Category Archives: Health care

We have nothing to fear…

Amidst the current global pandemic of COVID-19 there is another more sinister and stealthy infection moving through society: BBD-20, Binary Brain Disease. It renders the victim incapable of analyzing any topic, in particular the COVID response, in anything other than a good/bad false choice mode. For years this disease festered amongst the political class but for the most part was confined to that realm. It has now broken through those ranks and spread to the general populace. It sickens the soul of this country, as its victims willingly disown the Constitution while all but begging for martial law. And people wonder how the fascist regimes in Germany, Italy, and Japan so easily subdued their populace into compliance.  They did so through fear; fear of the “other”. Today that other is not some corporeal enemy but instead the invisible specter of a potential harm. 

Currently the most common symptom of BBD-20 is the belief that any discussion regarding the immense social, economic, and mental devastation resulting from bankrupting tens of millions of people equates to an obvious desire to kill grandma and millions like her. Furthermore the infected commonly engage in very public virtue signaling via sanctimonious pronouncements about how obviously basic morality compels us to lock ourselves in our basement for an indeterminate period in order to protect the “vulnerable”. Newsflash: those that are immune compromised face that risk from all diseases, not just COVID. Anyone else at risk with COVID should protect himself or herself and not expect the rest of the planet to bankrupt themselves trying to protect them. There are reasonable precautions and there are unreasonable. Right now we are in the unreasonable zone, but even the mere thought of a conversation about dialing it back to the reasonable zone sends BBD-20 victims into apoplexy.

I suppose this is to be expected. Our society is largely the product of a public school system that propagandizes its citizenry into the false narrative that the state is our savior. A savior is of course omniscient (after all a less wise being cannot save us). It is imprudent to question our betters, so unsurprisingly those of us that do so are chastised to no end: “How dare you question such and such, don’t you know he’s an EXPERT!?” This mistaken belief in state level omniscience compels many to suspend their critical faculties and blindly follow the state anointed “experts.” Never mind that these very same “experts” told us in January that,

“this is not something that the citizens…should be worried about right now.” (Fauci, Jan 2020)

First we are told we don’t need masks, now we are told we do. Ok, well which is it? Were they wrong then and right now, or right then and wrong now? Were there weapons of mass destruction or were there not? When exactly is the state lying to us or when are they merely incompetent? I suspect it is a bit of both, after all, the political class (elected and appointed) are largely made up of the C-students that couldn’t cut it in the real world and so have carved out a cushy sinecure in the hierarchy of state mediocrity.

Again this ignorance is to be expected. The state school systems do not teach economics. They barely teach history. Nobody learns about tradeoffs, marginal benefits, or the division of labor. If they did they would understand one does not simply “stop” the marketplace and restart it later with little to no harm. If these concepts were taught, then the political class would understand one can’t repair the damage that they are causing throughout society by merely printing money. Most people genuinely have no idea how the goods they order on Amazon end up on their front porch. Even the most mundane of products is the result of the truly invisible hand of the market that coordinates millions of individuals across hundreds of sectors. To truly grasp the depth of that statement I encourage the reader to take a look at “I, Pencil” by Leonard Read.

In any event, in a non-political society where “the people” lack the power to meddle with things they don’t understand their lack of understanding would be irrelevant, insofar as they could not derail that which they cannot grasp. The current state of affairs is comparable to people banning electricity but expecting their smart phones to continue working.

It is telling that the more vocal proponents of these “shut it down” measures are those that work either directly or indirectly for the state or a state (tax) supported sector of the economy. Those other people, who have been deemed “non-essential,” they should lose everything. It’s for the “greater good” after all. Those in the non-essential camp see it differently. How grotesque a society have we become when someone can turn to their neighbor and tell them that they are “not essential” to society while they collect their “essential services” paycheck from their state connected employer? Were the hospitality and other “non-essential” sectors of the economy allowed to operate again would they not see a steep decline in revenues? Yes, of course – but it wouldn’t be zero revenue as it is now. At this point anything is better than zero.

