Monday, November 10, 2008

The Fall of Capitalism?

A loving father and mother watch their son grow up and approach an age of independence. Upon reaching that age he leaves home and begins college. However, once in school, the young man begins skipping classes, frequents the bars, and becomes a real party animal. He eventually drops out of school and is unable to maintain a steady job. His parents are heartbroken and comment, "We should have never let him leave home."

Compare this to a situation that is unfolding nationally. Several weeks ago the House Committee on Oversight and Government Reform held a hearing in which they hounded former Fed Chairman Alan Greenspan for the free market policies of his administration. If he had implemented more regulation, they pressed, the economy would not have stumbled. As reported by the forever-impartial New York Times, "A humbled Mr. Greenspan admitted that he had put too much faith in the self-correcting power of free markets and had failed to anticipate the self-destructive power of wanton mortgage lending."

The feeling in both above situations is the same: If we had not allowed so much freedom, things would not have gotten out of hand. If the boy's parents had forbidden him leaving home, he would not have wasted his life. If the government had taken control of the economy, we would not have the current recession.

But let's analyze the rationality of these feelings, starting with the parents. We sympathize with them in their sorrowing for their son's wasted years. Yet, we cannot pretend that they could prevent their son's actions once he left home. They could try to influence him, but he is an independent adult. Their belief that they could have controlled his actions is incorrect. Any effort to truly control his life would have been morally wrong.

The national reaction to our economical slump is likewise irrational. "If the Fed had just taken control..." we lament. Here, like the mourning parents we forgot ourselves. First of all, we forget the actions of the past and try to pin the blame on a free market for falling stock prices and bank failures. But more importantly, we forget what America's free-market capitalism is.

These days our free-market capitalism is often thought of as just another economic system. Our European allies have abridged it without regrets. Many, far too many, in our own nation want to do the same.

But capitalism is not an economic system. There is no structure or control involved in capitalism. Capitalism is the free-market economic state that comes as a result of liberty. Thus, if capitalism is substituted by another system, we have not merely swapped one system for another. We have swapped freedom for control. We have taken away American liberties.

The goal of capitalism is not to amass national wealth. The goal of capitalism is not to maintain our status as the world superpower. Capitalism is not maintained for the sake of the stock market. In fact, capitalism has no goal. Capitalism is simply the result of economic freedom. And so, we do not casually give up capitalism because our stock portfolio isn't doing well. Indeed, we fight furiously and bleed and die to maintain it because the loss of capitalism is tyranny. It is the loss of our God-given, won-by-blood American freedoms.

A sound byte from a speech by Ezra T. Benson (Secretary of Agriculture during the Eisenhower Administration) has been floating around the web. In it he describes a confrontation that he had with Nikita Khrushchev ("First Secretary of the Communist Party of the Soviet Union") during the 1959 visit that Khrushchev made to see American agriculture:
"As we talked face to face, he indicated that my grandchildren would live under communism. After assuring him that I would do all in my power to assure him that his and all other grandchildren would live under freedom, he arrogantly declared in substance: You Americans are so gullible. No, you won't accept communism outright. But we'll keep feeding you small doses of socialism until you finally wake up and find that you have communism. We won't have to fight you. We'll so weaken your economy that you fall like over-ripe fruit into our hands."
In a time of economic turmoil, may we stand fast in the liberties with which God has blessed us. May we reject the doses of socialism that are so constantly being offered us. Any threat to the American free market is a threat to American freedom. Let us be alert and treat those threats as such.

Rusty Scalpel

(I regret not having a primary source for the Ezra T. Benson quote. To listen to the quote click here and scroll to 8:15.)

Friday, October 24, 2008

If Elected President, I Will...

Free Market Physician's guide to solving the "Health Care Problem"

Of course we recognize that the fix that health care needs is not within the constitutional powers of the president of the United States. Any comprehensive plan that a presidential candidate offers is probably going to throw a wrench in the economy and is possibly unconstitutional as well.

What we offer is the hard, but true, solution to the health care problem. It's hard because it is not just an executive or legislative fix. Our congressmen are not going to pass a bill that makes health care affordable and available for everyone. No, the solution is to be found in the market and it requires politicians to do the thing that is most difficult for them- to untie our hands and stay out of the way.

And just to be clear, let's specify what the Health Care Problem really is. It is high prices due to a lack of supply of medical care. So without further ado, here are our three recommended actions for solving the Health Care Problem.

1) Remove the legislation of discrimination that denies non-traditional providers access to the field.

Spurred on by the physicians of the American Medical and American Osteopathic Associations, many state legislatures have passed strict laws regulating the practice rights of physicians assistants and nurse practitioners. Many physicians see them as a threat to their practice and believe that an unregulated medical market is somehow an infringement on their rights as physicians. However, the right to a monopoly of the medical market does not exist.

NP's and PA's, those "masters of the mundane," have the incredible potential of filling the gap in America's primary care services. Their education is less extensive than that of DO's and MD's, it takes less time, and it costs less to receive. They have the potential to drop the floor out of the costs of primary care, offering general care at a fraction of the price charged by traditional physicians. They have the potential to work for traditionally underserved populations, opening branches of practices in new locations.

NP's and PA's cannot do everything a doctor can do. They practice within a scope defined by their education, by their licensing, and especially by the market. If they provide competent medical care at low prices, the market will be very likely to reward them.

2) Remove state regulation preventing physicians from competing against each other.

In what other market is non-competition so actively advocated and enforced as in the medical market? We now have the natural effects of these efforts- a market that is not truly a market. The deliberately-limited supply of physicians and the lack of competition between physicians creates artificially high prices in health care. The medical economy is not consumer friendly. In fact it's nearly impossible to shop around. Medical prices are hard for consumers to verify, illegal for doctors to compare, and made homogeneous by insurance companies.

But remove regulations preventing physician competition, and you will see doctors scramble to please patients. Prices will be dropped, advertised, compared, and then dropped even lower. Doctors will be forced to show ingenuity in the administration of their practices, cutting waste across the board. Now empowered, consumers will swap their comprehensive health insurance plans for catastrophic plans and personally shop for price and quality. Health care prices will drop again.

3) Take the philosophical burden of patient care and place it firmly on the patients' shoulders.

After almost a century of modern medical grind, doctors are realizing that they can no longer be responsible for our patients' health. We deeply desire to keep our patients healthy and we've gone to extraordinary means to promote that health. In our frustration, we have tried to control our patients lives. We have tried to control patients by professional authority, we have tried to control patients by barring other practitioners from the markets, we try to control patients by by lobbying state and federal legislatures to pass laws regulating behavior.

We have had success in convincing them. Patients now see us as responsible for their health as well. This fact is evident in the call schedules we keep and in the onslaught of lawsuits we face. But the burden of responsibility for patient care is one we cannot truly carry. It always was the patients' and it must return to them.

When the true responsibility for patient care is established, medical care will be revolutionized. Doctors will see a reduction in status and income, but they will also see a reduction in call hours, malpractice suits, and headaches from dealing with insurance companies. America will find itself healthier and with a more efficient and less costly medical system. This truly is the final solution for all of our national woes- personal responsibility. The sooner this responsibility is acknowledged, the sooner this nation can begin to truly resolve the problems at hand.

