The WSJ re-posted an excerpt from Milton Friedman’s original article “A Way Out of Soviet-Style Health Care” a few days before the passage of the behemoth bill now known as ObamaCare. The mentality behind the legislation, of course, is hardly novel; attempts to insulate people from the costs of health care have been infecting public policy debates for as long as politicians have been deciding “public” policy. In Friedman’s piece, he quotes from the novel by Alexander Solzhenitsyn to demonstrate a vision of the consensual relation between the patient and the physician.
It is this freedom of association, the right to choose with whom one will exchange that is at the heart of matter of healthcare “reform”, yet this principle is conspicuously absent from the public discussion. Friedman follows this fictional scenario with an historical account of how the healthcare industry (and the nature of the relationship between provider and receiver of services) has been transformed over the years by political manipulation to become the distorted private/public healthcare system that is today condemned on both ends of the political spectrum.
In the words of Dr. Oreschenkov in conversation with Lyudmila Afanasyevna, a longtime patient and herself a physician in the cancer ward: “In general, the family doctor is the most comforting figure in our lives. But he has been cut down and foreshortened. . . . Sometimes it’s easier to find a wife than to find a doctor nowadays who is prepared to give you as much time as you need and understands you completely, all of you.”
Lyudmila Afanasyevna: “All right, but how many of these family doctors would be needed? They just can’t be fitted into our system of universal, free, public health services.”
Dr. Oreschenkov: “Universal and public—yes, they could. Free, no.”Lyudmila Afanasyevna: “But the fact that it is free is our greatest achievement.”
Dr. Oreschenkov: “Is it such a great achievement? What do you mean by ‘free’? The doctors don’t work without pay. It’s just that the patient doesn’t pay them, they’re paid out of the public budget. The public budget comes from these same patients. Treatment isn’t free, it’s just depersonalized. If the cost of it were left with the patient, he’d turn the ten rubles over and over in his hands. But when he really needed help he’d come to the doctor five times over…
“Is it better the way it is now? You’d pay anything for careful and sympathetic attention from the doctor, but everywhere there’s a schedule, a quota the doctors have to meet; next! . . . And what do patients come for? For a certificate to be absent from work, for sick leave, for certification for invalids’ pensions: and the doctor’s job is to catch the frauds. Doctor and patient as enemies—is that medicine?”
“Depersonalized,” “doctor and patient as enemies”—those are the key phrases in the growing body of complaints about health maintenance organizations and other forms of managed care. In many managed care situations, the patient no longer regards the physician who serves him as “his” or “her” physician responsible primarily to the patient; and the physician no longer regards himself as primarily responsible to the patient. His first responsibility is to the managed care entity that hires him. He is not engaged in the kind of private medical practice that Dr. Oreschenkov valued so highly.
When the talking heads decry the “death panels”, “rationing” and “lack of choice” they fear will come from this bill, their argument would be better served by acknowledging the fundamental principle of free exchange that has been methodically eliminated from the healthcare debate. Such freedom results in a infinite number of possible outcomes in each transaction between provider and consumer. The purveyors of socialist thought, however, keen to win favor (and thus democratic political power) with the masses, have sought to equalize those outcomes through their long quest for “universal” healthcare.
As economic freedom is still widely valued (at least in spirit), healthcare has been necessarily painted as a “special case”, where the normal rules (and outcomes) of free exchange ought not apply. Just like a “gravity-free” zone, enacted by political decree and enforced by police action would be an obvious farce in the middle of an airport, the idea that a doctor-patient relationship could possibly be more effective and efficient absent the freedom of both parties to set their own terms is laughable. The consequences of ignoring principles are unavoidable, but the economic illusionists seeking nirvana in price controls and regulations are apparently as happy to live in denial of those consequences as they are to preach their gospel to the willing participants who make their rational denial possible.
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I like that line, ” the consequences of ignoring principles are unavoidable”.
I’m puzzeled—- France, England, Japan, Canada, the gamut of Scandinavian countries—-they all have “socialized medicine,” yet pay less for it than Americans as a whoel do; further the distribution is comparatively equitable. You argue for choice as determined by personal wealth; yet, everytime you do that, you forsake the necessary opportunity costs that go along with it.
