This is a rather long lecture by Milton Friedman on the issues of government in medical care. As it is so long I’m not going to write a lot, but you should watch it because, despite being over 3 decades old, every word is still very relevant.
Tag Archives: Obamacare
So Republicans in typical fashion are trying to shoot themselves in the foot with their “Defund Obamacare push” (hint the liberals want the GOP to win on this one so they don’t have to have Obamacare hanging around their necks in 2014 and 2016, so they can keep the White House and take back Congress just long enough to make sure no one can ever take Obamacare out…if you want to get rid of Obamacare, really, really get rid of it, you need to make people see, and unfortunately feel, the misery they voted for. The point here is to get rid of the idea that government is the answer, not just a temporary reprieve on one horrific law. The Defund Obamacare group is looking to win the battle, possibly at the cost of losing the war). But while this is going on, Democrats are spending billions just to advertise Obamacare (if a law is so bad you have to advertise it, that should tell you something). And to top it all off, a couple days ago Obama made his one of his typically brain less statements. “Because in the United States of America, health insurance isn’t a privilege – it is your right.”
Why do I bring all of these different groups up in the same paragraph? Because they’re all idiots. They are all predicated on the idea that the government has to do something (less idiotic for the Republicans, but they seem to have given up the idea of full repeal, the only real answer, because they seem to acknowledge the lie that government needs to provide something). At best this belief is idiotic. At worst it’s just plain evil. (On another side note evil people are very rare, but evil ideas are all too common, and morons have a long history of latching onto evil ideas with the best of intentions. So please understand I’m not calling the people supporting Obamacare evil–unless their name is Harry/Nancy/Barrack/Michelle–merely their idea is). Why is it stupid/evil? Well, let me be as clear as I can possibly be:
YOU DO NOT HAVE A !@#$%^& RIGHT TO HEALTHCARE!!!!
Like the right to property, and the right to pursue happiness, you have the right to earn a living and to use that money as you see fit, perhaps by buying healthcare or healthcare insurance, but you have no natural right to healthcare.
Sorry, Barry, but just because you want something, it’s not a right.
I know I am about to repeat things that I have said before, but I feel I need to. I feel everyone needs to until this country learns that rights are not entitlements, rights are not things given to you but opportunities to be taken care of, and to exercise your rights does not require the acts, intentions, or contribution of anyone else.
A natural right as conceived of in the theory of natural rights and in the Declaration of Independence is something you would have without the presence of government or even society. It’s what does Robinson Crusoe have when he’s on the island before he decides to violate Friday’s natural right to freedom. Well, if you find yourself trapped in a bad episode of “Lost” you have the right to life, liberty, property, and to pursue happiness. A lot of what the original Bill of Rights includes is also there (speech, religion, assembly, arms, and self-incrimination) but notice that if you’re on an island by yourself you don’t have medical care. You have the right to take care of yourself, but islands in the middle of nowhere are not staffed with hospitals and doctors just waiting for you to get sick. So it’s certainly not a natural right.
But we don’t live on an island in the middle of nowhere. The upside to this is that we don’t have to engage in a philosophical war with a black cloud; the downside to this is that we do have to deal with other people. And while most people are rational and good intentioned, there are the random people who don’t respect your rights and try to take what isn’t theirs. Because of these random few who ruin everything, and because, we want complex things that we can’t do without laws and someone being in charge (like roads) we turn to the necessary evil of government. Now good government is a skill and it took us a while to realize that limits need to be put on it because just following the guy who can kill you or the guy with the best bullshit may not have been the best choice in the beginning, even though it’s what historically happened. So we had to come up with a whole new set of rights (quartering, due process, equality under the law). But notice all these other rights limit what the government does. Nowhere have you been given anything. You were either born with your rights, some of which you gave away to ensure protection against stupid people violating your rights, and other “rights” were restrictions placed on the government on top of which your natural rights were completely off-limits. But still no right has been given to you that you already didn’t have. And again, you didn’t have the right to health care if you were stuck in the state of nature.
The right to healthcare is a ridiculous, idiotic and borderline evil idea called a “positive right.” A negative right means something that no one has the right to take away from you–like your life, your liberty, or your property. Those are things you’re entitled to, thus no one has any right to reduce your rights to them. A positive right on the other hand means something that you have a right to expect to be given to you. If you’re reading that last sentence a few times because it seems to make no sense, good, that means you’re sane. Healthcare is a positive right. It is the idea that just because I showed up you have to give me healthcare. Just because you’re alive other people have to give something to you? Well I know that really egocentric people act like this, but to actually portray this as a theory of government is insane. And while virtues of love and charity say that ethically we should give people more than they may deserve, it doesn’t work in the opposite way where you have the right to demand people give you more than you serve—that’s not ethics it’s also insanity.