Rusty Scalpel

Wednesday, October 22, 2008

Reader Recommendation: "Affordable" Health Care

Thanks for this suggestion to read economist Walter Williams' article "Affordable Health Care." The article points out that socialized medicine schemes in other countries have turned out very poorly. It recognizes some of the following shortcomings:

In Canada, the average waiting time for treatment by a specialist is between 5 and 40 weeks. The average wait time for an MRI or CT is 4 to 28 weeks.

One out of three Canadian physicians refer patients to the United States and the Canadian government pays over one billion dollars for health care in the United States each year.

Great Britain's National Health Services has a goal of having a maximum wait time of 18 weeks for general practitioner services and diagnostic tests. Many people in both Canada and Great Britain have illnesses that become incurable due to lack of care during long waits.

Great Britain Prime Minister Gordon Brown hopes to adopt a "presumed consent" that would essentially make the bodies of Britons property of the state. The plan makes every citizen an organ donor at the time of their death, unless they carry a card or have family at hand at the time of death that state otherwise.

Rusty Scalpel

Saturday, October 18, 2008

Reader Recommendation: Hawaii Drops Universal Healthcare Failure for Children

"And we're supposed to believe that a program that can't work in a state of about 1.3. million people is supposed to work for an entire nation?"

America seems to be in love with universal health care right now, but is any government-administered universal health care system economically feasible? Thanks for this reader recommendation: Hawaii ends universal child health care and commentary- we'll be talking about it more in the future.

Rusty Scalpel

Wednesday, October 8, 2008

A Conservative Approach to Universal Health Care

I believe that most Americans believe that all Americans should have access to health care. We believe that in times of necessity, every American should be able to receive health care despite personal economic difficulty. We can all agree that we would not have a single one of our American brothers or sisters suffer when prudent use of medical care could alleviate that suffering. In this I believe we all stand united.

The division of thought perhaps lies in how relief ought to be administered. A part of our population, often referred to as liberals, generally believe that government programs should be put into place to relieve the suffering of the medically uncared. They believe that adequate funds could be taken from the population to provide for basic medical care for the entire populace.

Another part of our population generally disagree with such government-run programs. These are those who are called conservative and the growing population of those called libertarians. There are many reasons they may oppose such programs and among those are the following:

1) They simply oppose big government. They may oppose growth of government beyond traditional constitutional bounds for constitutional reasons.

2) They see government-administered programs as ineffective. They believe that increased taxation actually results in a decrease in tax revenue. They believe that the collected funds are ineffectively administered. They believe that many government programs foster dependence on the system and prevent the development of productive citizens and progressing human beings.

3) They resent government intrusions into personal liberty. They believe that growth of the government comes at the expense of personal liberties. Government programs hit pocketbooks and limit Americans' utilization of personal funds. Government programs often lead to regulations that limit personal choice. They believe that the preservation of liberty is more important than overall economic strength and that liberty should not be sacrificed for any other goal.

4) They recognize that governmental assistance to the needy does not result in the same spiritual or moral growth as personal assistance to the needy. They see no moral progression in being taxed to help the poor. They see little patriotism in having a pocket unwillingly picked. The funds that they might otherwise dedicate to the good of their fellowmen are taken from them. In addition, the substitution of government checks for loving service and assistance from neighbors and friends considerably blunts the moral growth that could take place in those on the recipient end of charitable action. Those who believe in this way believe that there is no institutional salvation for America without the individual salvation of American citizens.

For those who share this mindset and who cherish personal freedoms, might I suggest a potent means of combating the incoming wave of American socialism. Let's use our freedoms to decrease the need for increased social programs now.

What need can there be for liberal social programs if we use our still-present freedom to alleviate the suffering of our fellow Americans? What driving force would there be behind socializing health care if all Americans had adequate access to basic primary care?

As we look beyond ourselves, we will see solutions to the "health care crisis" that require the exercise, not the sacrifice of personal liberty. How striking it would be if we could demonstrate examples of entire communities where the utilization of innovation and personal freedom lead to a complete independence from federal funding for health care. What a statement we would make if without tax impositions we achieved a society where there is no poor among us.

All Americans, compassionate conservatives and bleeding-heart liberals alike, desire the good of their fellow Americans. As conservatives, and especially as physicians, let's use our own agency to benefit our fellow men. Let us show how our to exalt our liberties and what a great loss America will suffer if these liberties are taken away.

Rusty Scalpel

Reader Recommendation: The Four Ways Money is Spent

We very much appreciate the following recommendation by one of our readers:

I saw this on C4L so I thought I would pass it on...

Milton Friedman brilliantly described the four ways that money is spent.
  • The first and most common way in the private sector is people spending their own money on themselves. In this case, the buyer is interested in both quality (the best product or service that he can afford) and value (getting it at the best price) because he is both the producer of the wealth being spent and the consumer of the good or service being procured.

  • The second way is when people spend their own money on others (such as gifts). Here they are still concerned about value (it's their money), but less concerned about service quality as they are not the consumer.

  • The third way is spending other people's money on yourself. Think of the rich man's girlfriend who buys herself the nicest dresses in the store on his credit card without even looking at the tag. She wants quality, but value is irrelevant since she sacrifices nothing.

  • The fourth way is when people spend other people's money on other people. In this case, the buyer has no rational interest in either value or quality. Government always and necessarily spends money in this fourth way. This guarantees inefficient public spending because the spenders have no vested interest in efficiently allocating those funds.

Friday, September 26, 2008

Resistance to Federal Assistance

Yesterday FMP received the following comment to the post Among These are Life, Liberty and the Pursuit of Happiness from our reliable reader, Anonymous:

How can we expect to be "free market" physicians when we don't allow those currently treating our wives and children to do the same? I know it is uncomfortable to talk about this, but by giving in to using social (programs), we are exacerbating the problem rather than solving it. We cannot use these programs now, but expect others not to use them or not accept their payment when we are the ones providing care and paying taxes. Just a thought that we all should consider.

(It is FMP's understanding that Anonymous was referring to medical students who personally may not approve of expanding medicaid and other welfare plans, but nevertheless accept aid from those programs for their families while they are in medical school. Should they utilize a program they personally disagree with?)

The comment raises an important question. As Free Market Physicians, what is our responsibility regarding national and state welfare programs that we don't approve of? In a time when we may disagree with the expansion and universal establishment of federal health care programs, should we deny ourselves federal aid that we otherwise qualify for?

As Anonymous acknowledged, the subject is indeed a little bit sensitive. But let's look at it from a market perspective.

All along we have argued that, like all other markets, the medical market is best governed by the consumer. Low prices and high quality products are achieved, not by government intrusion, but by consumers actively selecting the products that best suits them. With that understanding, let me compare our current discussion with another market movement.

There are those that believe that "Corporate America," or the big national businesses- the Walmarts of the industry, have been unethically driving local businesses and producers out of the market. They are saddened by the loss of culture and personality in small communities when the big national stores arrive. Apparently, people cannot resist the attraction of low prices. As the locals forsake their neighbors' businesses to shop at the retail outlets, local industry dies.

We free marketeers probably see nothing wrong with the situation. We may have sympathy for the local loss. But we argue that the consumer has been presented with a choice. The consumer knows best what his or her needs are and has evidently chosen lower prices because that value trumps other values. The consumer apparently values lower prices and convenience more than he or she values local industry and personality.

Let's go back to the medical market and the enticement of federal aid. In each community a medical market is available with variety of prices and services. The medical care may vary and the prices and means of paying vary. Involved in the market are such commodities such as health insurances, cash-only practices, and government-paid health care.

