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Physicians and the Business & Professional Community
Restoring Accountability in HealthCare & Medical Practice
Tuesday, July 30, 2002
State Medicine Subsidizes Sickness
Lew Rockwell, Jr, founder and president of the Ludwig von Mises Institute, gave an address at the Annual Meeting of the Association of American Physicians and Surgeons titled “State Medicine Subsidizes Sickness.” He pointed out that the history of socialist theory is bound up with policies toward the Medical MarketPlace. To control people’s access to medical care is to control their very lives. So it’s no wonder that this is the goal of every state. In the course of a century we have taken a long march from a largely free system of medical provision to one dominated by unfree programs and mandates. Privatizing of medical provisions isn’t on the radar screen of the world’s politicians, even after manifest failures. Even after the collapse of all-out collectivism in the Soviet Union and Eastern Europe, there has been precious little movement toward reform in the medical sector. We are a long way from clear thinking on the subject of medical care and the realization that the provision of medical services of every kind is best left to the forces of the market economy and the charitable sector than placed in the hands of the regulating, taxing, intruding state.
State Medicine has difficulty
differentiating Necessities and Luxuries
This week one of my COPD patients asked me to obtain an $8,700 electric wheel chair so that he could get around the neighborhood and go shopping. He didn’t ask for this benefit for his respiratory failure, but because he had flat feet and fallen arches. He felt that Medicare funds, which are extracted by the federal government from taxpayers, should pay for this since he was far more disabled than some of his friends who had obtained electric wheel chairs at taxpayers’ expense.
In Sacramento we have large enclaves of seniors living in communities with common dining and recreational facilities. It only takes a few days for one senior benefit to become known to hundreds of others in that community. The knowledge of these “benefits” seems to jump from one senior community to another, much like a forest fire, thus spreading to all the seniors in other communities across California and the nation. If only one million obtain what many of us consider a luxury, this is an extra $8.7 billion for one item of equipment and no end in sight.
The Medicare intermediary had barely denied this benefit to my patient when another patient who was about 100 pounds overweight requested a chair with a lift because she had difficulty in getting up from a sitting position. The brochure featured what looked much like a lazy boy chair with a steel frame beneath it with a hydraulic lift. The price was $875. She had a family member who had heard about the chair and, of course, wanted her mother to have one. Why should she pay for it if Medicare would? Thus it is that medical necessity is no longer applicable; a significant portion is “keeping up with the Browns.”
Human greed will always exceed human
At this time I played my favorite game of “At what percentage copay does the patient leave Medical Greed and re-enter the Medical MarketPlace?” So I asked, “If you had to pay $87.50 (10 percent), would you still want that chair?” She was willing to pay that or even twice or three times that to obtain the chair if Medicare paid the rest. I got a “no” when I reached $350 (40 percent). In other words, the patient and her family did not feel the $875 chair had more than $250 (30 percent) personal and family value. Hence, a 40 percent copay placed this item, perhaps a necessity to some and a luxury to others, into the Medical MarketPlace. Insurance denied this item just as the electric wheel chair was denied. This family will continue to help their aging mother get up to go to the bathroom or table like the rest of us help our elderly folks. But wouldn’t it have been kinder if the adversarial policing required of any government or third party programs, were simply left to the more pleasant human interaction of the Medical MarketPlace? Wouldn’t benefits be more humanely distributed to those that really needed it rather than to those that wanted it? From this and other anecdotal evidence, it appears that a 40 percent insurance copay is a recurring level that may nearly restore the Medical MarketPlace on durable medical equipment.
Illness and Health - a Continuum
Ludwig von Mises, socialism's greatest critic, wrote the decisive attack in a book in1922. He states, "To the intellectual champions of social insurance, and to the politicians and statesmen who enacted it, illness and health appeared as two conditions of the human body sharply separated from each other and always recognizable without difficulty or doubt. Any doctor could diagnose the characteristics of health. Illness was a bodily phenomenon which showed itself independently of human will, and was not susceptible to influence by will.”
