Health

Unit Thirteen

Objectives

The goal of this unit is to:

• Explore the question of whose life it is when considering the provision of health-care services.
• Discover the purpose of insurance and how it is suited to health-care.
• Examine the history of government intervention in the medical profession.

Everyone gets sick from time to time, and always has; so there has always been a market demand for cures and care. That demand has been met by a remarkable saga of research and development of cures from the earliest times on record; and those trying to meet the demand have been always held in high regard, with compensation to match. Their rewards have come not just in terms of money and respect, but in those of satisfaction derived from helping fellow human beings; a strong motivator that has drawn many into the medical, pharmaceutical, and nursing professions.

That saga has seen its setbacks, and plenty of mistakes; a mere three centuries ago physicians were solemnly bleeding patients so as to effect a cure. Perhaps three centuries from now medical scientists will be ridiculing some aspects of current practice.

The main setback to the saga came in the thousand years following the fourth century, when the Christian church was made part of the Establishment. Research continued in China and other parts of the world unaffected by European progress, or lack of it, but the enormous impetus given to rational enquiry by the ancient Greek thinkers, who had pushed Europe far ahead in the race for knowledge, came to a screeching halt; for that millennium, known as the “Dark Ages”, the best and brightest of every generation were funnelled into the Church as monks. No doubt they tried to heal the sick nearby; no doubt there was nothing wrong at all with their motivation; but their methodology was totally flawed. Instead of pursuing the scientific method of observation, deduction, theory formation, and testing they were all taught that no useful knowledge existed outside the Church and its scriptures. They were, in other words, hunting in the wrong haystack because there was a central directorate of control.

All that changed with the Renaissance, and science — knowledge — has blossomed ever since — medical science included. Until now.

The twentieth century brought some disquieting developments, as well as many spectacular advances. Treatment of all kinds is vastly improved from a hundred years ago but –-and it is a big “but” — there are signs that progress may soon come to another screeching halt; for once again, control is being passed to a single directorate. Government is being placed in charge.

Whose life is it, anyway?

Each individual own themselves, period.

Therefore, they each have complete control over what gets done to their bodies; over what is ingested, whether as a pill, a drink, or an injection, and over what bits get carved open and cut out. The choice is absolutely their, for them.

Put another way: By mere existence individuals are each entitled to self–medicate. If one desires to ingest something expected to change a condition they do not like — a headache, a fever, a depression, a feeling of acute boredom with a government school teacher, a pulled muscle, a persistent pain, a rash, a broken leg, cancer — the right to decide what to do is completely up to them.

But, but . . . for many of those conditions it is not known which treatment is best! And for that broken leg, one certainly needs help from someone else, to set the bone!

They can certainly obtain advice and help. Still, the decision what to do is their own, and their’s alone; assuming they are conscious — if not, then emergency physicians will take the risk that you later disagree, but that would be a reasonable risk of which a free–market court would be very tolerant, if satisfied they were acting in the best interests of their patient as far as they could tell.

The above pretty well covers the whole field of health care and drug use, in a free society — one compatible with human nature. That leaves one key factor to address: Who pays?

Health insurance

Free–market health care will be far less expensive than it is today — but still, complex surgery might be beyond the means of many. What is to be done?

Enter the friendly local or national health-insurance salesman. They would be everywhere, because everyone gets sick sometimes and anyone can have an accident. First, carefully note what “insurance” is supposed to be for.

The idea is to compensate the victim in the event of some unpredictable, catastrophic event. It was born in a coffee house in London in the early 1700s, to meet an old and serious need: The loss of ships at sea. All shipowners knew there was a risk, every time one of their vessels set sail — and they could calculate how big was that risk. Perhaps one ship in one hundred, on average, failed to return from a long voyage. But it was not possible to predict which ships would be sunk by storms, in any one year or month.