The decision of which of the products or programs to use is ultimately at the discretion of the consumers. That's us. This is our opportunity to choose a product based on our personal values. In my case, the values that should determine my purchase include the following:

I want my family to receive the medical care it needs.

I would like doctors who view me as an equal and who counsel, not dictate, treatment options.

I don't believe in taking anything I haven't earned.

I rely on myself, my family, and my God before I look to the government for aid.

I do not believe that paying taxes is patriotic.

I would like use my resources to help those around me- not to have those goods confiscated by the government to help those around me.

It is plain to see that my values rule out certain options on the market. Based on my values, I will choose a medical plan and product that best suits me. Other people with other values will choose the plan that best suits them. There are those whose chief value is taking care of their family, but they have no means to do so. I will not criticize their decision to accept federal aid.

In our market decisions, let us always beware of the bargain. It appears to be human nature to purchase an item marked as "on sale," even if we had no intention of buying it in the first place. Even more provocative are those things marked as "free."

The federal government is advertising "free" health care. It will be aggressively advertising it in the presidential election. Let us buy our health products and services wisely, based on our values. With consideration, I think we will find market options that suit us much better than any federal plan.

Rusty Scalpel

Friday, September 19, 2008

Reader Recommendation: Amateurs Outdoing Professionals

This article, written by economist Thomas Sowell, demonstrates why centrally planned economies will always lag behind free markets. His comments indicate what we can anticipate from a centrally planned medical economy. Thanks for the recommendation!

Rusty Scalpel

Friday, September 12, 2008

Among These Are Life, Liberty, and the Pursuit of Happiness

We live in a time where phrases from the Constitution and Declaration of Independence are thrown around glibly to achieve personal and financial ends. A current abuse to our great founding documents is the argument for universal health care, construing it as part of our inalienable, God-given right to life.

To put it in context, this reference to the right to life is part of the rationale for breaking away from Great Britain in the Declaration of Independence:

We hold these truths to be self-evident:

That all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness; that, to secure these rights, governments are instituted among men...

We've discussed the subject in length before, but let's briefly use the Declaration to show why the increasingly-popular right to health care is not truly a right.

  1. The “right” to heath care is not self-evident. It is a head-scratcher. There are many applications of the right to life that are self-evident, for example the right to protect oneself against violent assault to preserve life. However, the right to health care (i.e. compel others to care for you) is not one of these self-evident rights.

  2. The “right” to health care is not endowed by the Creator. Our God-given moral agency encompasses the right to do a great many things. We can clearly see that God endowed us with the ability and right to reason, to speak, and to express our thoughts- in other words the freedom of speech. However, to my knowledge, none of us is endowed with the ability and right to free health care.

  3. The “right” to health care is not unalienable. Unalienable means incapable of being alienated, surrendered or transferred. Clearly, the “right” to health care can be transferred or alienated since it does not currently exist in our country. It is not part of our innate human nature. Parts of our population want that right transferred to us by law. By so doing, they blatantly demonstrate that it is not unalienable.

  4. The “right” to health care interferes with the governmental role of securing true rights. Federally-administered universal health care cannot be instituted without the infringement of other freedoms.

The Declaration establishes that universal access to health care is not a right. However, this doesn't mean that universal health care is an undesirable goal. Resistance to a federally-mandated universal health care is not resistance to the goal of making health care accessible to all mankind, or by definition, universal.

It seems very logical and natural to want all members of the human race to have adequate medical care, regardless of their ability to pay. That concept is already incorporated into modern medical ethics. Many physicians volunteer their time and skill to this end. Many non-physicians volunteer their means to fulfill this goal. This service is ennobling and part of that great right to the pursuit of happiness that our Creator has endowed us with.

However, contrast this humane service to a federally-implemented and mandated universal health care system where. What was once a service becomes literal slavery. The difference may appear subtle- in one case we freely serve because of love of God and men. In the other we are legally compelled to support a dependent population.

This is the difference between freedom and slavery, a difference that the Constitution has perfectly defined for over two hundred years. May we understand that difference and cherish and defend those rights with which our Creator truly has endowed us.

Rusty Scalpel

Friday, August 29, 2008

Smoking Bans Are Bad for America's Health

Main points:
  • The dangers of smoking and second-hand smoke is scientifically established, however
  • Smoking bans are an infringement on property rights
  • Consumers possess economic clout to combat public smoking
  • Smoking bans open the door for further, more extreme breaches of Constitutional Rights
In light of a consistent stream of research citing the dangers of second-hand tobacco smoke, public smoking bans are seeming to become increasingly popular. I live in a town that passed a ban on public smoking last year. The city ordinance was written as follows...

a. Smoking is prohibited in all bars, city operated facilities, recreation facilities, restaurants, amusement places, bed and breakfasts...

The debate leading up to the decision was extensive and passionate. The public record for the city meeting leading up to the decision is much more interesting than public records usually are. The arguments in favor of the ban were varied and compelling, as seen in these excerpts from the record.

Tom Mayer... works at the lung health clinic. He tests people who have been exposed to second-hand smoke. He has to talk to people who are experiencing health problems due to a smoking environment.
Nicole Stevens... worked two years in a smoking area of a restaurant. She did not have a choice since she needed a job. She asked that smoking be banned.
Fred Peterson... said he is tired of paying for smoker’s diseases. His father, step-father and mother died of smoke related diseases. One-half hour of smoke exposure affects us.
Sarah Shelton stated this is an opportunity for Kirksville to become a pioneer city by passing an ordinance to ban smoking.
Alana DeCooyer... stated it is her right to go into a business without there being smoke there. She does not go into those businesses that allow smoking. Kirksville should set a standard by banning smoking here.

The arguments demonstrate the fact that smoking is indeed dangerous and has had a devastating history of damage. They certainly demonstrate an intellectual progress in that the majority of the participants in the public hearing recognized the dangers of smoking and wanted to halt its destructive effects.

However, was a ban on smoking in public buildings the best course of action to combat smoking? Consider two more excerpts from the record.

Brenda Sewell, owns Uptown Café, presented a petition signed that says business owners should have the right to choose. She said that 80% of her patrons are smokers.
Jan Collins, Washington Street Java, said that her business became smoke free in 2001, and she believes their business has grown.

First of all, let's consider two opposing claims from the record. From the final excerpt from the Pro-Ban group, a citizen claims that she has the "right to to go into a business without there being smoke there." Yet, the owner of the Uptown Cafe states that "business owners should have the right to choose" whether smoking is allowed on the premises.

Whose right is it to determine whether smoking is allowed on a property- the owner of the property or the visitor to the property? I believe that most of us would agree that this is a property right of the owner. Traditionally, the owner of a property determines its use. In addition, many of us agree that it is a constitutional right. It is implicit in the "Nor shall private property be taken for public use" phrase of the Fifth Amendment.

This is not to say that the citizens of Kirksville were obligated to enter smoke-filled public buildings. They still had a right- not the right to "go into a business without smoke being there"- but the right to choose not to go into buildings where smoking is taking place. No one forced them to eat in smoky restaurants- they ate there for reasons of convenience.

This doesn't mean that Kirksville citizens had no say in the use of private buildings. Actually, they had available a means of promoting non-smoking businesses just as profound as the city-wide ban would be. They had an economic vote.

All it would take to bring non-smoking businesses to Kirksville would be for the non-smokers to quit patronizing smoking establishments. The non-smoking establishments like the above-noted Washington Street Java would bloom with such action. Those businesses that continued to allow smoking would be forced to consider prohibiting smoking in their establishment or face the consequences of a smaller customer base.

