Medical Apocalypse – the dramatic climax of a very bad horror movie.
The United States has massive problems to solve. I believe the collapse or corruption of our health care system, our financial system and our election system are the most important to us as libertarians. Any one of these three issues could destroy the country. At the very least, our economy and our ability to compete on the world stage have been severely compromised. These issues feed directly into an unsustainably high cost of production which is in turn caused by an unsustainably high cost of living. America’s costly and inefficient medical system is a major factor. The result of a high cost of production is a reduced standard of living. Our health care system is destroying us.Some would make the argument that the failure of our health care system is a failure of the market. To them, the government must step in to solve the crisis. This is just flat out wrong. Our health care system is anything but a free market. What it represents is the failure of government intervention. Health Care system reform must be a priority for our communication and our candidates. We must insist that our candidates are educated about the problems and solutions and can explain them well. We should be communicating as a political party to get this message out and calling out other party candidates and office holders for not providing leadership. I think the three books I’m about to highlight can provide a foundation for this knowledge and drive home to all of us why this issue is so critically important.
Priced Out by Uwe Reinhardt was published in 2019, two years after his death. Reinhardt was the James Madison Professor of Political Economy and Professor of Economics and Public Affairs at Princeton. He was highly regarded by mainstream participants in the health care discussion. His life’s work, including this book, made a clear case that the U.S. Health Care system is a chaotic mess. Hospitals have pricing and economics that very few people understand, and that includes administrators, doctors and patients. Reinhardt is a master at breaking down the key metrics to explain the American system and “why it costs so much more and delivers so much less than the systems of every other advanced country.” If you have a desire to wonk out on the economics of health care in the U.S., Priced Out is an excellent choice.A forward for the book was written by William Frist, MD., a Republican from Tennessee who served in the Senate from 1995 to 2007 and as Senate Majority Leader from 2003 to 2007. Being a heart and lung transplant surgeon by occupation, and a student of Reinhardt, Frist understood the financial complexities and the ethical considerations discussed by Reinhardt. In the forward, his respect and admiration for Reinhardt is obvious.
Reinhardt’s analysis of our health care system made him the darling of Congress and mainstream stakeholders. His grasp of detail and complexity was impressive, but it gave perfect cover for politicians and members of the health care establishment to avoid changing the system. There are many that benefit from a needlessly complex and dysfunctional system. This grasp of detail is actually a central flaw in his analysis. He made it too easy to for politicians and medical professionals to say, “you know, it’s complicated”, or “we did the best we could” or “you can’t change it over night” and “you can only do so much”.
The second flaw is a central organizing philosophy of Reinhardt’s life’s work, which he considers the fundamental question: “As a matter of national policy, and to the extent that a nation’s health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a preventable illness as does the child of a rich American family?”
William Frist certainly thought the answer was yes. It is clear he was a fan of George Bush’s compassionate conservatism philosophy and proud of his role in it. In his forward, he claims credit for writing and passing PEPFAR, The U.S. President’s Emergency Plan for AIDS Relief, a framework by which the U.S. government provides money for medical programs, mostly in Africa. It was launched in 2003. Since its inception, the United States government has funneled roughly 100 billion dollars into various programs using the authorizing legislation of PEPFAR. This vast expenditure has mostly had the effect of enriching pharmaceutical company executives and others at the top of the world health food chain while leaving death and destruction behind it. In my opinion, the record of experimentation and blatant exploitation on the people of Africa is well documented in Robert F. Kennedy’s book which I will mention last in this piece. Frist should be more ashamed of the PEPFAR program than proud of it. He seems like a good man. I wonder if he would concur.
Frist and Reinhardt are both misled by the central organizing question. It’s the wrong question phrased in the wrong way leading to the wrong outcome. It allows politicians to make themselves feel good about themselves by imposing their moral compass on other people. The question uses phrases like “national policy”, “nation’s health system”, “poor” and “rich”. The question is a shaming device and implies force to make some people pay for other people’s health care. The question does not raise any consideration regarding individual responsibility for health of themselves and their children. The question of cost of the “nation’s” health care is only vaguely referenced and left open ended to an unlimited expense. What is included in a “nation’s health system”? Does it include agricultural policy and the incentives for more healthy food as opposed to less healthy food choices? Does it include food as medicine as opposed to only relying on pharmaceutical drugs? When American political leaders authorize vast expenditures of money for a continent thousands of miles away, does it ever occur to them to follow up to ensure that money has been put to a good use, not to an evil one?