            Maybe, just maybe, the solution to this problem is not to go running to the very entity (the state) that is the proximate cause for the dilemma we see ourselves in. The state has only one solution for every problem it encounters: pass a law and then back that law up with the threat of violence – the state is literally a hammer that sees every problem as a nail. There are a million instances of state created distortions in society that have hampered our ability to cope with this pandemic, but let’s just look at the top three:

(a) Certificate of Need laws severely restrict the number of hospitals and hospital beds in Georgia (and in 34 other states in the US) – there would be far more beds right now had these laws never existed, this one is not even debatable,

(b) Regulatory bodies like the FDA have for years thrown up a wide assortment of regulatory barriers that have kept safe, cheap, and effective treatments and tests for a myriad of diseases and ailments from being available to the public or needlessly delayed them for years; to wit, the CDC delayed testing in this country for weeks as it bungled about trying to make its own kit while existing kits were already available

(c) the sclerotic monetary and financial system propped up by the inflationary monetary policies of the Federal Reserve ensured and promoted wide ranging financial moral hazards that rendered most companies unable to cope with unpredictable downturns such as this pandemic – a pandemic that would never have become a pandemic in the US had (a) and (b) not been an issue.

            To turn to the state now as our savior is like asking your dentist to remove all your teeth, both cavity infected and not, when it was that same dentist that advised you your whole life to eat sugary foods and brush your teeth with cake frosting. Yes, perhaps now you have few options, but at least get a second opinion and make a note to ignore or critically evaluate all future advice. 

Warren’s Healthcare Plan Dead on Arrival

The likely Democratic front-runner, Sen. Elizabeth Warren, has at long last lifted the proverbial kimono to reveal the wizardry by which she proposes to fund the so-called “Medicare for All.” She has long insisted her plan would require no new taxes for the middle class while deftly sidestepping questions seeking details on the funding scheme. Those details have now been revealed and it is apparent that the veracity of her prior assertions depends on her definition of “tax”, “middle class”, and “total costs.” In Warren’s world a payment that the government requires you to make is not a tax but rather a “contribution.” Ok. Although Democrats are not shy about wanting to drain your wallet via taxation, they assiduously avoid associating themselves with that particular term, instead opting to use feel-good Orwellian phrases such as the “Affordable” Care Act’s “shared responsibility payment.” Other common taxation weasel words include “revenue,” or board/department of “equalization” when referring to the entity responsible for taking the money. The Department of Theft would be more honest, but I digress. 

The crux of the financial underpinnings for her plan rely on a new employer mandate, that is, a “contribution” paid by every “large” (whatever that means) employer to the federal government in place of the amount they used to pay in health insurance premiums. But I’m sure that amount will never go up, just like the original income tax rate of 6% was promised to never increase. New government programs always cost exactly what they are estimated to and efficiently achieve their stated goals. 

But wait, there’s more. The remaining funding for her plan relies on what George Bush senior would have charitably called “voodoo economics.” It makes broad assumptions about economic growth and how much can be saved by consolidating services under the federal umbrella as well as laughable estimates of how much more tax revenue can be brought in by increasing IRS enforcements efforts. How tone-deaf does a candidate have to be to propose increasing IRS audits? Truly, Americans love nothing more than the prospect of an IRS audit. It’s right up there with Root Canals for All. 

But don’t take my word for it. Just listen to what her fellow Democrats have to say about this plan. Vice President Joe Biden’s campaign went on the record stating that,

For months, Elizabeth Warren has refused to say if her health care plan would raise taxes on the middle class, and now we know why: because it does. Senator Warren would place a new tax of nearly $9 trillion that will fall on American workers.”

Additionally, the Urban Institute (a highly regarded liberal think tank) projects a Warren/Sanders style single payer plan would raise health care spending by $7 trillion over a decade, while healthcare economics Kenneth Thorpe finds such a plan would increase costs to more than 70% of people who currently have private insurance. And these are people on the left!

To briefly touch on the economics of her new “contribution” it should be obvious this would have the side effect of suppressing future earnings of the very middle class she is pandering to. Economics is (partly) the study of the seen and the unseen (Bastiat). The seen benefit here is the “free” healthcare. The unseen result is that future wages and hires will necessarily be lower in comparison to a world where this new “contribution” does not exist. Companies do not have an infinite supply of money; if resources are mandated toward an MFA payment scheme, then that much less will be available for raises, new hires, and expansion of operations. In short this new tax would be a million ton anchor on the American economy. To suggest one can add $20 trillion in new spending without harmful economic consequences is either deranged or willfully dishonest. Neither is a good option from a presidential candidate.

CON Job

There are a myriad of reasons that health care costs are sky high. Every cause shares a common genesis – government. From the World War II era tax benefit of allowing tax-free employer sponsored plans to state imposed price controls (Medicare/Medicaid) to today’s outright subsidies (Obamacare), it has been a 70+ year slow motion train wreck that has annihilated anything remotely resembling a “free” market in health care.

