The contrast between, say, the Canadian and American approaches [to healthcare policy] is frequently described – by both sides – as a contrast between a “governmental” or “socialised” system on the one hand, and a “market-based” or “free enterprise” system on the other. But the American health care system bears little resemblance to a free market; instead it represents massive government intervention on behalf of private special interests, from insurance companies to the medical establishment. The choice between the American and Canadian models is simply a choice between different two different flavours of statism – each with somewhat different vices, it’s true (e.g., do you prefer higher prices or longer waits?), but ultimately coming down to a matter of the percentage to which control of your healthcare is exercised by people sitting in government offices as opposed to being exercised by people sitting in governmentally-privileged “private” offices – but in either case by ambitious, avaricious apparatchiks who aren’t you.
So what would a libertarian approach to health care policy look like? At a minimum it would have to include:
1. Repealing laws that have the effect of cartelising the medical industry (e.g., the licensure monopoly granted to the A.M.A.), thus artificially boosting the cost of medical care.
2. Repealing laws that have the effect of rendering the labour market oligopsonistic, thus artificially lowering people’s ability to pay for (and collectively negotiate for) medical care.
3. Repealing laws that shift healthcare funds from the 25%-devoured-by-overhead voluntary sector to the 75%-devoured-by-overhead coercive sector, thus decreasing the amount of healthcare that gets to needy recipients. [Link well worth reading]
4. Repealing laws that transfer the power to make medical decisions for individuals from those individuals to centralised bodies, thus increasing the impact and scope of fatally bad decisions and suppressing the competitive signals that allow the identification of better and worse policies.
5. Repealing laws that wiped out the old mutual-insurance systems (basically HMOs run by the patients instead of by corporations) and empowered insurance companies at the expense of patients.
6. Repealing laws that suppress innovation and distribution in the pharmaceutical industry in the name of “intellectual property.”
Until the unlikely day when the Republican Party embraces this program, let’s hear no more of their favouring a free-market approach to health care.
Some of these issues have been talked about within the party, but have yet to make it into formal policy (e.g. removing the need for formal accreditation to offer medical treatment), whilst others haven't really been looked at. It would be interesting to hear people's thoughts on this topic.
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4 comments:
1) Provision and finance are two completely separate issues.
2) Provision is best done by competing providers. Nobody cares if the providers are 'not for profit' (as in Germany, churches, trade unions, universities, mutual insurance companies, local councils, charities or private companies) as long as they are competing.
3) Finance is a red herring - there's nothing wrong with taxpayer funded vouchers as a least worst option, if people want to top up with their own money or private health insurance, then great.
4) Sin taxes on tobacco, alcohol, drugs (once legalised) can be largely earmarked towards treating cancer, liver cirrhosis etc. Or else these sin taxes can be scrapped so that smokers, drinkers, junkies can pay for their own treatment.
5) All these national pay scales for nurses and doctors can go straight out of the window.
[5] is covered in our manifesto as it stands: "Abolish national rates for local authority and local body (e.g. police) pay. This will allow local communities to determine their own priorities in their local area."
Patrick,
"e.g. removing the need for formal accreditation to offer medical treatment
I may have misread this but is this saying you dont need a licence, degree or even formal education to practice medicine? We have enough witch-doctors out there already able to derive a healthy crust out of snake oil as it is without further delegitimising the medical profession even further.
>>>"e.g. removing the need for formal accreditation to offer medical treatment
I may have misread this but is this saying you dont need a licence, degree or even formal education to practice medicine?
No, you read it right. I obviously need to explain further why licensing is such a bad idea -- I'll try to find the time in the next week or so.
Meantime, you might like to read this. Further easily accessible background can be found throughout US Libertarian Mary Ruwart's Healing Our World and Dean Baker's The Conservative Nanny State. Both books are worth reading, although there are points where LPUK and they diverge (particularly Baker).
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