "How shall we defend our country" and not how shall we outline variables in marketing solutions.
We are under siege. Health care has economic problems created by the same politicians that now propose the cure. Health care will fall into the same corrupt state as bank mortgages when the applied principles will be issued through the same socialistic principles of failing to face realities choices and forcing those with the inability to pay to steal their value from those that can with a political force that has no set economic reality trigger.
Obama has chosen a very slick avenue to impose a full scale socialist agenda by using the fears and sympathies of personal health decisions as being curable by surrendering to the governments bureaucratic will. This is no solution and they know it; this is a strengthening of political will over capitalisms risks and rewards of free choice, liberty and self destiny.
The game is much bigger than a health care system over hall; it is about the very system of protection of individual liberty our fore fathers died for. Otherwise some of your points would already be on the table for discussion.
Published: August 15, 2009 10:03 AM
2nd Amendment
Marc,
It's not killing if there is no foetus yet. You screen the genes of both future parents and you come up with a strategy to prevent genetic malfunctions in the first place.
Published: August 15, 2009 5:21 PM
2nd Amendment
Marc,
"If the Chinese tomorrow decide to kill off Americans because they see us as weak, and they have the power to do it, is it your opinion that this is justified and acceptable?"
If they have the might and the will to do it, my weak opinion is certainly not going to stop them.
Published: August 15, 2009 5:24 PM
2nd Amendment
Tim,
"From what I take, anyone who's not in explicit approval of Hoppe's suggestions runs a risk of being branded a statist liberal collectivist by some of the people here."
You're not quite a libertarian austrian free market capitalist anarcap either aren't you ?
Why are you affraid of abiding by your brand ? Are you ashamed of being a statist liberal collectivist ?
You should at least come out of the closet, you would earn half my respect already.
I'm an anarcap and I am not ashamed of my brand.
Published: August 15, 2009 5:34 PM
Gil
The whole crux of the matter is that of healthcare is a good to traded in an open free market. Just as poor people forego driving a car until they can actually afford so too will they forego the healthcare they can't afford.
Published: August 15, 2009 8:49 PM
RWW
Are you saying that's a bad thing, Gil? I'm not sure if I understand.
Published: August 15, 2009 9:10 PM
Bruce Koerber
Economic Wisdom
Saturday, August 15, 2009
Four Steps To 'Cure' The Health Care Problem!
When there is an economic problem it can be solved if:
a). the economic charlatans who are ego-driven interventionists are ignored,
b). and instead the advice of a brilliant economist is adhered to.
Regarding what appears to be uncontrolled skyrocketing of health care expenses the economic solution is pretty simple. There are four major steps needed which removes the corruption of interventionism. Here they are, according to Hans-Herman Hoppe:
1. Eliminate all licensing requirements for medical schools, hospitals, pharmacies, and medical doctors and other health-care personnel.
2. Eliminate all government restrictions on the production and sale of pharmaceutical products and medical devices.
3. Deregulate the health-insurance industry.
4. Eliminate all subsidies to the sick or unhealthy.
This cure may seem like a strong dose of justice but ultimately it is the remedy for the cancerous socialism and the addictive interventionism.
Published: August 15, 2009 10:00 PM
Poop Tart
What about an even better one step solution?
1. abolish government!
Published: August 15, 2009 11:11 PM
Mark D Hughes
A well stated and to-the-point prescription. Step four seems a bit harsh at first read, but, I am certain Professor Hoppe is not including private voluntary subsidies from eleemosynary institutions and churches etcetera.
In my view, point three is the rudimentary rot at the center of this entire problem. Mandated Health Insurance Benefit (MHIB) laws have been around since the late 1960s. In 1970 there were only thirty MHIB laws in America and by 1990 there were close to 1000. Since then they have continued their exponential rate of growth.
For an analysis of this, see my 1991 National Review article "Don't stay healthy in America" at:
http://tinyurl.com/kvay7u
Mark D Hughes
Published: August 16, 2009 2:48 AM
ganpalou
Professor Hoppe assumes, like all who are voicing an opinion, that the
medical/pharmaceutical/insurance complex is too expensive for what it is. He prescribes the building of a beautiful barn door. However, O'bamas followers believe the barn has rot in the post and beams, and the roof leaks, with collapse imminent.
I, for one, stand in amazement that the system works as well as it does. My prejudice is to believe that it works well, as an unintended consequence of the ignorance, primarily in mathematics, of the experts. Data demonstrates that there is no correllation between cost and quality of care, reinforcing my prejudice. Yet I have no regrets that the tax dollars which are wrenched from my hands are being spent on medical care for derelicts and illegal aliens, and on Lear jets for CEOs, rather than on missiles and mines for colonial adventurism.