However, today I want to focus on but one sliver of that regulatory quagmire: Certificate of Need (CON) laws. When I first learned about these I honestly thought I was reading satire – this is America after all! How can such monstrosities of law exist? And yet they do. For those unaware, CON laws basically allow one or more local hospitals to have a say in whether a prospective hospital may be permitted in their “backyard.”

It’s like if McDonalds had a vote in whether any new fast food restaurants could be built within say 30 miles of their location. What do you think McDonalds’ choice would be? This is nothing but state backed protectionism, pure and simple. And like all protectionism it harms consumers while benefiting the protected class (unions, taxi drivers, any tariff protected industry, etc.) But please, tell me more about this free market in health care we have.

Supporters of CON laws try to appeal to ones sense of “fairness” by claiming that if these mean old private hospitals come in why they’ll “steal” patients from our poor old public hospital by only offering the most lucrative and profitable services leaving the extant hospital with money losing care and indigent patients. Hogwash. In other words they are saying that in terms of those “lucrative” services they can’t compete because they are in fact overcharging for their “lucrative” services in order to subsidize the money losing services.  In other words they don’t know how to properly run a (hospital) business and are afraid of someone coming in and competing with them that does. 

Ludicrously, these same people will turn around and decry the “monopoly” of a company like AT&T or Microsoft or Google or Apple and claim “why we need to break them up, don’t you know monopolies are bad and that competition lowers prices and helps consumers?” But then will unironically tell you that monopolies in hospital services makes perfect sense and why don’t you just trust the guy telling you he doesn’t need competition to give you a fair price? I guess state backed monopolies are “a ok” (schools, courts, police, utilities, roads, etc.)

Ironically many of these people who support CON laws are “conservative” Republicans! Indeed there was a recent Bill 198 in the Georgia House that died in that Republican dominated chamber. One representative quipped in a local paper

“I was very happy to help kill the elimination of the CON process that would hurt local hospitals.”

David Belton
R – Buckhead, GA, District 112

Wow, give that man a Bernie Sanders medal, he is a Democratic Socialist and doesn’t even know it. Socialism claims the right of the “people” (aka the State) to own the means of production. Ownership implies a right to control. If you don’t own it, then you have no authority to exert control. But if the state tells prospective investors in a new hospital what they may or may not do with their own money, then what is the state doing other than asserting an ownership (control) claim over those investors’ money? We have a word for people that control the property of another that they don’t own: thief. I’m sorry Republicans; I must have missed the part in the Constitution (Federal or State) where it says we have a right to a livelihood unfettered by nettlesome competition. Repeat after me, just because a violation of rights can be harmful doesn’t mean anything deemed harmful is a rights violation.

Quora post: What are libertarian solutions to market failure in emergency healthcare?

My reply here:

There is no such thing as “market failure”. That’s just a term for “outcome I don’t like”

maybe if government got out of the way we’d see these solutions. People are quite innovative and I’m sure solutions I can’t fathom would crop up.

But lets take one example I presume is meant here. Someone needs emergency care and has no insurance or means to pay. Well we already had a solution for that but government killed it. We used to have numerous charitable church run hospitals that would supply such care at no or little cost. But then government got involved with Medicaid and Medicare and started paying everyone so why do stuff for free? Now everyone expects a hand out expecting to be paid by government and the church run hospitals lost their reason to exist and went away (there are only a handful left now).

Government distorts the market and creates the very failures that are so often pointed to.

The fallacy here is believing that 51% of the populations deems policy x so important that they elect people to carry out policy x but absent government somehow those same 51% would just shrug their shoulders and do nothing? No. They would support anyone trying to achieve end they desire

 

 

And then a good exchange below fleshing out the details a bit:

 

 

Qurora user

 

Greg Morin

Well you’ve got several scenarios mixed in here which are all quite dissimilar. If as you claim there is no market for some scenario how can that be a market failure? That’s like saying Christianity failed as a religion because it didn’t aid in maintaining societal cohesion in 12th century Mayan society. If something isn’t present how can its absence be blamed on it. Anyway.