Further, if a ship did sink, the owner might be financially devastated; they might own only a few ships, and so be unable to “self–insure” — that is, pay for a replacement ship out of cash, should one be lost. The term “self–insurance” came later, of course.

The ingenious answer was to share the risk, with the help of an “insurance company”, an enterprise that was invented for the purpose. Anyone wishing to protect themselves would pay a small premium — perhaps one percent annually of the cost of a new ship, plus a little to yield the insurer a profit — and the insurer would buy them a new ship if one sunk.

Thus was born the worldwide insurance industry. The name of the coffee house was Lloyds.

It is quite easy to see how this idea can be applied to health care. One need only talk with their salesperson, pick the risks that they cannot afford to bear themselves, they quote a premium price, and one may haggle and go to their competitors to select the most suitable option, and eventually sign up. You pay a little, and normally you see nothing back; but if the unaffordable and unpredictable happens — a broken leg, a case of cancer — then the insurer picks up the tab. Simple!

That is the kind of thing that will prevail, in a free–market society. Notice, one would be foolish to buy an insurance policy to cover the cost of predictable events like ordinary visits to the doctor’s office for minor maladies; for you know that the insurer is going to make a profit and that would mean you will pay the cost of the visits plus a share of those profits! That would be silly, irrational. But for rare and unexpected problems, insurance makes a lot of sense.

What went wrong

Government put in its jackboot!

It did so steadily over a whole century, starting around 1900, and in several ways:

1. Governments required physicians to be licensed before practising as such.
2. Governments introduced certain “free” medical services in the 1960s, extended since.
3. They regulated drugs; outlawing some, making some others “prescription only”.
4. They established the regulatory bodies — the Food and Drug Administration in the United States — to approve or reject new drugs.
5. To obtain government reimbursement, providers are loaded with administration.

At first sight — which is all that government people hope voters will give them — these seem positive goodies. Who wants to be treated by a quack, for instance? By now, one should know to give such programs a more careful examination.

Licensure, first, causes an increase in the cost of consulting a physician. While it is true that travelling “quacks” sometimes misled people in the nineteenth century about the efficacy of their potions, there was no need at all for government to intervene; if a patient wants to choose a physician on the basis of their reputation and training, they are well placed to do so on their own. All medical schools issue diplomas and keep records, and those can be examined easily before entering a contractual relationship such as undergoing treatment. Licensure, however, at once enables the licensed physician to charge more, knowing that the patient’s choice is limited; they may even be the only choice in town!

“Free” treatment, secondly, arrived in the 1960s as part of the fraudulent “War on Poverty” — fraudulent, because the war was lost decades ago but never abandoned; there is as much poverty now as there was then — so naturally, demand for services ballooned and therefore the real price, again, increased.

That is because of the iron economic principle that if supply of some service is limited — physicians cannot be trained and graduated overnight — and the demand increases, so will the price. Here, the apparent price approached zero — the Johnson tooth fairy was let loose — and so the demand for services shot up. Then, so did the real price — for everyone, including the many not covered by the government scheme. The tragedy was that this was entirely foreseeable, even by the economic illiterates in government; the same idea had been tried in Britain twenty years earlier, with identical results.

It must be added that government was not the only party providing “free” medical insurance in the 1960s; it became the fashion, in a time of low unemployment, for businesses to offer it in a “package” of employee benefits, to attract new hires. In their case the cost did at least come out of the labour of the people hired, even though that obvious fact was not drawn to their attention, but it did have the same effect of disguising the true cost of medical care; a doctor’s visit would appear to be “free” while its cost was actually being borne by the employer first, and then by the employee in the form of lower salary raises next year. As has been shown, health insurance makes good sense for unexpected disaster, but none at all for everyday, predictable events — no matter who apparently pays the premium.

Forty years later, the whirlwind is being reaped; America’s one–time biggest company, General Motors, was in 2006 on the brink of bankruptcy primarily because its generous employee health–care package was adding $1,500 to the price of every car it sold. At least a for–profit company has that option; government never declares bankruptcy, it merely ratchets up taxes.