Within a short amount of time, the policies of businesses would be proportionate to the tastes of the consumers. There would be adequate businesses to accommodate both smokers and non-smokers.

Consider the two votes that Kirksville citizens had. They had a democratic vote, one in which they could compel an entire populace to accommodate to the preferences of the majority. The use of this vote was an attractive option- with it they could significantly decrease public smoking in a single stroke. They also had an economic vote- one in which the local economy would respond to the tastes of its citizens.

Note that by using a democratic vote to establish a smoking ban a precedent would be set. Property rights would be infringed upon by a majority wielding "scientific data" showing harm- a majority enforcing what they felt was "right" and "healthy." But once these rights are infringed, they are forever in jeopardy to the next data-wielding majority who believes they are promoting something "right" or "healthy."

Think of the possibilities-a majority of the population with data showing that organized religion promotes depression, or conversely a religious majority determined to shut down businesses on Sundays. How about a health conscious majority forcing restaurants to serve vegetables with every meal? The action solely depends on a majority view and a rationale.

So even though we understand why Kirksville residents adopted a smoking ban, we must insist that it was bad- bad for the health of America. Freedom, even if it is the freedom to allow smoking in your business, must be preserved. Freedom must encompass the power to choose the wrong. By protecting this freedom, we preserve the power to do right.

Rusty Scalpel

(A final point to consider: how did the smoking ban affect businesses that had already prohibited smoking on their premises. Did they benefit from the ban?)

Tuesday, August 26, 2008

Reader Recommendation: AAPS

A couple of alert readers have now recommended the website of the Association of American Physicians and Surgeons. The organization claims to be "...Dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine."

That's certainly something we support here. We like what we see from them- their work seems informed, well-written, and generally in agreement with what we think here. Take a look and let us know what you think.

Rusty Scalpel

Saturday, August 16, 2008

A Little Autism Means Big Money

Reviewed: "New Ways to Diagnose Autism Earlier" by Jeremy Singer-Vine of the Wall Street Journal and "Autism Cures" a critique of the Singer-Vine article by Thomas Sowell.

Pertinent Points from "New Ways to Diagnose Autism Earlier":

  • New diagnostic methods indicate whether children under 30 months old may be at risk for autism.
  • "At-risk" children can begin early behavioral treatment. Pre-school treatment is shown to be more successful in raising IQ and improving language in autistic children than later treatment.
  • New methods provide "useful clues" as to whether the child may have autism. The author notes that "there is something about a clinician that adds to the predictive value."
  • Early intervention may be expensive, but if successful, may decrease overall spending on treatment of autism.
  • "Just eight states have passed bills mandating coverage by private insurers for autism and related disorders." The author notes that 27 other states are working on autism initiatives.

Pertinent Points from "Autism Cures"

  • An "Autism spectrum" allows for easy false diagnosis based on a range of autism symptoms.
  • Parents that allow children to be diagnosed as autistic can receive funding for desired therapies such as speech therapy. This encourages diagnosis of autism even when the existence of that condition may be questionable.
  • False positive diagnosis of early autism makes "curing" the disease easy work and generates false data about cure rates.
  • False positive diagnosis diverts money from truly autistic patients that need treatment.

The implications:

Of course FMP has no problem with parents electing to utilize non-definitive early diagnosis methods and expensive early treatment if they so desire. The problem comes when these elective procedures become the public burden.

For evidence that it is becoming the public burdern, note two excerpts from the Autism Votes website, an activist site dedicated to support bills benefiting autistic patients. These excerpts are two of many such notices.

1)(Baton Rouge, LA - July 2, 2008) Today, Louisiana Governor Bobby Jindal signed House Bill 958, the autism insurance reform bill passed last month by the state legislature, into law. The new law will require health insurance coverage for the diagnosis and treatment of autism disorders in patients under age 17. Benefits are capped at $36,000 per year and $144,000 per lifetime.

2)NEW YORK, NY (July 9, 2008) -- Autism Speaks today commended Pennsylvania Governor Ed Rendell for signing into law the most comprehensive autism insurance bill in the nation. The new law provides $36,000 a year for Applied Behavior Analysis (ABA) and other necessary treatments, and goes beyond many state insurance reform measures by mandating coverage up to age 21 with no lifetime cap. It also creates, for the first time under Pennsylvania law, an expedited appeals procedure for denied claims as a safeguard to ensure compliance by insurance providers. Private insurers will be required to provide coverage beginning in July 2009.

We can't help but wonder how this mandating of particular coverages on the insurance industry is affecting health insurance premiums. Health insurance isn't a charity program. Every time coverage expands the price of premiums must go up. These diagnostic and treatment procedures certainly have a place. But, should the government mandate non-conclusive, early-diagnostic procedures for autism and similar procedures for other illnesses?

Especially in these financially questionable practices, parents and doctors must be the decision makers- not the government. Efforts by the government to enforce a standard of care on the health insurance industry and on taxpayers can only make health care more expensive and less acessible to Americans.

Rusty Scalpel

Wednesday, August 6, 2008

The Most Important Constitutional Right

And Health Care's Threat to It
Part I

Of all the rights guaranteed in the US Constitution, which is the most important? Is it a free-speech right, a right to religious observance, or right to vote?

We would hold that the most important of all constitutional rights is the right to hold property. The Fifth Amendment states that "No person... be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation."

Property is the exclusive right to possess, enjoy, and dispose of a thing (as defined by Webster). Included in this definition of property could be land, money, commodities, and assets.

Contrary to opponents' inferences, it is not for reasons of greed or to gain dominion over other men that we so cherish this right to property. It is because without property rights, all other God-given, constitutional rights are placed in jeopardy. Consider, for example, how deprivation of property effects the first four of the Bill of Rights:

Amendment 1- The establishment of religion, freedom of the press, etc.: How is religion to be established without private funds and lands dedicated for buildings, publications, support of ministry, etc.? Where are tithes and other contributions without private property? Without private property, churches are established and administered by state funds and state discretion. Also, what happens to freedom of the press without private ownership and thus private discretion for what is printed?

Amendment 2- The right to bear arms: What happens to the private, personal right to bear arms if we are not permitted to own arms? Also, without private property, what are we protecting with those arms?

Amendment 3- "No Soldier shall, in time of peace be quartered in any house, without the consent of the Owner..." is literally obsolete without property rights.

Amendment 4- "The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures..." is also literally obsolete without property rights. What houses, papers, and effects are in danger of search and seizure if we own no property?

As John Adams said at the signing of the constitution "'property must be secured or liberty cannot exist.'"

Property is the means by which all other liberties are exercised. With property we are able to support our families and thus maintain independence from the government. In addition, with property we have a constant economic vote. We are able to support those causes and institutions that we find beneficial, good, and just.

What happens then, when this right to property is abridged? What are the consequences?

With a loss of property rights to the state, citizens become dependent on the state and the state becomes a custodian and guardian to its citizens. The state begins to wield an economic vote. It begins to apply moral values to determine which causes and institutions to support. Property-less citizens find themselves not only wards of the state, but find that they have unwittingly surrendered their other rights as well.

Sadly, this doesn't sound too different from our current situation...

To Be Continued

Rusty Scalpel

Wednesday, July 30, 2008

Reader Recommendation: The Cato Institute

The Cato Institute is a libertarian think tank in Washington D.C. It's mission is to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Toward that goal, the Institute strives to achieve greater involvement of the intelligent, concerned lay public in questions of policy and the proper role of government. Cato provides great resources such as "The Cato Daily Podcast" and "Cato Events" which can found directly at their website or via iTunes.

