Sunday, December 16, 2007

On Medical Freedom

Lately, in regards to the current debate as to whether we ought to have some form of federally sponsored health care regime, I've been running across the following type of comment: We already know what a free market in medicine looks like (or capitalistic health care), and we already know that it doesn't work. I beg to differ.

I am not any kind of expert on the health care industry. I am not a doctor. I do not work in the insurance industry (though I did once process records for workman's compensation). I'm not any kind of lawyer. However, from my own vantage point, I can see that we do not have a free market in health care in this country. And it isn't merely that it isn't "free enough," so far as I'm concerned, it's not really all that free, at all.

I have worked for a couple employers over the years that provided health benefits. One of them allowed a choice between Kaiser Permanente and Cigna; the other, Kaiser only. Those were my options. Sure, I could have opted not to participate in my employer's program and gone with an independent provider, but in doing so I both forgo the matching contribution of my employer, and become one in a very small, noncompetitive market: people who get their health care through someone other than their employer. In short, it is very expensive to get health insurance via any source other than an employer, and your employer offers very limited options, if any. With such a captive subscriber base, is it any wonder health insurance is expensive?

This state of affairs is not the result of the functioning of the market. It is the result of government regulations that require certain kinds of employers to provide health care to certain kinds of employees. These regulations, creating a captive market, drive up the price of health insurance. Given it is mostly insurance companies paying doctors for their services, it also drives up the cost of health care, in general.

Then there are the doctors themselves. Medicine is a highly guarded field in this country. In unregulated product and service fields, you generally have a range of qualities of product and service, with a similar range of prices. You can pay some kid or immigrant to mow your lawn, or you can hire a professional, highly paid landscaper to turn your yard into a work of art. You can buy the older model car used for a couple thousand, or you can pay fifty grand for a luxury car. You can get a free cell phone from a service provider that has frequent outages for next to nothing, or you can get one of the latest models with all the bells and whistles from a carrier that covers everything for considerably more. But when it comes to medicine, if you're not doing it yourself, it's either The Doctor, a Nurse supervised by The Doctor, or nothing at all.

Simply put, Doctors (along with people in many other service professions, including teaching and my own industry: pest control) enjoy a situation much like that of the crafts guilds in mercantilist Europe: the right to control the supply in order to keep prices artificially high, to the point of being able to prosecute anyone outside their club of practicing "without a license." With the AMA enjoying a monopoly--established, once again, by the government, not by the market--in medical services, is it any wonder prices are high?

Even if anyone was allowed, there's still the paperwork. No, I don't know the details, but sending enormous stacks of records and reports to the government costs money, as well. Either the doctor has to waste time he could spend helping patients filling out stacks of redundant paperwork, or he can hire someone else to do it. Either way, that's more money to spend.

Then there's prescription drugs. The price of bringing new drugs to market includes the price of assuring the government that the drug is totally and completely safe: that price is astronomical. And if you think that the approval process is necessary for public safety, understand something: under current regulations, aspirin would not be approved. This is a drug that, while most people are aware there are potential problems with it, most people use safely both as a pain reliever and as a heart medication. I won't even go into the tendency of the federal government to ban any potential medicines that could be grown just about anywhere (cannabis was long known as an effective medication until that "evil Mexican weed" marijuana was banned during the early twentieth century).

Put all this together, and you have an enormously expensive system, and every last extra expense is the result of government regulation. I'd say it isn't the result of the greed of the market participants, but understand that the organizations I mentioned earlier--the AMA and the big pharmaceutical corporations--lobby for and approve of efforts to regulate the industry further. There is corporate greed, but the tool with which they express that greed is not the market (where the consumer is king--that's you and me), but the government.

Sure, there are people out there that can't afford medical care regardless, and perhaps some change is necessary to help those people out. However, I am certain that the number of people unable to get care would drop considerably if both existing and potential medical providers were given the freedom to compete for our business, rather than existing providers alone being given barriers to prevent competitors from finding ways to lower prices. It wouldn't surprise me a bit if those last few who couldn't afford care in a society that possesses medical freedom are few enough that doctors (and other medical practitioners) could afford to treat them themselves, without government payment. Or not.

Public distribution of land rent could help.