Drug regulation, thirdly, added another boost to the price of health care, and as above it had two aspects: Prohibition and prescription.

Prohibition targets drugs that may not have to do with health care, as such, though marijuana certainly has been found effective in relieving chronic pain and laudanum or opium was a commonly available painkiller right through the 1800s; one may recall John Wayne’s last movie, The Shootist, in which his character’s landlady’s young son was sent to buy a bottle at the pharmacy for some trivial price. Nonetheless, as has been shown, humans have an absolute right to control what enters their bodies and if they want to enhance their sense of wellbeing, whether with bourbon or ecstasy, it is nobody else’s business at all. It may be unwise and damaging and in a rare case even fatal, but whose life is it, anyway?

The street price of illegal drugs is greatly magnified, generating real crime — the sort with victims — as addicts rob to get money to pay the illegal dealers; dealers settle disputes with guns, killing innocents in the crossfire, because civilised resolution services are closed to them by government edict, and on and on. What a tragedy; government could have learned it all from its disastrous experiment with alcohol in the 1920s; but government is, as always, irrational.

Prescription control on the other hand does pretend to enhance health care, but its primary effect is to magnify its cost. The idea is that before one can take certain medications into their own body, they must get permission from one of the government’s licensed physicians.

Now, most might want to get expert advice anyway, especially for a drug new to the market; but government takes the decision out of their hands. That violates an individual’s fundamental right. It also means that time must be taken out of the schedule of a highly trained physician, whose time is naturally expensive — whether one wants to ask their advice or not. Hence the higher cost; perhaps $75 for an office visit, to add to the price of the drug itself. Then one must show an identification card to the dispensing pharmacist, as well as the prescription form itself; totally needless and intrusive, except that government has decreed that the pharmacy must collect and verify that information. Another cost item, that someone — the individual, eventually — must pay.

Result: By the late twentieth century, many medications were being priced in terms of dollars per pill and ordinary people could simply not afford them; having broken their legs Congress then handed Americans a crutch in the form of limited subsidies for medication purchases, and so the ridiculous cycle took another vicious turn; the apparent price of drugs, though far too high, is lower than the actual cost — so the demand will rise again, and . . .

There is no rational alternative to a free market.

Government approval, fourthly, greatly magnifies the price of prescription drugs. In the United State, the Food and Drug Administration acts as a hoop, through which drug companies must jump before they can place a new medication on the market. This was sold to voters as a “safety” measure to ensure that Big Pharmaceutical did not profit from unsafe drugs.

In a free market society Big Pharmaceutical would not do that for long anyway, because if any were unwise enough to poison its customers by neglecting a thorough pre–release testing program, they would pretty soon be bankrupt on account of the lawsuits they would lose. Nonetheless, the hoop is there; and it adds several years to the development cycle — something that by its nature is bound to be a slow search anyway.

During those extra years, patients awaiting the new drug will die. Those deaths are not counted when the Food and Drug Administration does its calculation of relative safety. And since its employees presumably like their salaries, it is reasonable to assume that they would rather err on the side of caution than approve a drug from the use of which one in a million might die. It might better be called the Federal Delay Agency for that reason, and this government generated delay costs money as well as lives.

That is because there is a “window” of patent–protected life for any new drug. The manufacturer must recover all their substantial development costs, plus profits, within that window — for when the patent expires, rivals can copy their formula and make the pills for a cost like aspirin.

The multi–year delay eats in to that window and multiplies the price two to four times.

Health hobgoblins are — alas — only too common. The perceptive humorist Mencken observed that “the whole aim of practical politics is to keep the populace alarmed — and hence clamorous to be led to safety — by menacing it with an endless series of hobgoblins, all of them imaginary” and this is true for health as for other subjects.