The Cato Institute was founded in 1977 and is named for Cato's Letters, a series of libertarian pamphlets that helped lay the philosophical foundation for the American Revolution.

The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World, is a policy analysis by Micheal D. Tanner, the director of health and welfare studies at the Cato Institute. It is a 35 page analysis that critiques arguments made for national health care system in the US. To back these claims the author includes 13 pages of 300+ references. The length may seem daunting, but take the time and read the first 7 pages where the meat of the article is. You will find such statements as - "To a large degree, America spends money on health care because it is a wealthy nation and chooses to do so." & "When you compare the outcomes for specific diseases, the United States clearly outperforms the rest of the world." It definitely is a must read.

Monday, July 28, 2008

An ALDI sort of health care

In the town where I live is a branch of a German-owned, discount grocery store chain. It's ALDI. ALDI takes on interesting strategies to fulfill a simple goal: delivering high quality goods at discount prices. The end result is a quirky little grocery store that fulfills it's goal nicely. The quality of their goods are generally above average and their prices are low, usually lower than Walmart.

So, how does a business achieve rock-bottom, low prices without compromising the quality of their product? In ALDI's case, they focus on this goal and cut out normal grocery store functions that don't lend themselves to fulfilling the goal. The result is a store with less widespread appeal than a Walmart or Krogers, but with lower prices and a devoted customer base.

A person entering our location of ALDI will spot several departures from normal grocery store setups. For example, the customer has to supply a quarter to get a cart that is chained to the front of the store. They get their quarter back when they drop their cart off. That eliminates the expense of lost and stolen carts and the need for employees to gather them up. The customer saves money.

ALDI doesn't supply bags. The customer can buy bags from them or bring their own. And of course, ALDI has no baggers. Thus, ALDI saves paying additional employees. The customer does a little work but saves money.

I don't think I've ever seen more than two employees at any given time at our ALDI. But with a small store and no responsibilities other than checking people out, they are able to push people through at a good rate. I would imagine that ALDI has a much lower employee to customer ratio than most grocery stores. That may sound like a bad thing when considering customer service, but it's a lot less paychecks to pay and those savings are passed on to the customers.

ALDI carries a limited assortment of goods. They buy privately and in bulk and ship out to their stores. Their are able to beat national prices and end up with an impressive (and interesting) assortment of products. Of course their German products are good. Their produce is fresh and beautiful and their breads above average. Customers learn the nuances of their products, find their favorites, and get hooked.

So, ALDI may not be for everyone. But they fulfill their goal: high quality goods at low prices. They reach that goal by cutting out the peripheral services. They may not appeal to customers who like to be waited upon, but for bargain shoppers and those on tight budgets they can't be beat.

Now, we've said it many times on Free Market Physician, but the national health crisis (if such it can be called) can be boiled down to high prices. America is unhappy with the price of health care. For those of us who are business oriented, why not make our goal the ALDI goal: to provide high quality service at the lowest price possible?

To do so, I would like to suggest the ALDI method of price slashing: eliminate peripheral services. Doing so may make us quirky and limit some of the general appeal of our practices, but it will fulfill the crucial need to make health care affordable. What health care features could we slash?

Our favorite feature to slash at FMP is working with insurance companies. In some clinics, employees assigned to insurance billing outnumber physicians. I recently spoke with physicians at a practice who said that they could save up to 30% of their cost by accepting cash only. (Imagine the devoted customer base you would have if you delivered your services at 30% below other physicians' costs.) Patients who have insurance can pay at the office and later contact their insurance companies and be personally reimbursed. It's a hassle for some patients, but saves significant money for all of them.

Of course there are all sorts of other features that could do with some slashing. The goal is high quality service at rock-bottom prices. The current alternative is allowing the government to take control of the industry. So, what can we do to make our services more affordable? We'd love to hear your slashing ideas- post them in the comment box or send them to us at

Rusty Scalpel

Friday, July 25, 2008

What is the SGR?

The SGR is the Sustainable Growth Rate Forumla that determines physician pay rates for Medicare B patients. The plan is meant to control overall Medicare B spending.

For the last several years physicians have been seeing an increase of Medicare B patients and have been billing more for those visits year in and out.The SGR adjusts for this increase in spending by reducing payments to physicians- by about 4 or 5% a year. These cuts come to a field where prices generally increase about 7% each year. As a result physicians are increasingly underpaid for their Medicare patients.

For the last 5 years, those paycuts have been overridden by legislation. This year's threat of "Medicare Meltdown" was another SGR scheduled paycut. Currently, about 90% of physicians will take Medicare patients. The "Meltdown" occurs if paycuts are implemented and physicians find the Medicare patients to be too much of a financial burden and begin to turn them away. Annual overrides postpone this "Meltdown."

The problem with these temporary annual fixes is that they are refactored into the SGR. Each time a paycut is postponed, it is factored into the future Medicare budget. If the SGR remains as currently stands, annual paycuts will increase to higher percentages that will continue to have to be overridden year to year.

Scheduled paycuts that must be overcome by annual legislation: another reason I don't want to be part of a U.S. Government-run health care industry.

Rusty Scalpel

Wednesday, July 23, 2008

Medicare Bill Passed and We Smell a Rat

As our readers already doubtless know, last week President Bush vetoed the Medicare Improvements for Patients and Providers Act of 2008 (HR 6331), a veto which was promptly overturned.

President Bush’s move certainly did not make him popular with the AMA and AOA, which had been whipping their constituents into a frenzy to get the act passed. Of course, both organizations responded to the veto with an even greater vigor, calling for another volley of communication to representatives. As stated by ACOFP President Ronnie Martin in the July 15 newsletter, “The danger lies in not letting our voices be heard loudly and often as we face this final hurdle in our attempt to reform Medicare and the SGR.”

The AMA and AOA had their way and physicians have avoided their scheduled Medicare pay cuts again this year. They’ve done their annual civic duty. But what else did they do in getting HR 6331 passed?

The money to cover not cutting physician fees from the Medicare budget had to come from somewhere. The source of that funding probably passed unnoticed in the radar of many AMA and AOA constituents. That funding came from the Medicare Advantage program, which will now lose $14 billion in funding over the next five years.

Medicare Advantage, or Medicare C, is the branch of Medicare that allows its enrollees to use Medicare funding to select a private insurance plan instead of using Medicare A and B. The plan is sort of stepping stone towards privatizing Medicare, allowing enrollees to let insurance companies compete for their business, potentially driving down prices and improving quality.

Analysis of the aftermath of the bill by insurance rating and analyst company A.M. Best shows that less insurance companies may now participate in Medicare Advantage plans and that many enrollees may switch over to Medicare A and B. It stands to reason that with less funding available to purchase private plans, the quality of plans available decreases and that more seniors will be back on government-prescribed health care.

Free Market Physician won’t go so far as to call foul play on the act. The physician cuts for Medicare patients are ridiculous and needed to be dealt with. However, the means of fixing it in HR 6331 were only a temporary fix and played perfectly into the hands of those who advocate increased government control in the health field. For example, the AOA received a special letter of congratulations and thanks for their leadership and work in securing passage of the legislation by Senate Majority Leader Harry Reid of Nevada.