To be clear, constrained or limited choices do not constitute “failure”. Just because options are limited doesn’t mean one is being “forced” into a choice. Force only applies if violence or the threat thereof is being employed to constrain ones choice (eg I choose to freely give my wallet to the mugger…my choice was constrained by the threat of violence so it’s not a real choice nor truly voluntary). But your example is no different than saying we are forced to work because Mother Nature threatens us with starvation if we don’t earn money to buy or grow our food. This fact of existence limits our choices in what we can do everyday of our lives. So if I break my leg and I end up in the hospital and my only option given there is amputation or death even though there actually does exist a better option at a different hospital two states over still doesn’t constitute failure. That’s just life. It’s no different then being in the wrong place at the wrong time…we don’t call that life failure. Sure it would be great if you could pull up an app on your phone that told you exactly where to go for the best care and you could teleport there in a second, but people who died before organ transplants existed weren’t sitting around discussing how the market had failed them because it had not invented a cure. Options in life are always constrained by the simple facts of our existence; who are parents are, where we live, where we go to school, who are neighbors are, what language(s) we speak etc. all of those factors can contribute to outcomes we deem positive or negative. Markets are no different because markets as a thing don’t exist…it’s just people doing stuff for other people. So going back to the hospital example and the broken leg, if you happen to end up in the best hospital in the country for that does that then “prove” markets work?

I think what you’re getting at is the classic “”information problem”. This is what the socialist believe, that a perfect market would be a socialist market because with perfect information the state could direct precisely the right amount of each good to produce just in time to satisfy all needs, and so all would be employed, with zero waste and maximum efficiency. And so anything that falls short of this utopian perfection is considered imperfect or a “failed” market. It’s an impossible standard as we are not omniscient beings, so perhaps it makes interfering intellectual fodder, but in the real world is of no real consequence.

its funny how markets are deemed to fail because one can come up with either real or hypothetical scenarios where some outcome was negative…yet such failures exist today under our state controlled markets and somehow that is never seen as a failure of state control. Indeed it just produces calls for more control. Indeed, if whipping the patient isn’t helping then surely the solution is to whip him even more.

Qurora user

 

Greg Morin

I think that this scenario would be such an extreme outlier (i.e. a person with no insurance, no identifying information, completely family-less and friendless, suffers a life threatening injury and is also unconcious) that indirect (outside groups) or direct (the hospital itself) would cover these 0.01% occurrences without a second thought.

It think the question to treat without explicit consent is a common libertarian debating point and there are differing opinions on it… but in my opinion you can call it implied consent or “when in doubt” principle or whatever, but I think it is entirely reasonable for people to assume that every person will always prefer any alternative to death and to then act on that assumption. Or to proceed on the course that reasonably seems it should produce the least amount of harm.

I just can’t see how anyone can argue with that position. To argue against it is to argue that you prefer to die over the notion of your right of consent being violated. Right. I don’t think you’ll find many takers on that one. 😉

Now maybe someone’s religion says they should not get medical treatment and they would prefer death, but doing so is not a rights violation per se as they are perfectly free to kill themselves later if they don’t like the outcome of being treated and the person doing the treating is acting in a reasonable and reciprocial way (that is they acted in a way they would wish to be acted upon were they in the same state).

And at the end of the day the whole notion of rights is about reciprocity… we cannot demand rights for ourselves that we are not ourselves willing to honor for others. If we say we have the right to kill other people and take their stuff then we have little cause to complain when someone does that to us. If we say we only have a right to our body and our property etc then we are obligated to respect those same rights in others. So acting on this unconcious injured victim comes down not to what version of rights that victim lives by (unless you happen to know what they are and thus are able to act according to them, but we’re assuming in this extreme example we have no idea what they are) but rather what version you live by (the one treating him/her). You must act in a way that is consistent with your views or how you would want to be acted upon (“do unto others…”)

So the libertarian position in my mind then is “do unto others” and I think 99.999% of people or institutions would treat them, but for the small minority that wouldn’t and let them die, that should be “legal” in the sense there is no legal obligation to act… of course the real world ramifications of not acting would probably be quite similar to it being illegal. pretty much everyone who thought that was a dick move would boycott the hospital or doctor or whatever and they would flush all value in their reputation down the toilet. So you don’t need a “state” to force these things on people… the morality of that society will most directly reflect what actions are approved and what are shunned and thus tend to eliminate those that are shunned… you’re free to do whatever you want, but you’re not free to avoid what others think about you for doing whatever you want.