Saturday, December 01, 2007

John McCain Invokes Godwin's Law


Throne, Altar, and Uniquely American Conservatism

I honestly didn't expect, when I first read this article, to digg and blog off it. David Gordon's review of Paul Gottfried's "Conservatism in America" initially came across as dry, long, and moderately interesting... worth a read, but probably not worth adding my digg to maybe ten others. Then I got up to start cleaning my kitchen, and all kinds of thoughts started sparking off. You can read, and digg, the article that has inspired me by following the links below.

read more | digg story

I have, for the past few months, been very perplexed as to what, exactly, Conservatism is. I understood that, in the REALLY old days, Conservatism in America would have meant loyalty to the English king, and opposition to the American Revolution. In a way, I've seen today's Conservatism meaning a leaning toward enthusiastic assumption of Britain's former imperial glory. How does that square with the longstanding rhetoric Conservatives have given in favor of the Constitution, and reverence of the Founding Fathers, most of whom were, in their day, quite liberal?

Paul Gottfried's Conservatism in America (or rather, what I gleaned from David Gordon's review) points out that European Conservatism has always referred to "an all-encompassing reverence for 'Throne-and-Altar,' for whatever divinely sanctioned State apparatus happened to be in existence." Thus, French Conservatism was distinguished by loyalty to the French King, the feudal order, and the Catholic Church. German Conservatism was distinguished by loyalty to the Kaiser, the feudal order, and the Lutheran (or possibly the Catholic) Church. British Conservatism was distinguished by loyalty to the British Monarchy, the slightly less feudal order, and the Anglican Church. And so it would go for any European country.

The American Conservative would appear to be in a bind. Without a feudal order, without a state-sanctioned church, and with liberalism (in the old European sense, not in today's socialistic sense) firmly ingrained in the American character, what is a would-be Conservative to do? Where is their "throne-and-altar?" The answer that came to me (as I placed dishes in the dishwasher) suddenly became a startling argument in favor of American Exceptionalism, a doctrine I normally reject. For the American Conservative, the only throne they can look to is the Constitution, and the only Altar they can look to is the melchisian high priesthood of Jesus himself!

At its best, this produces an uneasy unity between Conservative and Liberal that was absent in Europe. The Conservative can be devoted to liberty, limited government, religious tolerance and similar ideas due to their enshrinement in the Constitution. The Liberal shares a similar devotion on principle alone. A Conservative with a view of scripture that prohibits warfare on the grounds that warfare is as far from "love thy enemy, and pray for him that persecutes you" as it can get, can ally with a Liberal that opposes warfare on humanistic grounds. Constitutionalist Conservatives and Liberals can rally together in defense of the freedom of speech, assembly, and worship.

Of course, this doesn't make America into some kind of land without conflict. In addition to the disagreements and dislikes that naturally arise between the two temperaments, there is another conflict that is, I believe, uniquely American (today, at least): that between those who favor the limited government spelled out in the Constitution (for whatever reason), and those who favor a much more active, authoritarian government (for whatever reason). This is a conflict that transcends "Conservative" and "Liberal", for both sides can rally behind one, or the other.

For the Conservative, I suppose it is the underwhelming nature of Constitution and Jesus as their "throne-and-altar" that produces this schism. From the very beginning of the Republic, there have been those who hungered for a much more down-to-earth hierarchy to revere, which I identify with Alexander Hamilton's advocacy of a government headed by a congressionally elected president with a lifelong term (a king, basically), which would pursue "imperial glory" (his words). Being a Puritan, he likely also favored the idea of a state-sanctioned church (as the Puritan Church was in his day). Today, we see this idea coming to full fruition: a staunch Conservative alliance lining up behind an Imperial Presidency, with interchurch associations bragging about their closeness to and influence over various politicians, even as the influence flows the other way as well, and various church leaderships actively support one candidate or another.

For the Liberal, I suppose it is the disappointment in the failure of the Liberal political program to achieve Liberal results. Egalitarianism is a prime goal of Liberalism, and the fact is, even if you extend the vote to every last man and woman in the country, the State will continue to be largely the playground of the rich and the politically connected. The belief that this can be dealt with by the forceful application of the power of the state, at the behest of a popular majority, to the distribution of property, is yet strong in this country. Thus, while Liberalism in continental Europe continues to refer to what we call Libertarianism in this country, in America Liberalism became, in the minds of many, synonymous with Socialism. Thus, from another angle, we see Liberals advocating a government every bit as powerful as that aimed at by conservatives dissatisfied with the Constitution as written.

To big government Liberals, I pose a question: how is it then that an institution that is incorrigibly under the influence of wealth and power is expected to supply a remedy to the problem of the misuse of wealth and power?

To big government, religious Conservatives, I pose a warning: you seek to bring throne-and-altar down from heaven onto earth. Understand, however, that what you will get is not throne-and-altar, but usurper-and-idol. In particular, America has long been blessed by a Church which is lead, at the top level, not by Man or Men, but by God. Will you overturn this, and place your image of God in His stead?