Naturally, one would still maintain a choice, a certain baseline degree of coverage sustained. Extreme measures might warrant other avenues of treatment beyond that provided by the State, but that it provided aplenty abroad.
How many of you have been without insurance? Medical knowledge doubles every decades; it’s not merely a question of government interfernce driving up prices, but, simply, the increased capital infusion in medicine which necessitate a greater proportion of society’s wealth. Moreover, it reflects society’s greater interest and need for it, particularly with our aging population, massive revolutions in genetics, stem cell research, conventional small molecule drugs, gamma ray therapies utilizing advaned operation research techniques, tremendously sophesticated imaging technique, among others. What’s more, the infusions of human capital are enormous; look at the number of doctor and nurses per capitia in the United States, and then compare with the state of affairs 50 years ago. To further strengthen the argument, juxtapose that data and mortality in the United States (and abroad, especially the countries with sustainable socialized healthcare) over the course of the 20th century.
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PS Seriously, try living without health insurance for awhile; add cancer, asthma, psychotic illnesses, appendectomies, torn ACLs, among others, and see where you stand, and see how you would argue.
Try doing more research, because the pretend-normative judgments in your post have little validity — especially the part that pretends there has ever existed sustainable socialized anything. I myself have watched two good friends die in the past few years as a direct result of the shortcomings of Canada’s socialized health care system.
This site has ample material to enlighten you about the numerous fallacies to which you appear to cling. You might want to start with “Socialism” or “Bureaucracy” by Mises, or Bastiat’s “The Seen And The Unseen” essay. For now, I’ll point you toward these two articles:
Socialized Medicine in a Wealthy Country
Socialized Healthcare vs. The Laws of Economics
“You argue for choice as determined by personal wealth; yet, everytime you do that, you forsake the necessary opportunity costs that go along with it.”
As is the case with socialized systems, as is the case with any action; what exactly, is your point? Seriously, your post is incoherent.
I don’t disagree…
“it’s not merely a question of government interfernce driving up prices, but, simply, the increased capital infusion in medicine which necessitate a greater proportion of society’s wealth.”
This is a popular but foolish notion. All other factors remaining equal, advances in technology reduce costs, not increase them. Think of the home PC. Year after year, CPUs get faster while the median prices inch downwards. To get a situation that mirrors healthcare, you would need to have consumers pushing into the server market, demanding ever more powerful products that far outstrip their needs. The computer market would respond by marketing and selling their enterprise level products to consumers while neglecting the low-end home PC.
Or how about this? The same thing could happen if the government began regulating the market, outlawing home PCs while incentivizing employers to provide “computer insurance” which would cost consumers a monthly fee but would pay for most of the cost of server purchases. It’s simple, really, once you rule out insane notions like the one I quoted above.
Ole S. Hertzog: “I’m puzzeled—- France, England, Japan, Canada, the gamut of Scandinavian countries—-they all have “socialized medicine,” yet pay less for it than Americans…”
There is no puzzle. Those countries set the wages and prices below the market rate, then they ration care. It’s not any different from the Indian Health Services in the US, or the military health system. On the other hand, the US restricts the supply of doctors and hospital beds while promoting unlimited demand through Medicare, Medicaid and company-paid insurance. What does limited supply with unlimited demand give you?
“PS Seriously, try living without health insurance for awhile; add cancer, asthma, psychotic illnesses, appendectomies, torn ACLs, among others, and see where you stand, and see how you would argue.”
My liberal friends use this argument all the time. “You’d feel differently if you were in this or that situation!” As if my political or economic views were based solely on my feelings, and so would simply change just because my feelings changed. Regardless of any difficulty I may face in my own life, my views are based on a consistent set of principles that I would not simply discard in the face of adversity. Of course, experience may cause me to examine those principles from a different perspective, but anyone who is honestly in search of truth will do that on a nearly constant basis anyway…challenging one’s own assumptions and beliefs based on new information.