The ruse succeeds because epidemics do occasionally happen: The worldwide influenza in 1919 was real and dreadfully lethal. But government people trot out crisis after crisis, almost all of them false — and probably deliberate — alarms; in 2006 it was bird flu, in 2009 it was swine flu.

Lastly one should take note of the administrative burden that government places on all participants in health care.

Doctor Glenn Winstead, a former physician who is now too discouraged to re–enter the profession:

It is true that the theory of our Constitution is, that all taxes are paid voluntarily; that our government is a mutual insurance company, voluntarily entered into by the people with each other...

But this theory of our government is wholly different from the practical fact. The fact is that the government, like a highwayman, says to a man: “Your money, or your life”. And many, if not most, taxes are paid under the compulsion of that threat.

The government does not, indeed, waylay a man in a lonely place, spring upon him from the roadside, and, holding a pistol to his head, proceed to rifle his pockets. But the robbery is none the less a robbery on that account; and it is far more dastardly and shameful.

The highwayman takes solely upon himself the responsibility, danger, and crime of his own act. He does not pretend that he has any rightful claim to your money, or that he intends to use it for your own benefit. He does not pretend to be anything but a robber. He has not acquired impudence enough to profess to be merely a “protector”, and that he takes men’s money against their will, merely to enable him to “protect” those infatuated travellers, who feel perfectly able to protect themselves, or do not appreciate his peculiar system of protection. He is too sensible a man to make such professions as these. Furthermore, having taken your money, he leaves you, as you wish him to do. He does not persist in following you on the road, against your will; assuming to be your rightful “sovereign”, on account of the “protection” he affords you. He does not keep “protecting” you, by commanding you to bow down and serve him; by requiring you to do this, and forbidding you to do that; by robbing you of more money as often as he finds it for his interest or pleasure to do so; and by branding you as a rebel, a traitor, and an enemy to your country, and shooting you down without mercy if you dispute his authority, or resist his demands. He is too much of a gentleman to be guilty of such impostures, and insults, and villainies as these. In short, he does not, in addition to robbing you, attempt to make you either his dupe or his slave.

Hospitals were once the tools of physicians; now physicians are the tools of hospital administrators. The transfer of power began with the advent of Medicare and Medicaid. Physicians were bribed with stolen tax money to cooperate. Incomes shot out the roof, but at a price of integrity and control. Competition was obliterated in favour of a generous, guaranteed income from the state.

Eventually, however, this benevolent creature turned on those it had enticed into its den. No longer are the best and the brightest attracted to medicine, and with good reason. Intuitively, they see that physicians have become whores of the state. Drug companies used to persuade physicians to use their drugs. Now they market the drugs directly to the public with slick television ads, that are very powerful in inducing the public to demand certain drugs from their physicians, who are all too easily cowed into compliance, lest the patient complain to the hospital administrator, who holds the keys to the physician’s career. Monstrously inappropriate prescription of powerful antibiotics for the common cold is one obvious result, cost be damned.

Any attempt to step outside the box results in armed goons busting down doors, be they those of physicians or other people who do not seek approval from the state to use unapproved medications. Look at whatever surgical procedure is paid for well by the state, and there will be, of course, lots of those procedures done. First, it was hysterectomies. If you had a uterus, it needed to be removed. Then orthopaedic procedures, such as back surgery covered by government insurance programs, became the vogue. Then heart procedures became the money–pit for hospitals and physicians. The Food and Drug Administration stifled anything that was new or cheap from coming on the market. The entire game is rigged against the patients’ welfare, which is the last consideration.

When the free market was mostly operational, medical care was cheap and readily available. Now, medicine, like law and education, has become an obscene beast. Everyone with integrity loses. Physicians know there is something very wrong, but few of them can put a finger on it. Most of us are the product of many years of indoctrination, the blinders which keep the horse on the state track. There are so many interwoven channels of corruption and control that it is nearly impossible to sort it out.

Good, honest medical care has become an item for the history books alone.

Unit Thirteen

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