 

 

Qurora user

Greg Morin

Well I was assuming a “libertarian” society in which case nearly everyone would have insurance 😉 because it would be so cheap, like car insurance… because medical costs would be reasonably and low. Otherwise it’s an unfair question, like assume everything is exactly as it is today but you just removed all government force… how would you solve this the day after that? Well of course you wouldn’t have some perfect solution as the entire structure of society has been distorted by state force such that we end up with these scenarios where medical costs are sky high and insunrace is likewise expensive due to mandates. It’s kinda like saying well the government forced me to sit in a wheelchair my whole life and the liberatrian solution is to get out of the wheelchair, but look when you get out you can’t walk, so clearly the libertarian solution is the wrong one.

But I would concede your point it might be a bit more common than 0.01% 😉 as one can still have family etc and not be able to get in touch in time. But far more people would have insurance so the question then just becomes one of how do we insure we can be identified and our insurance status determined if we are unconscious.

But not sure why you say that doesn’t happen right now? It does. I don’t recall the law’s name off hand but there is a federal mandate that hospitals must treat patients to the point they stablize them so they don’t die. They don’t have to “fix” everything, but they do have a legal obligation to keep them from dying. That does create some moral hazard as those that choose to remain uninsured know this and may rely on this in some small part. Now not everyone will but on the margins it must be happening.

In a libertarian world there would be a mix of hospitals that will treat you in these situations and those that won’t and might let you die… and you’ll never know which you might get, so this creates a big incentive to get insurance and carry that fact with you at all times!

But if the original question is asking how can we implement libertarian solutions within the framework of a state run society, i.e. just have some “reforms” while keeping everything else in place (mandates, regulations, certificates of need, moral hazards,e tc) then I don’t think there is such a solution… everything is connected, you can’t just change one small part without needing to change other parts in order for it all to work properly.

Qurora user

Faith Healing

The current outrage-du-jour over the skyrocketing price of EpiPens is a perfect example of the effectiveness of a societal indoctrination that leaves us blind to the parasitic ills wrought by the state. The credulous media reports with much indignation and finger wagging over yet another example of an evil profiteering corporation charging outrageous sums for a life-sustaining drug. Clearly this fits with the media’s preconceived narrative that capitalism is bad and we need government to right such wrongs. Case closed. No need to scratch the surface and investigate the cause and effect of this phenomenon. Even those media outlets that do ask the right question and get the right answer are still somehow blind to the necessary solution. They recognize that prices are high because of a lack of competition (a result of patents), third party payment distortions, and cronyist-driven increased demand (fueled by FDA mandates). Even the likes of the Journal of the American Medical Association have admitted as much in a recent article.

“The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents. “

But the universal answer to solve these woes? More of the same: state intervention. If we can’t even imagine a world without state-driven influences in the market then there is only one option that remains – more state intervention. The state is entirely responsible for the current quagmire that is our health care system, but hey, maybe more regulations can fix the problem the first, second, and third set of regulations caused. As they say, if all you have is a hammer, then every problem looks like a nail.

There is no quick fix. The foundation is built upon the sand of wishes and emotion rather than the stone of the unwavering principle of liberty. To solve the problems in the health care market we must dismantle the framework of rules, laws, and regulations that can do nothing but produce this distorted market.

Step 1: Eliminate the patent system entirely. Without patents competitors can instantly respond to prices that get out of control. Novel inventions have a natural period of protection because of secrecy and first-to-market advantages. The more obvious the invention, the more easily it could be copied. Praising the patent system for rewarding inventors with monopoly pricing while simultaneously pining for the low price of generics is the height of cognitive dissonance.

Step 2: End the FDA’s monopoly privilege of being the ONLY agency allowed to review the safety and efficacy of drugs. If the FDA is going to take years to approve a drug or device (resulting in countless needless deaths and higher costs) then perhaps it is time to let competitors help them out.

Step 3: The FDA and its competitors should be financially responsible for their mistakes just like any other company. Presently the FDA bears zero responsibility if they approve a flawed drug. If there existed in any other sector of the economy such a lack of competition and accountability we would be outraged. Yet somehow this state of affairs exists with the FDA and no one bats an eye. Most curious.

It’s almost like society has been brainwashed into the credulous narrative that those in government are not mere mortals but rather angels who are immune to normal human foibles. This blind faith in the supremacy and righteousness of the state has closed our eyes to the truth no less than medieval faith in the Church blinded men to the truth of heliocentrism. Time to question that faith. Our very lives depend on it.