It’s unfortunate that so much legislation is based on feelings rather than any sort of logical evaluation of outcomes. It virtually guarantees that government’s intrusion into every part of our lives will continue at an ever-increasing pace.
There are a lot of things that can be said about this post. I would suggest reviewing the “Healthcare reader” under the daily tab on this site, some decent info there.
From personnel experience( 20years in medical industry) let me say this; NO PERSON in the USA is denied health care for most of the list of ailments you described. 90% of all hospitals are either state or county run and it is ILLEGAL to turn away anyone!!! This is the first fallacy of the “uninsured”. Also the free clinics etc. are seldom mentioned. We all will become well aware of them in the not too distant future.
You will be happy to know that we spend countless millions on citizens from all over the world who happen to be on “vacation” when they get sick. People without 1 penny to their name get the best treatment in the world. When you are in the system it is easy to see that the main drivers of increased costs ( besides of course inflated money supply) is mountains of regulation. Also where I am from ( South Florida) and most large urban areas the cost to treat non- citizens is HUGE. But I guess many libertarians and socialists alike do not believe in such a thing as non- citizens. Well then let us take care of the world – your paycheck first please.
Most of the technological advances you mention come from the US system, not from the state run systems. An honest review of the care received in the Utopia’s of Europe would show a different story than what the main stream leads us to believe.
So many of the statics used to compare systems are not apples to apples – if they were, infant mortality and life expectancy in the US is as good as any in the world. Also the heterogeneous population is seldom considered because it is unPC.
The sad thing is that no matter how bad any system gets the majority never see that it was government policy that started the problem, from there the cry is always more more more.. The evidence is all around us, just open our eyes and mind.
I want to help everyone, most of us do. But we must realize gov. interference does indeed make the problem worse for the vast majority and may only improve it for a tiny minority – utilitarian, yes I know, but principals aren’t everything……………..
Let me stop as I am getting emotional and babbling.
“So many of the statics used to compare systems are not apples to apples – if they were, infant mortality and life expectancy in the US is as good as any in the world.”
So true. Infant mortality in the US is measured differently than most of the rest of the world. Newborns near death that would be declared stillborn in many countries are counted as life births here. Also, the fact that the US has the highest rate of teen live births, with the accompanying risk of low birth rate and hence, mortality, certainly doesn’t help the statistic look better. However, this is largely a matter of US teenagers having abortions at a much lower rate than other nations.
As for life expectancy, when you adjust out a much higher rate of deaths due to murder, suicide, and vehicular accidents, the US ranks right at the top of the chart: http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/tab/article/
Obama has pulled off a scam on the US populace nearly as brilliant and malicious as the one Bush Jr. did with Iraq. The only difference is that the lies have been repeated for so long that people were bound to begin believing them.
I am a Canadian in my mid-40′s, and in all my adult years I have never been able to visit the same doctor twice (during childhood I had no official visits because my old man is a GP). The socialist delusion relies heavily on pretense of social interchangeability.
Vanmind – Please tell us more – do not keep first hand knowledge of your Utopia to yourself.
Thanks
What utopia would that be? The one that enslaved my father?
The Inevitable Depersonalization of Medicine — Mises Economics Blog adler@gigemail.net
Many countries have better health care than US, these are the facts! Most Americans do not know much about health care in other countries.
Corporatism and socialism each have their own different ways in which they are more awful than the other.
This is one of the most interesting areas. Health care in general. People will demand more but the sate can’t even afford current provisions (especially in the UK). How will it play out?
Depersonalized kind of relationship is not that good since we are dealing with life here. We tend to trust to a physician that we really think can help us. It is of great impact that our doctors see patients not merely as some kind of just a case. Patients tend to find empathy when dealing with there condition. I believe it’s morally good to offer a not so depersonalized type of relationship between doctors and patients. What if it happens to you? (What would you feel?)
Medical care should be shared by all American citizens regardless of religion, race or sex. Since we are a capitalist regime there are citizens that can not afford medical treatment. This should be changed.
Here’s a question that none of you lefties ever think to ask:
Why does the fact that a person is ill or injured give him a right to other people’s money?