Professor Hoppe's appeal for marketplace alternatives further assumes that the responsible individual can and will choose between alternatives. Ask yourself this simple question: "What are my back-up plans, and alternatives, if the food distribution system collapses, like the banking system almost did?" I and ninety-nine percent of Americans have no back-up plan, or even know how to develop one. And eating is a lot simpler than diagnosis and treatment of disease.
My irrational fear is the development of a new paradigm. I fear the advances in volume of computer data manipulation could result in finding and controlling all "outliers" of some Utopian system, resulting in "overreach and collapse," an oversimplified term used by ecologists for the bifurcation, cascade and/or fractal behavior of computers, and life itself.
I enjoyed professor Hoppe's article.
Published: August 16, 2009 8:29 AM
2nd Amendment
Step 5: ELIMINATE INVOLUNTARY PSYCHIATRY
Psychiatry should be VOLUNTARY and should follow the same contractual principles as the rest of medical practices.
That way, you would eliminate all the unnecessary costs related to involuntary committment and forced drugging.
Psychiatrists should be their patient's agents anyways and should not work for the government nor the police nor the judges nor for any third party.
Not only would that save money, it would also save lives.
Published: August 16, 2009 4:03 PM
Richard W
There is an existing, and fairly common, approach to health insurance that goes a long way to resolve the insurability problems. Yet, it seems to have been overlooked.
The HSA (Health Spending Account) allows an individual to personally pay for his/her own health care; unusually large expenses are protected by a policy with a very large deductible.
Therefore, individuals who are in poor health and use more services will pay more, up to a limit. This also serves to discourage individuals from using unnecessary or optional services.
Another benefit of the HSA is that individuals who are hospitalized will pay insured rates, rather than the incredibly high rates charged to the uninsured.
Published: August 16, 2009 8:50 PM
wesleybruce
Kenneth Mathews said
"Those who do not have the means temporarily or permanently to provide medical care for themselves should be provided for through free-market/non-government charitable individuals and institutions, and/or through alliances, fraternal organizations, churches, synagogues etc."
His point is very important but as a staff member of such a charity there is a problem. Charities are not set up normally to fund long term services. Restrictions on what charities can do with donations, particularly paying the insurance differential between the insure-ability and uninsure-ability would help and allowing charities to create long term trust funds to cover the chronic cases. I agree with Kenneth without mentioning the charity options we hand victory to the socialists. Hans-hermann Hoppe has made the same mistake that every libertarian makes: Assuming that everyone can stand on their own two feet if the socialist props are removed. History tells us that tis is not true. That's why the former soviet union territory is sliding back to socialism. The skills personal responsibility can't be learned in a few years or even decades, it may take generational change to create a population that can stand in Hans' world of free market medicine.
Published: August 17, 2009 5:18 AM
wesleybruce
Bruce Koerber gave a summary of Hans' argument.
I'd like to expand and fix it. This should fix Hans' argument.
1. Eliminate all licensing requirements for medical schools, hospitals, pharmacies, and medical doctors and other health-care personnel.
But hold both them and their private licensing agency and any advertiser liable for damages if harm is done.
2. Eliminate all government restrictions on the production and sale of pharmaceutical products and medical devices. But hold both them and their private licensing agency and any advertiser liable for damages if harm is done.
3. Deregulate the health-insurance industry. But ask them to include a 'pro bono clause' in their policy that allows them to pay a slightly higher voluntary premium to cover the uninsured and uninsurable. Where this clause is taken up by the members the insurance provider is obligated to cover the uninsured family and others with connections to members. Coverage, (dollars or gold) is proportional to the take up of the 'pro bono clause' and can't be counted in profits.
4.Eliminate all subsidies to the sick or unhealthy but allow charities to pay insurance, create trust funds for the uninsurable poor, create investment funds to cover emergency care, aged care and medical research. (Most charity law does not allow such long term investment, donations are generally meant to be banked and spent in the same financial year) Create a general charitable fund that doctors can claim from with the proviso that the patient, when well, be obligated to repay the fund over a three year period and that the patient gets donor requests subsequent to the completion of the repayment.
5. Allow the free press, medical media and any medical school to initiate endangerment lawsuit against bogus medical service providers. However where such a lawsuit is won the winner pays their own legal costs. (This will limit malpractice proactively but the cost clause will eliminate trivial lawsuits and harassment.)
All this is standard anacapitalist / Austrian school/ libertarian theory but the parts I've added in bold italics are often assumed and forgotten in the debate. This is why we loose.
Published: August 17, 2009 7:35 AM
C
"[P]ersonal health care is seldom a matter of choice: one does not get sick by choice... and frequently the choice of health provider is dictated by urgency/proximity."