Free Market Physician won’t go so far as to out rightly condemn the AMA or AOA for using the Medicare pay cuts to motivate their constituents to fall in with a political agenda at this time, either. However, this act is just one of many examples of how the professional organizations have contributed to higher prices for health care, physician shortages, and increased government meddling in the industry.

Nancy Nielson, MD, President of the AMA thanked the physicians who had fallen in line for preventing a “Medicare meltdown.”

“I am so grateful to all of you, the patients and physicians of America. Without your effort this victory would not have been won,” she wrote on the AMA website.

She also stated that only the health insurance industry, for purely selfish motives, opposed the bill. She can put Free Market Physician on the list of those who are at least a little cynical about it. FMP will certainly have a more skeptical eye out in 18 months when Congress proposes its next “solution” to Medicare pay cuts.

Rusty Scalpel

Friday, July 18, 2008

Opposing Tides

While Free Market Physician advocates free market solutions and shaking off debilitating government restrictions to resolve health care problems, other entities continue to push increased centralization to try to control the industry. For such entities, a "smoldering crisis" justifies increased government control. We affirm that these efforts to control the industry are the core cause of its current dysfunctions, and further efforts to do so will cause increased dysfunction.

An example of these attempts to control is evident in a new publication from the Association of Academic Health Centers (AAHC) addressing problems in the healthcare workforce. The publication is available from the AAHC site. The stated premises are as follows:

• The dysfunction in public and private health workforce policy and infrastructure is an outgrowth of decentralized decision-making in health workforce education, planning, development and policymaking;
• The costs and consequences of our collective failure to act effectively are accelerating due to looming socioeconomic forces that leave no time for further delay;
• Cross-cutting challenges that transcend geographical and professional boundaries require an integrated and comprehensive national policy to implement effective solutions;
• The issues and problems outlined in the report have not been effectively addressed to date because of the inability of policymakers at all levels to break free from the historic incremental, piecemeal approaches; and
• Despite many challenges, the prospects for positive change are high.

We encourage our readers to examine the publication and comment on its merits and downfalls.

Rusty Scalpel

The Invisible Hand

A Concept All Too Often Forgotten or Not Understood and Left Out of the Debate

(Free Market Physician welcomes its first guest contributor, CATO, to the forum. Thanks for your submission.)

Earlier this week I watched a documentary, made by a physician, addressing the problems facing our medical system. I was hoping that the physician would reach a free-market based conclusion. However the documentary appeared to be more of an elitist version of Michael Moore’s “Sicko.” The producer/physician made the following statement: “Our healthcare system is a bizarre blend of the worst of capitalism and the worst of socialism. It isn’t a system at all. We need to get over our fear of the government and embrace the idea that in healthcare somebody needs to be in charge so we can keep our eye on the prize which is health, not profits.”

I’ll have to admit the first part of his comment tugged at my heart strings. I remember thinking - has capitalism failed us? After all, the only logical approach to fixing healthcare is the free market system, right? After much thought I realized that we don’t even have a capitalistic system and I guarantee that we don’t have the worst of a socialistic system. We should call our system for what it is - interventionism and corporatism. Capitalism implies that a free market is in place. Our healthcare system is so heavily regulated from state and federal agencies that hardly any free market forces exist.

Another statement in the movie that I found to be disturbing was when a former editor of the New England Journal of Medicine said “I don’t believe that Americans are born as greedy cowboys who don’t care about the community and who’s aim in life is to be richer than anyone else. This happens to many Americans because they are bathed in that ideology.” After hearing these comments I started to wonder if they had forgotten, do not understand, or have lost faith in the “invisible hand.”

The invisible hand is a fundamental economic concept that is all too often forgotten and left out of the debate. Adam Smith, the father of economics, described this concept in his magnum opus The Wealth of Nations. Smith said that when man intends only to increase his own gain he is “led by an invisible hand to promote an end which was no part of his intention. Nor is it always the worse for the society that it was no part of it. By pursuing his own interest he frequently promotes that of the society more effectually than when he really intends to promote it.” In other words when everyone does what is in their best interests, society benefits as a whole. It is as if by pursuing individual self interest there is an invisible hand pushing society towards it’s best interest as well. Smith did not state that when government does what appears to benefit itself it in turn benefits society. He was referring to individuals.

Capitalism is one of the purest forms of democracy. With each dollar, individuals are able to vote and give proper value to the goods and services they consume. Our current healthcare system is almost void of capitalism and it is not surprising that there is not an invisible hand pushing society towards an optimal state. Consider these questions - Who owns your healthcare dollars- your vote in the system? and - Do you own the decision what to do with those healthcare dollars? More than likely, half of it is owned by an employee-based health insurance company, and the other half is owned by government to fund Medicare and Medicaid. The decision on how the dollars are spent are left up to those respective single payer systems.

Before World War II American’s paid cash for medical expenses. Rich and poor received care regardless of ability to pay and government intervention. During WWII the government implemented wage restrictions to reduce incentives to work in the private sector. To counter that obstacle the private sector offered health insurance to compete with government restrictions. In 1965 the Medicaid and Medicare was signed into law. Then in 1973 the Health Maintenance Organization Act was passed.

All these programs have transferred ownership of healthcare dollars from individuals to a select minority with the promise of managing healthcare dollars more wisely. Unfortunately this has not been the case. With the convergence to single payer systems our healthcare system has been insulated from free market forces, driving up costs and thwarting the invisible hand. To counter and restore capitalism to the healthcare industry, health savings accounts are starting to appear, returning ownership of healthcare dollars to the individual.

The concept of the invisible hand may seem contrary to utopian ideals because it implies that individual greed is good. The concept that American’s “aren’t born greedy and it is explained by an ideology they were taught” is completely erroneous. It is human nature to pursue one’s personal interests. We need to get over the concept that greed, doing something for personal benefit, is a bad thing. We need to embrace the idea that individuals, not government will serve the best interest of not only themselves but society. Putting everybody in charge by giving individuals ownership and the power to decide how their healthcare dollars are spent, returns the incentive to reach the prize which is health and profit.


Thursday, July 17, 2008

Reader recommendation-

Here's a great recommendation sent to us by one of our readers- The site has great arguments for why government-run health care is not for America. Thanks for the submission!

Wednesday, July 16, 2008

Congress Overrides Medicare Veto: So Did America Win?

We're looking for some feedback from our readers. As we all know, the AMA and AOA were pushing pretty hard to have this bill passed and now they've had their way. Doctors are now protected from a 10.6% funding to treat Medicare patients. One of many adequate news pieces on the subject is available at:

So did doctors, patients, and America win on this one? Let us know what you think! Please post your comments in the comment box or email them to

Maytag and Rusty Scalpel are doing some additional research on the subject and their take may surprise you. Check back in the next couple of days for their analysis of the bill and veto.

Rusty Scalpel

Thursday, July 3, 2008

Economics Dictate the Health Care Solution

The fact of the matter is that many Americans feel that the price of health care is too high. Lawmakers and pundits have confused this problem with the price of insurance, but that price is secondary to the high cost of health care.

Why then, is the cost of medical care high? Let’s boil it down to the simplest answer. Economically speaking, medical care, like all other commodities, is scarce. It is limited. Like every other good or service on this planet, there is only so much medical care to go around. There are only so many doctors who can work only so many hours. There is only so much staff to help those doctors. There are only so many pharmaceutical companies making so many medications. The price of health care reflects this scarcity.

Realizing that commodities are scarce is the bedrock concept of economics. Only accepting the fact that health care is a limited or scarce commodity and understanding its implications will allow Americans to crack the nut of health care prices.