The problem I see in Reinhardt’s book is not intended as a criticism of the whole work. He does give an unbiased and tremendously insightful look at the data. It is a great book to study regarding the problems in our health care system.
The Price We Pay by Marty Makary, MD, is another great work, also published in 2019 (with an update in 2021). This book is probably more accessible to the average person than Reinhardt’s book. Makary is a great story teller. He is not trying to address every aspect of health care. His primary focus is hospital system billing practices and the shocking abuse of the low-income wage earner. Many hospitals systems, and especially the not for profits, sue patients for non-payment of invoices and have the courts garnish their wages. The patients have no way to know in advance what the cost of the service will be and little they could do to avoid them. Almost no one understands any particular hospital’s price structure. Makary mentions one hospital that has over 3,000 contracts, each with a specified discount. That’s 3,000 different prices for the same medical procedure!
Makary’s mission has been to lobby Congress over the last couple of years to force hospitals to display their prices in a similar way that food labels are required to include nutritional content. He has achieved some success with this initiative, but unfortunately this success is little known due to being drowned out by the tsunami of Covid information. Marty Makary’s book is relevant today, and maybe more relevant today after the revelations presented in the third book and last book I’m reviewing.
The Real Anthony Fauci by Robert F. Kennedy Jr. was published and released to the public in late 2021. This is a highly controversial book. It blows the lid off the many individuals using science and medicine for their own selfish or evil purposes. It pulls no punches in accusing Big Pharma and its supporters in government run Public Health agencies of conspiracy, probably criminal, but at minimum worthy of termination of employment and public disgrace. The conspiracy described is the push for vaccination at the expense of all other public health measures. The motive for the conspiracy is simply greed and power. The amount of wealth gained by the perpetrators is immense. The damage to the world’s health is immeasurable. Kennedy’s book is comprehensive, detailed and exceptionally well referenced, but whether or not the accusations are true, there is no doubt that the leaders of the CDC, NIH, NIAIA, FDA and the majority of the health care establishment will push back. They cannot allow this attack on their actions, motives and reputation to stand.
However, this opinion piece is not about the conspiracy. It’s about the reform that was discussed in the Bush, Obama and Trump administrations but never got resolved. It never got resolved because liberals have made nationalized, government run health care one of their signature goals, while conservatives and libertarians have been adamantly opposed. It never got resolved because the criminal conspirators are masters at covering their tracks and concealing the true problems. It never got resolved because the military industrial complex and the medical industrial complex came together as a nearly unstoppable force in public policy. The mess we are in today might have been avoided if the right discussions had taken place and we had come to the right conclusions. Unfortunately, a better solution has not been advocated strongly enough. We have an opportunity to make a difference because at this point it is painfully obvious to many Americans that government involved health care is dangerous and doesn’t work.
This system deserves a radical destruction/restructure, but it isn’t always productive to be viewed as too radical. Fortunately, we can play the Jinga game as well. There are blocks that can be removed which can dramatically bring down the whole system.
My favorite goal advocating a small change with big potential to upset the system is to remove any tax advantage for insurance provided by an employer. This hoary chestnut of a health care policy has been around since right after World War II. It was promoted by employers to counter union organizers who were advocating health care benefits for union workers. It has become a Frankenstein monster. It has enabled insurers to reduce cost by marketing primarily to businesses while only offering crappy, expensive products to individuals. Over time, this system has created a barrier between the individual and the health care system while HIPPA laws have created a barrier between the health care system and the employer to hide the true cost of the medical from the employer and the employee. While allowing the insurance fox to guard the medical establishment hen house was in their best interest for a while, it has even begun to work against them. The medical insurance industry has eaten all the chickens. Costs have gotten so out of control that insurance companies have nearly destroyed themselves. Removing the tax advantage for the employer provided insurance over insurance provided to individual will over time put the individual back in charge of his or her health care. Medical providers will not be able to hide the cost of their services and patients will be enabled to negotiate the price of the services they receive before the service is provided.
The health insurance industry will need to be deregulated in an additional way. Private enterprise would normally elect to offer insurance against events over whose outcome the insured possesses no control. One cannot buy insurance against suicide or bankruptcy, for example, because it is in one’s own hands to bring these events about.