Is public health care possible? I`ve heard it would cost millions to get the US medical service run by a public entity and as to the previous comment I do believe that if we all contribute to a public health care system it would help whoever needs it. Let’s not forget that some people are lucky enough to be blessed with good genetics in order to never get sick but others aren´t and as human being we can be healthy one day and sick another so if we have a public system one day you will be paying for someone else´s health care but one day some else will be paying for yours. And I just say this as a personal opinion, for instance I rely in alternative medicine like acupuncture but that’s just me and it’s given me great.
I guess what you propose wouldnt be an issue if the current medical sistem wasnt run by a bunch of unscrupulous elitists. Let’s face it, if you are by any means considered less than well off, good medical service is practically unattainable under said system. On the other side, here in Canada although we have “free” universal health care, it is a joke! To get attention in a hospital you have to wait several hours, to see a specialist you have to wait several months, to get any type of attention means you have to wait far more than American counterparts, but it’s free. does that make it better though? I guess what I’m trying to get at is: either way, the system is far from perfect, it all just boils down to how it affects you.
I think it’s interesting to note that no matter what system we have, there will always be a significant portion of the population that wants a different one. Even if everyone had insurance that paid 100% of their medical costs, people would still look outside the box for other options. Did you know that in 1997 out-of-pocket spending on ‘Complimentary and Alternative Medicine’ exceeded out-of-pocket spending on general medical care for the first time? The gap has been growing every year since, and it shows just how dissatisfied people are with their medical coverage. When they vote with their wallets, people are willing to pay for options not covered by insurance.
I don’t know if I agree at least part of Cameron’s post – in the pre-managed care days here in the States most everyone was please with coverage. Somehow or other the equation seems to have changed over the years. As a psychologist, I found the stats on “Complementary and Alternative” out of pocket costs fascinating. I have not been paneled for a number of years and, even though a number of people grumble about the insurance coverage (or lack thereof) it certainly has not deterred them from seeking care. My practice is located in a wealthy suburb and while my clientele has not been affected, I’ve heard horror stories from colleagues in rural or less well to do areas about people sacrificing not only mental health, but basic health care. One of the alternatives I’ve seen those colleagues very successfully offer is weekend seminars or classes with more of an educational than psycho-therapeutic focus. I sometimes wonder if this is the future of mental health for the majority of our population. Interestingly, there are some studies which suggest that in some areas, such as marital satisfaction, the educational approach is just as if not more effective than traditional therapy.
Here in the UK we have the National Health Service, which is free at the point of use. It has plenty of detractors, but on the whole it functions very well. Of course, everyone has the option to pay for private health plans or insurance, or to pay for complementary treatment such as acupuncture if they choose. I think it works pretty well.
Do people have the option not to pay for the National Health Service through their taxes? If not, then it’s certainly very big of the government to let the people pay for decent health insurance or health care out of their own pockets, after they’ve already been forced to pay into the socialist system.
Infant mortality in the US is measured differently than most of the rest of the world. Newborns near death that would be declared stillborn in many countries are counted as life births here. Also, the fact that the US has the highest rate of teen live births, with the accompanying risk of low birth rate and hence, mortality, certainly doesn’t help the statistic look better. However, this is largely a matter of US teenagers having abortions at a much lower rate than other nations. pilates exercises
Our healthcare systems sucks. Drug compainies have too much control and influence. There needs to be a change somewhere. I am not sure if i like the socialized medicine yet but atleast someone is trying something. to me that is the only way to see if it works.
Take it easy. It is not the worst thing in the world. That there, you’re just in a bubble insulation, probably due to a traumatic event has occurred or is suffering in some way, it could also be lack of sleep. When you exercise this feeling will disappear and you will feel full concrete reality in all its senses. When you go a bit idle will start to return, but not so bad. You still have the ability to absorb their experiences and really appreciate them, have not lost so it’s not like you’re missing anything. If everything was so concrete all the time, it would probably be a bit too “heavy” and would stop you. Just relax and go with it, I snap back into tune when you are aimed a. It probably will not even notice that you have.
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