The blog of Freedom and Individual Rights in Medicine (FIRM)
Myth No. 1: Opponents of Obamacare are the ones creating myths.Feel free to circulate their article as far and wide as possible!
Myth No. 2: Opponents of Obamacare are "anti-health care reform."
Myth No. 3: Opponents of Obamacare are criminals, thugs and mobs.
Myth No. 4: We need Obamacare to give everybody health care.
DON'T TREAD ON THE RIGHT TO BE FATThis mirrors one of my themes from my earlier Christian Science Monitor piece, "Universal Healthcare and the Waistline Police".
In a free society, the individual has the right to make diet and lifestyle choices—and the responsibility to enjoy or suffer the consequences.
The government should not try to solve the obesity problem by coercing consumer behavior or by restricting the freedom of businesses to advertise their products. Some argue that such controls are justified because people who develop obesity-related illnesses will be treated at taxpayer expense. But the sole legitimate function of government is to protect individual rights, not violate them. Just because government currently violates individual rights by forcing citizens to pay for others’ health care does not justify further violations in the form of telling Americans what we may or may not eat. Two wrongs don’t make a right.
Those who become ill as a result of their poor choices should pay the price themselves or rely on voluntary charity rather than be supported by taxpayer dollars.
--Paul Hsieh, a physician in Denver, is a co-founder of Freedom and Individual Rights in Medicine, a nonprofit group that promotes personal liberty and free markets in health care.
Health care statisticsFor more information on life expectancy claim, see this column by ABC News reporter John Stossel, "Why the U.S. Ranks Low on WHO's Health-Care Study".
Life expectancy and infant mortality statistics are notoriously poor measures of the quality of a nation's health care system. For instance, more Americans are killed in car accidents and homicide than in Canada and Europe. According to ABC News, if one adjusts for these fatal injuries, then U.S. life expectancy is actually higher than in nearly every other industrialized nation.
International comparisons of infant mortality rates are similarly suspect. The U.S. counts any premature infant born with a heartbeat as a live birth even if it survives only a few hours. Many European countries count such children as "stillborn" if they weigh less than 1 pound even if they show a heartbeat. Japan doesn’t count such infants as "live births" unless they survive for more than 24 hours.
Flawed statistics make a poor basis for public policy.
Paul Hsieh, M.D., Sedalia
The writer is co-founder of Freedom and Individual Rights in Medicine.
When Tommy Douglas, architect of Canada's government-run health care system, (and head of North America's first socialist government) nursed his pet project to fruition in the early 1960s, he envisioned a medical utopia, where contented citizens, freed from the ravages of market forces, heartless insurance companies, and greedy doctors (sound familiar?) would receive timely, quality medical care on demand, provided by an army of cheery yet determined practitioners whose only concern in the world was to advance the general welfare of their fellow man. Paradise in a lab coat.Sloan also offers some positive recommendations to improve the current American system:
Some 40 years later, the reality bears little semblance to the idealistic vision of Kiefer Sutherland's grandpa. Skyrocketing costs, crippling tax rates, chronic doctor shortages, months-long waits for routine tests, (years for many specialized services), and oftentimes outright denial of procedures are the norm. Governments, desperate to control costs and prevent a total collapse of the system, are continuously de-listing previously covered procedures, and seeking new taxes or even, (heaven forbid) user fees.
As a Canadian, I can testify to the elongated waits for tests that often result in additional and more costly treatment, when you do finally get around to being treated. Those who can afford it flock south for their medical care.
So what went wrong?...
This is not to say that improvements can't be made. America has been in the business of improving things since its inception more than 200 years ago. Few would deny there are costs associated with the system that can be controlled. Tort reform (it is somewhat ironic that under President Obama's plan, the only segment of the health care industry who would not be making great financial sacrifices are the trial lawyers), addressing the issue of portability, easing mandates on insurance companies, and Health Savings Accounts would all go a long way toward creating real competition, lowering costs, and helping solve the problem of dropped coverage associated with job loss and pre-existing conditions, as individuals took ownership of their insurance. Many of these common sense reforms were, incidentally, voted down by previous Congresses, which included then-senator Obama in the "nay" column.These would be excellent steps in the right direction -- and would constitute real reform.
...There are countless reports, articles, essays and books that will give you all the statistics, anecdotes and arguments you could possibly want (please see the links at the end of this article). I don’t want to debate figures here; plenty of misinformation is swirling around on both sides of the political divide and I see no value wading in to fight over the shifting minutiae. I’m interested in exploring the underpinning ideas.The consequence of this is clear:
...The primary reason, however, that the NHS has a death-grip on the psyche of our nation is tied to its founding beliefs. It is no coincidence that the NHS was sold to the British public during wartime. In a country conditioned by emergency measures, nationalised industries and rationing the idea of an egalitarian "free" health service, based on need not ability to pay, struck a powerful chord. No-one would be left behind; everyone would be treated the same; we were all in it together.