But more than insane it’s wrong. You can’t give a piece of property or a service without taking it from someone else–i.e. theft or slavery. Now while I believe the capitalist system isn’t a zero-sum game that always creates more and more, theoretically having no limit to how much wealth it can create, the kind of property transfer that the government deals in is a zero-sum for whatever moment it exists in. The government stealing things and giving it to others, transferring wealth from one person to another, not only harms the ability to create more wealth, but given government inefficiency, it actually creates less wealth (especially given the government’s addiction to spending money it doesn’t have). The government can’t just give people drugs without stealing it from drugs companies…if it pays for those drugs then it can only do that by stealing hard earned wealth from the taxpayers. Either way it’s theft. A person can’t be guaranteed healthcare without doctors being forced to treat them. After all either the doctors are paid (and if the government’s involved it’s paid with stolen taxpayer money) or simply forced to work as a slave. And you’ll find most doctors will not want to work in that system which will cause the greatest healthcare system in the world, the US, to become one of the worst when all the doctors leave or simply retire.
But some idiots (Alan Colmes to name one) say that the government has a right to help the people under the actual Constitution. They quote Article I Section 8:
“The Congress shall have Power To lay and collect Taxes, Duties, Imposts and
Excises, to pay the Debts and provide for the common Defence and general
Welfare of the United States; but all Duties, Imposts and Excises shall be
uniform throughout the United States;”
And then they point to the part that says “General welfare” , isn’t providing healthcare promoting the general welfare? Well one that would first depend on the government being able to do anything well, which it can’t, but more importantly it is a gross misunderstanding of the meaning of “general welfare.” Even if you took the most liberal meaning of the phrase at the time the Constitution was written the term general welfare does not mean helping people like our current meaning of welfare–it means providing improvements to the whole of the country that affects everyone (roads, bridges, communication systems, in other words – infrastructure). The key is the word general. It needs to be something that can be used by everyone. I can’t take your doctor prescribed drugs after you’ve taken them, so there is nothing general about a system that helps individuals. (And don’t even give me that bullshit about their being able to provide for society if they were healthy…if they were providing for society they would have a job with which they could afford healthcare).
The government isn’t there to protect you from yourself or from nature. It’s there to protect you from other idiots. Your bad living habits and your genetic disposition toward a disease, while unfortunate, is not the government’s responsibility. But given that the government has stolen and inefficiently used the money that people who might have been able to charitably donate to your healthcare, the government is not only destroying their rights it’s destroying their ability to help you.
The government destroys all it touches–it can’t help it, it’s its nature. Especially when it tries to give you things you don’t have a right to. And you don’t have a right to healthcare!
So this week started out with Paul Ryan stating that he is still planning on the complete repeal of Obamacare. And from what he said before his keynote speech at CPAC…I’m laying even odds that he starts a chorus of “Do You Hear the People Sing” and leads a march to build a barricade around the White House.
But it’s good to know that the crusade to end what is perhaps the worst bill in memory (it’s hard to say it’s the worst bill of all time when you have to compare it to the terrible socialist bills of FDR and LBJ’s presidencies)…still this bill is pretty close to being the straw that broke the camel’s back for this country and it must go before we can fix all the other monstrosities.
But liberals, being the whiny brainless sort that they are will whine “but medical costs are too high. But people have a right to insurance. But people have a right to healthcare!”
Ignoring the simple fact that healthcare isn’t a right by any stretch of the imagination and that if you need healthcare, get a job and earn it, let’s deal with their claim that medical costs are too high.
I would agree medical costs are too high. But, like a bad doctor, liberals want to treat the symptom not the disease. Healthcare costs too much, throw money at it; that should cut the costs.
Conservatives however, like to determine the causes of high costs, which is the disease and treat that. So what are the causes of high costs (hint, it’s not the private sector)?
(Everything that will follow will assume that Obamacare has been justly killed because there is nothing in the bill that should be saved).
So what are the three main costs to medical care: Insurance, doctor’s/hospital bills, and drug costs?
So how do we cut insurance costs?
Tort Reform. Tort Reform. Tort Reform.
Every state that has instituted tort reform has seen medical costs drop, the number of doctors increase, the number of unnecessary procedures drop like a rock and even the number of deaths drop. If the federal government and every state were to institute real and sweeping tort reform you would see every single thing you buy drop in price, but you would probably see the biggest increase in the quality of medicine.
We allow insurance companies to cross state lines. Right now all insurance companies are banned from selling insurance across state lines. Look at any insurance card you have. Farmer’s Insurance of California. Blue Cross of Arizona. There may be a national corporation, but it owns 50 separate corporations in 50 different states. That’s a lot of overhead. It also stifles competition. A smaller company can’t expand beyond its own state because it can’t afford to set up a whole infrastructure to have a multi-state operation. This limits competition, and as anyone knows the less competition the higher the prices. If we remove the federal block against insurance crossing state lines you will see drops in every form of insurance you have: medical, car, house.
Just those two things would easily drop the cost of health insurance to probably 90% of its pre-Obamacare costs, perhaps more.
But why stop there? Doctor’s bills themselves also contribute to a large portion of the costs. So what can we do there?
Well a lot of the initial costs come from the fact that when doctors start their career they are laden with college and med school debt. Obscene levels of debt. So let’s fix that.