"If you get shot, you are going to call 911, not want to research your options..."
To expand on others' arguments, the sensible consumer joins a "health emergency club," just as drivers join AAA, so that when they are in an accident or precipitously ill, they call their HEC (AAA), which dispenses an ambulance (tow truck), to take them to the nearest affiliated hospital (auto repair) on the approved list for the HEC. hospitals would compete to earn the high ratings from the HEC, because it would bring more customers.
Calling 911 is using a govt service. How is fixing your body different from fixing your car or a flat tire? We don't ask govt to determine who we can call for roadside automobauble help! Why must we have them determine how we get help for our body's ailments?
Just as OnStar wireless services today can solve the problem of how to get urgent assistance through a privately subscribed service, future free market "911" services could use technology to improve on the current govt controlled system of dispensing emergency help.
Published: August 17, 2009 10:01 AM
Michael A. Clem
C, bringing up the examples of AAA and OnStar is very good. When we talk of getting rid of government licensing and regulation, people seem to assume that it's supposed to be replaced by nothing, but there are and would be private alternatives with certification and such. Will people pay for them out of their pocket instead of through taxes? They will if they think such services are valuable. If you're really concerned about the competence of a doctor, aren't you going to do the research necessary to check up on the doctor? And if a private organization already does such research and makes it available for a small price, isn't that price worthwhile to pay? Obviously only each individual can decide how much they are willing to pay, but it's absurd to think that there's no market at all for such services. And if there's a market, there will be private organizations providing these services.
Published: August 17, 2009 10:40 AM
RWW
But hold both them and their private licensing agency and any advertiser liable for damages if harm is done.
Why would the licensing agency be liable for damages? This is nonsense. If a practitioner is licensed by XYZ Co. and, some time later, causes harm, this is through no direct fault of XYZ Co. XYZ does not employ the practitioner. However, XYZ's reputation is likely to take a hit.
But ask them to include a 'pro bono clause' in their policy that allows them to pay a slightly higher voluntary premium to cover the uninsured and uninsurable.
What does "ask them" mean? Who is doing the asking?
Where this clause is taken up by the members the insurance provider is obligated to cover the uninsured family and others with connections to members.
If insurance companies wish to enter into such a contract, they may do so. Or they may not.
Published: August 17, 2009 11:13 AM
2nd Amendment
I don't get it, WHY should it take insurance to pay for healthcare in the first place ?
I don't need insurance to pay for groceries !
Published: August 17, 2009 3:27 PM
trund
great article......i'd add one more thing no one mentioned but would reduce medical fees immediately......
The losers in med-malpractice suits must pay the court and lawyer fees of the winner. Simple.
Published: August 17, 2009 5:42 PM
Shay
2nd Amendment, please stop posting your drivel to every thread and often in multiple messages in a row. In answer to why (some) health care should require insurance to cover, it's the same reason that many people need insurance to cover their home burning down. Your insistence that all health procedures, no matter how long-term they are, be cheap enough that anyone can afford them is like insisting that people shouldn't need home insurance. The only solution to the latter would be to have everyone live in tents which cost only a few dollars to replace. In the medical case, nobody's forcing you to get expensive care, as there's always the option of living (or dying perhaps) with whatever the condition is.
Published: August 17, 2009 6:29 PM
wesleybruce
RWW you miss the point, if a licensing entity is not held responsible you will get fly by night licensing entities with high sounding names similar or identical to the reputable ones. Just as there are quacks claiming to be doctors you'll get phony entitles claiming to be the medical consumers society, AMA or whatever. By adding one word to the name, say " of Oceania" they create an entity that may confuse people.
You ask who asks the insurers for the pro bono the answer is ' the drafter of the legislation' the libertarian parliament (or its equivalent). With out such an entity able to make requests you have no libertarian society.
Published: August 18, 2009 5:36 AM
RWW
[I]f a licensing entity is not held responsible you will get fly by night licensing entities with high sounding names similar or identical to the reputable ones.
So do your due diligence.
You ask who asks the insurers for the pro bono the answer is ' the drafter of the legislation' the libertarian parliament (or its equivalent). With out such an entity able to make requests you have no libertarian society.
Ah, so you advocate unabashed aggression. This was my fear, which is why I asked for clarification.
By the way, notice that I use the verb "ask" in its proper sense, as in a request -- not in the sense that you mean it, as a demand backed by threats.
Published: August 18, 2009 9:16 AM
RWW
By the way, if a company goes so far as to truly pose as an existing reputable company, it has committed fraud. But this is not what you describe.