The wartime spirit is palpable in NHS hospitals even today. Nowhere else in 21st Century British life do you feel this atmosphere. The staff seem to be constantly fighting a losing battle. As a patient you're a supplicant, not a customer, pathetically grateful for what you receive. You’re just one of the many faceless victims waiting to be treated. Waiting, for everything, is a matter of course. Queueing, filling in forms, being moved by harassed looking nurses, more waiting. But you mustn’t grumble; stiff upper-lip and all that.
...People often assume that removing financial incentives encourages virtue and will somehow simplify the decision making process, but resources are limited and the need for medical care is infinite. If money is taken out of the equation other, less direct, constraints become necessary and the remaining incentives are twisted. Long waiting times, mushrooming administrative bureaucracy, rationing of care and lack of transparency are not simply a matter of insufficient funding; they’re inescapable components of this type of system.I highly recommend reading the full essay.
Here’s an example. You come in for a check-up and your doctor notices a minor discrepancy. It's probably nothing but to eliminate all doubt she needs to order an expensive test. If you were paying for your healthcare, or had control over your insurance, she could explain the situation candidly and leave the decision up to you. You would need to balance the small risk against the expense, or -- depending on the nature of the potential problem -- a change in your lifestyle. You might even shop around for a cheaper kind of test; it's your money after all. But if your doctor is required to give you free treatment the situation changes drastically. She must now consider the fact that if she tells you the whole truth you will naturally demand the test. It doesn't matter to you how much it costs or how tiny the risk; you’re not paying for it. Your doctor, however, has to think about the hospital targets, the other patients waiting for tests and, if you're elderly, the effectiveness of continuing treatment considering your age.
As far as I can tell, most doctors maintain their integrity. They're honest with their patients and zealously fight their corner against the hospital managers. But what kind of system sets up a clash between the interests of the patient and the doctor? What kind of system punishes virtue?
...Like every grieving family member, I looked for someone to blame for my father's death. But my dad’s doctors weren't incompetent -- on the contrary, his hospital physicians were smart, thoughtful, and hard-working. Nor is he dead because of indifferent nursing -- without exception, his nurses were dedicated and compassionate. Nor from financial limitations -- he was a Medicare patient, and the issue of expense was never once raised. There were no greedy pharmaceutical companies, evil health insurers, or other popular villains in his particular tragedy.In particular, he describes in detail the following major points:
Indeed, I suspect that our collective search for villains -- for someone to blame—has distracted us and our political leaders from addressing the fundamental causes of our nation’s health-care crisis. All of the actors in health care -- from doctors to insurers to pharmaceutical companies -- work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create.
* Health Care Isn't Health (Or Happiness)(Read the full text of "How American Health Care Killed My Father".)
* Health Insurance Isn't Health Care
* The Moral-Hazard Economy
* There's No One Else to Pay the Bill
* The Government Is Not Good at Cost Reduction
* Our Favored Hospitals
* You Are Not the Customer
* The Strange Beast of Health-Care Technology
* The Limits of "Comprehensive" Health-care Reform
...I too believe that the government must reverse its inappropriate manipulation of the health care industry and turn to free market solutions to repair the problems that prior government intervention has created.(Read the full text of Peck's reply to Whole Foods.)
I believe that the government's only proper role is the protection of individual rights. Interference by the government in the health care and insurance industries violates individual rights by forcing unwilling participants to pay for a predatory collective, by pressing physicians and other independent professionals into involuntary servitude for the sake of some mysterious, shape-shifting and ultimately illusory "common good," and by dictating the terms upon which an insurer can operate. This regulatory interference causes the rising cost of health care and diminishing access to the quality and innovation that only the profit-motive can supply.
The "public option" and "single-payer" health care proposals being advanced by disinterested power-seeking central planners in Washington would mean a government bureaucracy interfering in the private relationships between doctors and their patients. It is a subversion of the individual's right to contract. It is a subversion of the right to use one's judgment to act in one's own best interest without interference. It is a subversion of the right of doctors, nurses and insurers to voluntarily offer products and services to satisfied health care consumers for their mutual benefit.
...As philosopher Ayn Rand urged throughout her life, political and economic freedom are requirements of life. Statism serves to undermine those ends while capitalism serves to further them. Capitalism is not right because it works, it works because it is right.
TIM PECK
ASHEVILLE NC
The major impetus behind the Democratic health care plans is not economic -- it is moral. The claim that health care is a moral right has motivated enormous government coercions against the medical industry for nearly fifty years. But this moral claim has blinded people to the fact that huge price increases have necessarily followed the growth of the coercions. To understand why, it is instructive to consider what would happen if car insurance were considered to be a "right" and the right was enforced by the government.(Full text here at CapMag.com.)