Such a degree of emotional irrationality has been connected with health care, that let’s simply refer to it as Commodity A in this commentary. Commodity A is expensive because it is scarce. What can be done about it?

First and most obviously, we can produce more of it. To produce more of Commodity A, America needs more physicians, nurses, medical staff, pharmacists, chemists, research, chemical resources, etc. It needs more educational institutions and it needs greater focus from the consumer population. Without going into long economical explanations, we can with complete assurance say that if the market is undisturbed by external tinkering and if health care remains a priority for American consumers, then more of Commodity A will be produced. It’s availability will increase, scarcity will decrease, and prices will drop.

What else can be done to deal with the scarcity of Commodity A? Let’s think of a shortage in another commodity, say oil. That’s one we can comprehend. If America was faced with a shortage and thus high prices in oil, how would consumers respond?

Americans might be a little bit slow to respond to the price changes at first, but they would eventually become more frugal in their use of oil. They would try to use less of it. The high price of oil would force them to determine which uses of oil were most important. Is the use of oil for heating important? Is the use of oil for transportation important? Are there substitutes for oil that might be more cost efficient?

Compelled by high prices to make responsible decisions, American consumers would decrease their dependence on oil. They would find other fuels for transportation. They might decrease their overall need for transportation, perhaps by working from home and carpooling when necessary. They would find new ways to heat their homes and produce synthetic goods.

It may require a lifestyle change, but through conservation and substitution, Americans would reduce their need for oil if prices stayed high. Demand would decrease. Supply will be better suited to meet demand and the price of oil would fall as suppliers were forced to entice a now diminished number of demanding consumers. The oil crisis, if that’s what it is, would be over.

Let’s assume that the market for Commodity A were similar to what it is for oil. Commodity A is limited. The product is scarce. Demand exceeds supply and as a result, prices go up. American consumers for Commodity A are forced to start making decisions. How important is Commodity A to them? Are there ways that they can reduce their need for Commodity A? Are there substitutions for Commodity A? Are there some uses for Commodity A that are more important than others?

American consumers might be slow to respond and adjust, but they would be compelled by the high price of Commodity A to start making responsible decisions. They would find ways to decrease their dependence on Commodity A. High prices may compel them to better eating, exercise, reduced alcohol, tobacco, and other drug consumption. High prices would compel them to determine which uses of Commodity A were more important than others.

Eventually, through conservation and substitution, overall dependence on Commodity A would decrease. As demand fell to more closely match supply, scarcity would decrease. Prices would drop as suppliers were forced to entice a now decreased demand. The health care crisis, if that’s what it is, would be over.

Unfortunately, it is the sad truth that the market for health care (calling it now by its true name) is not a normal market. Americans have attempted to insulate themselves from the price of health care in order to avoid tough decisions about substitution and conservation. They try to avoid allowing cost to play into their health care decisions. They argue that health care should be obtained regardless of the cost and then complain about the cost.

Their philosophy is apparent in the health insurance industry. Americans choose comprehensive insurance plans that cost more than the actual price of health care, but allow them to be insulated from and thus escape facing the cost of each purchase of health care. Americans on comprehensive health insurance plans often behave as though health care were not a scarce commodity. They make office visits and obtain procedures without regards to cost, trying to "get their money‘s worth," since they have already paid their premium. As they use up available health care, scarcity increases. Supply decreases. The price of health care and thus their insurance premiums go up.

The philosophy is apparent in Medicare and Medicaid. Americans are opposed to certain populations going without health care. These populations are insulated from cost or even given free health care. As a result they do not seek substitution or conservation as they otherwise would and consume health care at an increased rate. The scarcity of health care increases. Supply decreases. The price of health care goes up.

Many politicians propose solutions to the “crisis” in health care. Such solutions generally involve more extensive insulating of consumers from the price of health care. For example, Hillary Clinton proposed that all Americans have access to the same level of health insurance that members of congress receive as a means of bypassing price and increasing access to health care. However, it is apparent that such a plan would only encourage an increased consumption of Commodity A. It does not address scarcity, nor encourage conservation or substitution for the commodity. Supply decreases. Scarcity increases. The price of health care goes up.

The same result can be anticipated with any plan to socialize health insurance or directly socialize health care. Any plan that treats health care as if it weren’t scarce will increase its scarcity. Price fixing, price subsidization, and increased numbers enrolled in Medicare and Medicaid- all these will encourage consumption, increase scarcity and thus raise the price of health care and likewise insurance premiums.

So, what can be done to decrease the price of health care? Of course, supply should be and is increasing. However, a rescue by increased supply will seriously lag as it becomes apparent that government tinkering in the market will increase.

The principal solution for the scarcity and thus the high price of health care is found in allowing the consumer to be exposed to and thus compelled by high prices to make responsible decisions about health care. There is no terror to be found in conservation and substitution. Consumers will face the scarcity in health care as they do with any other commodity- by limiting their use of the commodity to the most important purposes. As consumers shoulder this responsibility, they will find financial prosperity, increased health education, and an overall increase in good health.

And of course, demand will decrease. Scarcity will decrease. Supply will be better suited to meet demand and suppliers will be compelled to entice consumers to use their product. And the price of health care will fall.

Rusty Scalpel

Wednesday, June 4, 2008

The Proper Role of Health Insurance

Poll a hundred Americans and ask them what the purpose of health insurance is. The majority will tell you that it is important to have health insurance in case something happens to them medically that they can’t afford.

The general understanding of insurance is as follows: A large number of people make periodic, relatively small payments (insurance premiums) to a common fund. The payers do so with the understanding that, in the off-chance that physical hardship should strike, they will have access to the common fund so they won’t be ruined financially. Each payer must anticipate that they will probably not ever get back the money they put into the system. They are paying for insurance- the assurance or security that should something really bad ever happen to them, there will be funds to cover the medical care necessary.

The system makes sense. Each individual payer parts with the money paid as periodic insurance premiums, knowing that they will probably never see that money again. They are paying for the “just in case.” Their payment leaves them with enough income to cover their standard of living, and it is worth a small sacrifice to prepare for the future. They feel they are doing something responsible and they probably are.

Contrast the generally understood, common-sense version of insurance with what Americans are doing in practice. Americans forfeit significant percentages of their income, either personally or through their employers, to cover a different kind of medical insurance. The money paid is not dedicated to in-case-of-a-rainy-day medical problems. It is paid to insurance companies to cover routine prescriptions, health screenings, runny noses, ear aches, and allergies- health situations not in the least bit unexpected or catastrophic.

Comprehensive insurance moves beyond covering just the rainy-day emergencies. It expands beyond- is more comprehensive- than a catastrophic plan. It serves to allocate and manage routine medical payments and spread those medical costs among the customer base. Comprehensive insurance buyers pay insurance companies to manage their funds and even make some medical decisions for them. These managerial decisions include which medications they can purchase, which doctors they can see, and even how much money they can spend on medical expenses in a year.

The majority of Americans have bought into the comprehensive insurance system. But it is apparent that Americans are not happy with the system they are practicing. They gripe about the costs of their premiums. They mutter as they pay hundreds of dollars per person per month for health insurance. They rage when after paying a hefty premium, they are stuck with a co-pay at the end of each doctors visit. They complain when their insurance will not allow them to buy their medications of choice. Why, after dropping $250 as an insurance premium, should the payer still have to pay out $40 out of pocket as a co-pay for a $150 visit?