Because a person’s health, or lack of it, lies increasingly within his own control, many, if not most health risks, are actually uninsurable. “Insurance” against risks whose likelihood an individual can systematically influence falls within that person’s own responsibility.
All insurance, moreover, involves the pooling of individual risks. It implies that insurers pay more to some and less to others. But no one knows in advance, and with certainty, who the “winners” and “losers” will be. “Winners” and “losers” are distributed randomly, and the resulting income redistribution is unsystematic. If “winners” or “losers” could be systematically predicted, “losers” would not want to pool their risk with “winners,” but with other “losers,” because this would lower their insurance costs. I would not want to pool my personal accident risks with those of professional football players, for instance, but exclusively with those of people in circumstances similar to my own, at lower costs.
The current laws take none of this into account. Laws, mostly state but some federal, place legal restrictions on the health insurers’ right of refusal — to exclude any individual risk as uninsurable — so 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. They do not discriminate among various groups of people which pose significantly different insurance risks. The industry thus runs a system of income redistribution — benefiting irresponsible actors and high-risk groups at the expense of responsible individuals and low-risk groups.
To deregulate the industry means to restore it to unrestricted freedom of contract: to allow a health insurer to offer any contract whatsoever, to include or exclude any risk, and to discriminate among any groups of individuals. Uninsurable risks would lose coverage, the variety of insurance policies for the remaining coverage would increase, and price differentials would reflect genuine insurance risks. On average, prices would drastically fall. And the reform would restore individual responsibility in health care.
It is good news for libertarians that this initiative is primarily a state issue, an arena in which libertarians can compete on more equal footing. It is state legislatures that have succumbed to pressure from special interest groups to force insurance carriers to provide coverage for the special risks of their constituency. This is precisely the reason most conservatives want to remove laws that prevent companies from buying insurance across state lines. If individuals or companies could buy out of state insurance, it would make the legislators pay attention to what anti-competitive restrictions they are proposing that hurts the insurance companies in their own state. Not a bad idea. As our contribution, we can provide the platform upon which state legislators are evaluated.
All licensing requirements for medical schools, hospitals, pharmacies, and medical doctors and other health care personnel must be eliminated. Their supply would almost instantly increase, prices would fall, and a greater variety of health care services would appear on the market.
Competing voluntary accreditation agencies would take the place of compulsory government licensing — if health care providers believe that such accreditation would enhance their own reputation, and that their consumers care about reputation, and are willing to pay for it.
Because consumers would no longer be duped into believing that there is such a thing as a “national standard” of health care, they will increase their search costs and make more discriminating health care choices.
Government restrictions on the production and sale of pharmaceutical products and medical devices must be eliminated. This means no more Food and Drug Administration, which presently hinders innovation and increases costs.
Costs and prices would fall, and a wider variety of better products would reach the market sooner. The market would force consumers to act in accordance with their own — rather than the government’s — risk assessment. And competing drug and device manufacturers and sellers, to safeguard against product liability suits as much as to attract customers, would provide increasingly better product descriptions and guarantees.
Eliminate all subsidies and special privileges to pharmaceutical companies and hospital systems. Without a doubt, this means eliminating all liability protection laws currently in place for the pharmaceutical companies. This liability protection and subsidies from Congress given to the NIH, CDC and others seems to only have encouraged them to make people more sick than to try and cure them, if Robert Kennedy’s book has any truth within it. Subsidies create more of whatever is being subsidized. If you subsidize ill health you encourage ill health. Subsidizing ill health promotes carelessness, indigence, and dependency. If we eliminate them, we would strengthen the will to live healthy lives and to work for a living.
We will have to take a hard look at Medicare and Medicaid and highlight any provisions that seem to encourage carelessness with one’s health. Money should be spent on programs which educate people on healthy living, such as providing it to social service agencies to help the poor navigate the new insurance and health care landscape. However, force should never be used to make individuals do things which they do not believe is in their own best interest. We need to take a hard look at agricultural regulations to be ensure that individuals have the information and freedom to make healthy food choices.
The solutions section of this article borrowed heavily from one that originally appeared on Mises.org: https://www.lewrockwell.com/1970/01/hans-hermann-hoppe/a-four-step-health-care-solution/
John Stewart – FCLPO At-Large Member