After the purchase of a home and the ordeal of major surgery, a car is most people's biggest financial risk. One mistake -- or one bad driver -- can harm dozens of people. We need insurance, so why should it not be considered a right?
Car insurance is provided by companies that manage their investments in order to absorb financial losses. If insurance is considered to be a "right," then someone must be forced to provide it: either the companies directly, or the citizens through coercive taxation. Either way, the new "right" will be taken by physical force, that is wielded by the state against those who are bound, by law, to provide it.
To enforce this new "right," the government must take money from some people and give it to others, without regard for the actual risk they pose. As huge amounts of money are pumped into insurance markets, demand increases, and prices rise. Government officials blame the companies, so they pass more controls, thus squeezing the supply. Prices rise further -- the law of supply and demand cannot be thwarted.
People want to be protected from greedy repair shops and auto manufacturers. So the companies undergo a ten-year approval process costing millions of dollars for new products. As lawsuits mount, courts enforce claims of strict liability against the companies -- who pass the costs on. Price rises accelerate.
As people get used to a "right" to car insurance, they demand more coverage. Oil changes, brake jobs, torn seats and new tires become insurance matters. If insurance is a "right," then no one should be deprived of these goods because he cannot pay for them. Every visit to the repair shop -- big or small, routine or emergency -- now involves an insurance claim. Prices escalate.
Male drivers under 25 pay more because they are statistically higher risks—but they resent this inequality. So they assert their "right" to insurance at the same price as older, wiser drivers. Companies spread the costs out across the board -- and as good drivers face higher premiums, they demand more coverage. Prices shoot up further.
By this point, no one asks what a repair job will actually cost -- they ask only about their "co-pay." Customers have little incentive to keep costs down. Why bother to change the oil, if the insurance will give you a new engine?
As regulations increase, critics castigate companies who are unwilling to cover pre-existing conditions, such as a fender dented before the car was insured. As paperwork increases, repair shops that once had four mechanics and one secretary now have five secretaries, who spend their days filing claims. Prices rise further -- until car insurance becomes a crushing burden.
By this point, the very idea that insurance should be used for catastrophic losses—not routine maintenance -- has been lost. A chorus of calls for "reform" demands more government coercion to enforce the "right." Anyone who suggests reducing the controls is shouted down by those who blame the "free market" for rising costs. By this point, most people have forgotten what a free market is -- or that they had no "right" to insurance before someone else produced it -- or that there was a time when insurance was not so costly.
This is fiction, of course -- but it directly mirrors what has happened in health care. After World War II, companies began to offer employee health insurance because government controls forbid them from paying higher wages. Twenty years later, the "Great Society" lavished billions on programs -- and as prices rose, regulation against the producers multiplied. HMOs and a host of other schemes were tried.
Now, bucking under the weight of economic distortions and regulations, the law of supply and demand is wreaking vengeance on those least able to pay. Medicare and Social Security are approaching insolvency, insurance companies are forbidden from selling across state lines or from offering innovative health savings accounts, and the solution offered is—even more programs, with a price tag so large that it that cannot be grasped by the human mind.
To expand government programs is not "reform." It is an extension of sixty years of government interventions. The government now controls nearly fifty percent of all health care dollars -- paid for by skyrocketing prices, taxes and borrowing. The correlation with history, and with the law of supply and demand, is precise and inescapable.
The primary cause of medical price increases is the government coercions. But the cause of the coercions is the idea that health care is a right. Until we understand that nothing is a "right" if others must be forced to provide it, we will continue to swallow the same poison, and we will reap even worse consequences in the future.
John David Lewis (website) is a Visiting Professor of Political Science, Duke University. He has been a Senior Research Scholar in History and Classics at the Social Philosophy and Policy Center, and an Anthem Fellow. He is a contributing writer for Capitalism Magazine, and a Consulting Editor for The Objective Standard.
Dear conservatives:(Read the full text of "Down With The Health Insurers".)
Health insurance companies are not your friends. Keep opposing a new government-run insurer, a single-payer plan, and new regulations on the HMOs. But grant that Speaker of the House Nancy Pelosi is correct on this: Insurance companies are villains.
Insurance companies lobby for big-government regulations, subsidies, mandates, and tax-code distortions that funnel them money, keep out competition, and stultify innovation. These policies preserve the employer-based health-care system that mocks the idea of free-market competition. Then they cry "unfair competition" when government threatens to encroach on their government-protected monopolies.
But they're not just lobbying against a government option. Today, health insurers are lobbying to force you and me to buy their product or face a tax hike (the individual mandate).