The self-appointed experts, who are novices in medicine as well as healthcare, fail to see the human condition. I frequently see the “nearly well” contributing far less to society than the severely ill or disabled. I have a patient whose pulmonary function testing is 60 percent of normal, a level in which few people are symptomatic, asked to be put on disability with all the benefits pertaining thereto. Conversely, I had another patient whose pulmonary function was 15 percent of normal, and very short of breath, who simply wanted a refill of her medications so she could continue working at her desk job. Since her pulmonary function testing met the Social Security levels of total disability, I informed her that she could apply for and obtain Social Security benefits and receive checks within a few months. She declined. She preferred to work. She will live longer because of her choice. No central planner can allow or plan for human variations.
The Hazards of Subsidized Medicine
Thus, Mises' observations in 1922 were quite astute. There is a moral hazard associated with socialized and subsidized medicine. Because there is no clear line between sickness and health, and where you stand on the continuum is bound up with individual choice, the more medical services are provided by the state as a part of welfare, the more the programs reinforce the conditions that bring about the need to make use of them. This one insight helps explain how socialized medicine takes away the incentive to be healthy, and maximizes the problem of over-utilization of resources. Hence, socialized medicine must fail for the same reasons all socialism must fail: it offers no system for rationally allocating resources, and instead promotes over-utilization of all resources with denial of the very essence of their justification by eliminating or rationing care, or ending in bankruptcy.
National HealthCare Systems Imploding
Around the World
John Goodman, president of the National Center for Policy Analysis (NCPA), has recently updated his 1992 Twenty Myths about National Health Insurance. Over the past decade, he notes that socialism’s failures are evident around the world.
1. Canada uses the United States as a safety valve for its overtaxed health care system with more than $1 billion a year spent on US medical care with many Canadian provinces sending cancer patients to the United States for radiation therapy.
2. The British National Health Services (NHS) recently announced the decision to treat some NHS patients in private hospitals, reversing a longstanding policy of only using public (NHS) hospitals. More than seven million people in Britain now have private health insurance.
3. Australia has turned to the private sector to reform its public health care system and is now second only to the United States among industrialized nations in the share of health care spending that is private.
4. The German government has been experimenting with American-style health care by giving Germans the right to choose among the country’s competing sickness funds (insurers).
5. The Netherlands is turning to American style health care with an extensive network of private health care providers and slightly more than one-third of the population privately insured.
6. Sweden is introducing reforms that will allow private providers to deliver more than 40 percent of all health care services and about 80 percent of primary care in Stockholm.
This excellent work by Dr John Goodman again demonstrates that the Medical MarketPlace is more efficient and cost effective than state medicine. Our goal is to spare the United States this unfortunate experience with inefficient, insensitive, and coercive state medicine which has never worked in a kind or humane way.
The Medical MarketPlace
This week we welcome the 10,000 members of HEAL Indiana Foundation, an organization also interested in free market principles as related to the practice of medicine. Visit their website at www.HealIndiana.org. You will be able to informally meet their leadership, Kim West, Executive Director, & Christopher Jones, MD, President, at the annual meeting of the Association of American Physicians and Surgeons in Tucson on September 18-21, 2002.You may register on the AAPS site at www.AAPSOnline.org. This meeting will also feature Ann Coulter, JD, who will sign her recent book, Slander, and give an address on Big Brother and the Future of Medicine; Wesley Smith, MD, who wrote Culture of Death and Forced Exit, will speak on the New Bioethics; Lawrence Stratton, JD, coauthor of The Tyranny of Good Intentions, who will speak on the New System of Justice and Its Impact on Medical Ethics.
Stay Tuned to the MedicalTuesday.Network twice a month and have your business and professional friends do likewise. This message reaches the Physicians and the interested Business/Professional community in 13 states, 9 countries, on 5 continents. Each person was either personally known, requested to be placed on our mailing list, or was recommended as someone interested in our cause of making HealthCare affordable to all. If this is not correct or you’re not interested in or sympathetic to a Private Personal HealthCare system, send an email to me at DelMeyer@HealthPlanUSA.net and we will sorrowfully removed your name. Networking through the internet allows us to reach an audience that cannot be reached through the print or broadcast media. To increase the network, please forward this message to your doctor, colleagues, business associates, friends and relatives whom you feel agree with our principles, or are willing to listen. The life you save may be your own, or a loved one – after you become ill.
Del Meyer, MD