Published: August 18, 2009 9:19 AM
EnEm
This is my response to FarSide:
Why, exactly, does a business have "to understand... that they have to suffer the loss and eat it and NOT increase health care premiums just because they are in this for the money" ? An insurance company must recognize the fact that Risk is the main feature in their business. **When an insured claimant puts in a claim they have to honor it and pay up AND NOT RAISE THE PREMIUM BECAUSE THEY INCURRED A LOSS IN PAYING THAT CLAIM. THEY HAVE TO ACCEPT THE LOSS TO THEIR BOTTOM LINE. IF THEY CAN’T TAKE THE HEAT ….FORGET MESSING AROUND IN THE KITCHEN AND FORGET BEING IN THE INSURANCE BUSINESS. THAT’S WHAT I MEANT BY EATING THE LOSS AND MOVING ON**.
Why would an insurance company bother to exist, if they didn't want to make money? If they "suffer a loss and eat it" all the time, how will they have any money to pay out to their claimants? **THEY MAKE THEIR MONEY OFF OF THE PREMIUMS OF HEALTHY SUBSCRIBERS WHO DO NOT PUT IN CLAIMS**. (Oh, I know, it's because some board of super-intelligent aliens who can see into the future will set the proper prices). **Irrelevant, in light of the above explanation**
Secondly, I am sorry to hear of the heart trouble. However, pre-existing conditions is the #1 emotional tactic that is being used right now to advance this thing. **Read my post again… it was not a pre-existing condition**But the bottom line is, health insurance is NOT a right, and you can't force a business to give you something for free. **I too do not consider it a right and nobody asked for a free handout. On the other hand, a $1000 a month premium is preposterous **
If I want fire insurance, I can't buy it after my house burned down. **You are missing the point**
Yes, this sounds callous, especially to someone who has been at the bad end of the stick in this regard. However, I would submit that without much of the current red tape you would find some insurance companies would appear that would be better suited to address this sort of thing with people, at better prices than is currently possible. **There are no such companies out ther. If there were, I would have found them**
Published: August 18, 2009 10:40 AM
EnEm
My response to Nick:
I'm not real sure about the point of your story. Did the existing health insurer have a clause in the contract that allowed them to drop her?
**No, they did not. They merely called and said they would not be able to carry her because she had become "high risk". **My take on this is: Business as such, any and all business is entrepreneurial. And an entrepreneur is a risk taker. Insurance companies therefore cannot pass the risk inherent in their business to their clients**.
If this is the case, and I'm guessing that it was, then it should be self-evident that de-regulating the health insurance industry would help.
**I am with you on this. De-regulate, let smaller competitors join in that are willing to accept the risks involved and not pass them on to their customers. The big fat ones will have to follow suit or fold**.
If one was able to purchase insurance a la carte - and choose their levels of coverage and what clauses they approve of based on how much they were willing to pay, then she could have made sure she had a policy that contained no "heart patient" clause.
**She probably did not check for that clause, maybe because she was not aware that she was going to become a heart patient in the distant future**.
In other words, put the choice - and the *responsibility* - back into the hands of the individual.
**All this began when she had a bad fall at her work place. The insurance company refused to pay her medical bills because they told her that she could have avoided the fall. The employer refused to pay workers comp on the same grounds. Then when she had her first heart attack, the insurance company made selective payments of the medical bills, made her responsible for paying the bulk and then dropped her**
Published: August 18, 2009 10:58 AM
wesleybruce
RWW Thanks for your comments but the problem as I see it is that without some entity to initiate any change you get nothing. Mises institute has a leadership that does not threaten the use of force. Leadership is not inherently the use of government force. By ask I mean ASK. Not order, badger, threaten or kill. Request, suggest, include in any writings that implements a Libertarian solution.
It needs to be a simple free choice but to minimize transaction costs it ideally should be in the insurance paperwork or software that people do anyway. And yes I agree companies can and do add such clauses today.
I agree with you on due diligence but 80% of the current population don't even know how to start on basic due diligence and 5%, some of the people I work with, are intellectually incapable of such basic things.
If our alternative to government programs does not spell out things and the safeguards essential to its operation we hand it over to the statists forever. Also you are making a significant mistake of assuming that a libertarian/ anarchist society is a lawless entity. With out law there is no hope even where due diligence, etc, is done. In any free society there must be an agreed set of laws though not necessarily one enforced by even a minimal state. However a free state with an independent judiciary will create laws of precedent and judicial agreement. The question is whether it occurs in public or at some judges dinner table.
Published: August 19, 2009 12:44 AM
RWW
If your organization is educational in nature, or some kind of private court, I have no objection. But "parliament" has different connotations to me.
Published: August 19, 2009 7:11 AM