They are lobbying to force entrepreneurs to buy insurance for employees (the employer mandate). They are lobbying for more subsidies paid for by us taxpayers. In short, they are lobbying against regular people and against the free market...
...Most people who oppose socialized medicine do so on the grounds that it is moral and well-intentioned, but impractical; i.e., it is a noble idea -- which just somehow does not work. I do not agree that socialized medicine is moral and well-intentioned, but impractical. Of course, it is impractical -- it does not work -- but I hold that it is impractical because it is immoral.Last week, a local doctor called me up to tell me that he had started surfing the FIRM website, read Dr. Peikoff's essay, and thought it was the best analysis he had ever seen on this issue, precisely because it cut to the heart of the debate.
This is not a case of noble in theory but a failure in practice; it is a case of vicious in theory and therefore a disaster in practice.
I want to focus on the moral issue at stake. So long as people believe that socialized medicine is a noble plan, there is no way to fight it. You cannot stop a noble plan -- not if it really is noble. The only way you can defeat it is to unmask it -- to show that it is the very opposite of noble. Then at least you have a fighting chance...
...The problem, not the solution(Read full text of "Not a Health Care Remedy".)
Government's favoring employer-sponsored insurance is the problem, not the solution. When your employer buys your insurance, it's a non-taxable corporate expense. Employers save by "paying" you with insurance instead of higher wages.
This tax policy coddles insurance companies. They need only please your employer, not you. Most employers offer just one or two plans. Want more choices? If you prefer one of the many plans available at eHealthInsurance.com, you face a stiff tax penalty. Or try changing jobs. Insurers know you're essentially stuck with your employer's plan, so why should they please you?
Tax-discounted insurance has turned insurance into prepaid health care. If car insurance worked this way, it would cover predictable expenses like oil changes and replacement tires. You wouldn't price compare or consider whether services were really necessary. Rather, you'd ask if "it's covered." Costs would soar. This has happened with medical care.
The tax bias for employer-sponsored insurance punishes those who incur medical conditions and then lose their job. A pre-existing condition can make them uninsurable.
Bravo, Mike Rosen, for identifying the fundamental, moral health care issue -- there is no right to health care.Thank you, Anders!
True health care reform protects the fundamental right of patients, doctors and insurance companies to voluntarily exchange products and services in the marketplace without government intervention. Such reform must focus on repealing existing laws and programs, not creating new ones. Repeal laws preventing insurance companies from offering policies with selective coverage and individuals from choosing such policies. Repeal laws making health insurance premiums tax-deductible for corporations but not for individuals. Repeal laws forcing doctors to take on excessive amounts of malpractice insurance to protect themselves against lawsuits. And yes, eventually repeal Medicare and Medicaid.
In health care, as in life in general, the moral is the practical; true health care reform will result in an abundance of health care options for people of all means.
Anders Ingemarson, Denver
...Then the state created a "public option" known as DirigoChoice. (Dirigo is the state motto, meaning "I Lead.") This plan would compete with private plans such as Blue Cross. To entice lower income Mainers to enroll, it offered taxpayer-subsidized premiums. The plan's original funding source was $50 million of federal stimulus money the state got in 2003. Over time, the plan was to be "paid for by savings in the health-care system." This is precisely the promise of ObamaCare. Maine saved by squeezing payments to hospitals and physicians.The WSJ concludes:
The program flew off track fast. At its peak in 2006, only about 15,000 people had enrolled in the DirigoChoice program. That number has dropped to below 10,000, according to the state's own reporting. About two-thirds of those who enrolled already had insurance, which they dropped in favor of the public option and its subsidies. Instead of 128,000 uninsured in the program today, the actual number is just 3,400. Despite the giant expansions in Maine's Medicaid program and the new, subsidized public choice option, the number of uninsured in the state today is only slightly lower that in 2004 when the program began.
...This problem was exacerbated because since the early 1990s Maine has required insurers to adhere to community rating and guaranteed issue, which requires that insurers cover anyone who applies, regardless of their health condition and at a uniform premium. These rules—which are in the Obama plan—have relentlessly driven up insurance costs in Maine, especially for healthy people.
The Maine Heritage Policy Center, which has tracked the plan closely, points out that largely because of these insurance rules, a healthy male in Maine who is 30 and single pays a monthly premium of $762 in the individual market; next door in New Hampshire he pays $222 a month. The Granite State doesn't have community rating and guaranteed issue.
...Unlike the federal government, Maine has a balanced budget requirement. So out of fiscal necessity, the state has now capped the enrollment in the program and allowed no new entrants. Now there is a waiting list. DirigoChoice has become yet another expensive, failed experiment in government-run health care, alongside similar fiascoes in Massachusetts and Tennessee.Waiting lists, skyrocketing costs, and a failure to actually guarantee "access" -- who could have predicted that these would be the results of government intervention in health care and health insurance?