The reason why college costs are so high is because the federal government subsidizes them at outrageous prices. Subsidies always increase costs. Always! So cut all tuition subsidies and grants. Within a year you will see college costs drop. Now this won’t have an immediate effect as the doctors without massive debt will be years away from entering the market, but long term this will not only solve part of our medical problem but our massive college debt problem.
But part of the reason why doctors charge so much is because they know that Medicare and Medicaid aren’t going to pay them their full billing price, so to stay in business this has a threefold fix.
Adopt the Ryan Plan which will allow more competition in Medicare and Medicaid, which will both ensure doctors get better payment AND lower the cost to the taxpayer for these costs.
In a second step we need to move as much of Medicare and Medicaid costs to the states as possible. While the private sector does better when done on large scale, government and bureaucracy work in the exact opposite manner. The closer any government program is to the people the more efficient and the lower the cost. Lower costs means that Medicaid and Medicare will be able to get closer to pay 100% of doctors’ asking prices for their services (not to mention more doctors taking Medicare and Medicaid patients) which means they will be able to drop their prices for the rest of us and still make a tidy profit for their practice.
Increase the penalties for Medicaid and Medicare fraud. We’re talking about nearly $500 Billion in fraud every year. $500,000,000,000.00! I’ll let that number wash over you for a second. That’s one of the main reasons why Medicaid and Medicare can’t afford to pay full price to doctors. Now while I generally don’t believe the government should criminalize more things or come up with even stronger punishments, fraud is something even the most libertarian government must prosecute and fraud against the government doubly so. Penalties and enforcement need to be much stronger. If there’s $500 Billion in fraud it means the risk is much, much lower than the reward. Much lower. If we have to get a little Draconian, so be it, we need to make it very clear that the risk is now worth the reward.
Now the cost of drugs is also an issue. So how do we lower the costs of drugs (and liberals throwing money all willy-nilly at research never works).
However there are things we can do.
Allow drug patents to start when the FDA approves the drug. Right now a drug patent (20 years) begins when the drug is patented. So when a drug takes 10-15 years to get FDA approval. This means that the company only has 5-10 years to recoup all of the cost of not only research for that drug, but of all the other drugs that failed. So they have to recoup all of their investment for all R&D in only 5 years. And you wonder why the cost is so high. If we started the 20 year clock when the FDA grants approval they would have more time to recoup costs and thus would not need to charge as much.
Reform the FDA. Right now the FDA prevents human testing of experimental drugs on willing patients with terminal diseases….because the drug might kill them. You know if I have a terminal disease the last thing I care about is if a drug will kill me, because I know for a fact the disease will. A lot of medical costs are in cancer treatment; to allow willing patients to try experimental drugs could not only rapidly speed up research (thus cutting costs to a fraction of their current levels) but actually find some cures and real treatments to one of the biggest costs in the medical industry.
And then there are some other things we could do that could help medical care. Nanny’s in the government like to talk to us a lot about eating healthier which is odd since government programs are designed to make sure we don’t eat healthier.
End all government subsidies, tariffs, and controls for agriculture. We pay people to grow tobacco, we pay them to grow sugar, we pay them to leave ground fallow. We even pay people to grow corn only to be turned into fuel (ironically it takes over a gallon of fuel to produce a gallon of corn ethanol…that’s efficient.) When you subsidize something you get more of it. And you wonder why it’s hard to get healthy food. Yes, ending subsidies and tariffs on sugar would initially drop the price of sugar, but it would also result in less being produced which would again raise the price. It would also leave more ground for producing the fruits and vegetables we’re not getting right now because fresh food is so overpriced.
Suggestion # 10
And while we’re at it, if we want people to eat healthier maybe we could stop regulations on food. Stop sending SWAT teams at raw milk distributors, stop fining people for having their own gardens of fresh food, stop preventing the Amish from taking fresh food across state lines. You know little things like that.
Special Idea #11 Fluoridation
Now I usually hate talking about fluoridation. Why? Because so many wacko conspiracy theorist nuts think it’s some grand government conspiracy to control people. It’s not. It was, as with most government actions, a well meaning but idiotic plan. Let’s put fluoride in the water to strengthen their teeth (we can’t trust people with their own hygiene). Yeah let’s put a substance in the water that causes lower IQ’s, higher cancer rates and drastically lowers the thyroid gland (which might have something to do with obesity). What could possibly go wrong? You know between the expansion of the dental industry, better access to toothpaste, and personal responsibility I think our teeth are fine. Let’s stop fluoridating water.
Special Idea #12
Walmart and other such stores apparently want to get into the healthcare business. I say let them. They want to open small clinics. Honestly what they’re proposing will basically act as a triage center. They will tell all the people with just a cough to just get Sudafed, treat the small wounds, and thus clean up the real traffic at urgent care and the ER. This will almost certainly cut down costs from needless tests.
Notice something about this. With the exception of #6, involving the prosecution of criminals (a proper function of government), each and every one of these calls for less government not more. Why? Because government and regulation are what is causing so many problems.