Americans have forgotten that they are no longer paying for the insurance of possible catastrophic problems. They are paying for comprehensive management of their every-day health problems and every-day health expenditures. That comprehensive management costs money. That comprehensive management requires extensive manpower. In fact, Americans are paying the salaries of nearly 500,000 health insurance personnel with their insurance premiums. That is the salary of 500,000 individuals that they are covering in addition to the cost of their medical care with each monthly payment.

Comprehensive insurance is not for all Americans. In fact it probably isn’t for most Americans that are now on it. Many Americans pay for a policy, thinking that it will somehow save them money. The brutal truth of the matter is that the average American MUST by all the laws of logic, mathematics, and physics pay more money for their health insurance than they would otherwise pay if they directly managed their health care. In using comprehensive health insurance they are paying to have medical decisions made and their medical funds managed, a service most Americans would probably rather perform themselves. In so doing, they are covering the salaries of nearly 500,000 health insurance employees (see reference). How could they save money in the process?

In addition, we should not forget what the insurance industry costs the clinics. To maintain contact with insurance companies and maintain a current understanding of the ever-changing policies, medical practices must hire individuals especially for working with insurance companies. Primary care clinics often must hire MULTIPLE “insurance people” per physician to work with insurance companies. Thus American consumers are doubly charged for their health insurance: once when they pay for comprehensive services with their premiums, and a second time when clinics raise their rates to cover the manpower to correspond with insurance companies.

And so, in a time when America looks to decrease spending on health care, suggestions to legislatively increase the numbers covered by comprehensive insurance should appear absolutely ridiculous. Assertions that comprehensive health care should become mandatory should appear perfectly insane. Those who make such suggestions either do not understand the nature of health insurance or have sinister and damning plans for America’s future.

Rusty Scalpel

Monday, June 2, 2008

Free Market Physician's Response to an Invitation to Investigate the Wyden-Bennett Bipartisan Universal Health Care Bill

My thought- a terrible idea.

Why? It doesn't address the real issues in health care. The real issue is the rising cost of health care itself. America is fixated on health insurance, thinking that solving insurance problems somehow fixes problems in the medical system.

It doesn't, though. Increasing the number of individuals covered by insurances simply continues to bloat the insurance industry. That's just another level of administrators to pay- another hand reaching into the pocket. The addition of a another level of bureacracy can in no way reduce the cost of health care. The rising costs of medical care cannot be blunted by the insurance industry- it can only be further accentuated by the salaries of insurance employees.

In addition, making the insurance required limits individuals' control of their own health care and limits automony of physicians and other health professionals.

Consider the money spent by physicians performing unnecessary tests and procedures covering them from liability and conforming to insurance companies requirments. Now imagine them conforming to the requirments of a government subsidized and controlled insurance industry by which every American citizen is covered. I foresee an astronomical and loss of autonomy and money. I would consider the autonomy (both of patients and physicians) the most shameful of the two losses, since it would be the loss of the true means for solving health care problems.

The plan to maintain employers' contribtutions to 2006 levels is all fine and well, except it presents the prospect of either the federal government (and thus the taxpayers) coughing up the difference between 2006 rates and future inflated insurance costs OR the now federally-funded and embraced insurance industries locking down their reimbursments rates to health care providers. Since medical market economics have been legislated out of the picture, that is a very real possiblity.

Providers are already in a fix as the federal government does not fully reimburse them for Medicaid patients. If the plan goes through, essentially all patients are medicaid, and providers find themselves subject to the whims of insurances companies and senators as to whether they will actually be fully reimbursed. We think, poor physicians, they won't be able to make any money. But the real problem will be, poor America, it no longer has any health care.

The plan is simply a numbers game. The senators from Utah and Oregon say that they can make 2+2=3. But at some point 2+2 must equal 4. That difference will have to be made up.

Rusty Scalpel

Canada, 30th in the World Heath Care Ranking

While Canada ranks 30th in the world for health care according to the World Health Organization, United States ranks only 37th.

World Health Organization's Health Care System Rankings

1 France 2 Italy
3 San Marino 4 Andorra
5 Malta 6 Singapore
7 Spain 8 Oman
9 Austria 10 Japan
11 Norway 12 Portugal
13 Monaco 14 Greece
15 Iceland 16 Luxembourg
17 Netherlands 18 United Kingdom
19 Ireland 20 Switzerland
21 Belgium 22 Colombia
23 Sweden 24 Cyprus
25 Germany 26 Saudi Arabia
27 United Arab Emirates 28 Israel
29 Morocco 30 Canada
31 Finland 32 Australia
33 Chile 34 Denmark
35 Dominica 36 Costa Rica
37 United States of America 38 Slovenia
39 Cuba 40 Brunei
41 New Zealand 42 Bahrain
43 Croatia 44 Qatar
45 Kuwait 46 Barbados
47 Thailand 48 Czech Republic
49 Malaysia 50 Poland
51 Dominican Republic 52 Tunisia
53 Jamaica 54 Venezuela
55 Albania

Friday, January 18, 2008

Health Care: A Right or Commodity?

Little introduction is needed to the topic, considering the social and political climate of our nation. The question is proposed as to whether health care is a basic human right. For many, the answer to the question dictates whether a national health care policy should be implemented. The key to the argument lies in what we understand a right to be. For my argument I will appeal to the Declaration of Independence. This argument may appear outdated, but it has endured nearly 250 years while many other popular notions have come and gone.

What constitutes a right? Do rights change according to time and place? Are rights determined by their availability in a given economy? Who has the authority to determine what rights are? Or to suspend them? The Declaration sheds some light on these questions when it states that “Men… are endowed by their Creator with certain unalienable Rights.”

The Declaration describes rights as unalienable, meaning they cannot be surrendered or transferred. These rights are innate and inherent to humanity. They come inseparably coupled with man’s ability to think, to reason, to moralize. The rights are generalized as Life, Liberty, and the Pursuit of Happiness. They are specified as the right of free speech, the right to assemble, the right to pursue religion, property rights, the rights of self protection, and others.

The Founders’ claim to King George III was that he could not separate them from these rights, according to the Laws of God and the Laws of Nature. Those rights came not by the allowances of men or government, but as part of the package of human existence. God had bestowed them, and no earthly power could remove them.

Compare such rights with the proposed right to health care. The argument is now common: “In a nation as wealthy as ours, it is ridiculous not to have health care available to everyone.” The point has validity, but it demonstrates that universal provision of health care does not pass the criterion of basic human rights. The argument demonstrates that one motive for extending health care as a right is its availability. Health care, unlike true rights, is not unalienable- it is subject to economics, legislatures, the locations of clinics and doctors, and the goodwill and disposition of mankind.

This is not to say that it is not our responsibility as physicians to make health care available. We do have the moral responsibility to serve our fellow man, even at sacrifice to ourselves. However, this responsibility does not make health care a right or entitlement. It is not a basic human right any more than owning a home, owning good shoes, having high speed internet, or having any other available commodity that is so easily alienable from humanity.

The true rights, God- given rights, are not commodities. They are inseparable from our natures. They are God’s gift to us to choose our course and pursue our happiness. They are not the happiness in and of themselves, but the opportunity to embark on the chase.

Health care is not a right. It cannot be expected because of human existence. However, it may be part of that happiness and security mankind is chasing. May mankind treasure, understand, and exercise their true rights to obtain it. As a physicians we must do all we can to make it increasingly catchable.

Rusty Scalpel