Michael H. Wilson at Evergreen Libertarian:
Comparing medicine as practiced in the U.S. with that of other nations is like comparing the Catholic Church with the Protestant ones. They all profess to be Christians, but from there they all diverge.
It is nice to be able to talk about health care when you are healthy. It is an entirely different issue when it is you who is experiencing the problem. That being the case how do we Libertarians deal with the issue and I certainly won’t say solve it, because we are not going to solve the problem any time soon and by that I mean in the next fifty years.
Ironically the American Medical Association has been one the most vigorous opponents to change in the American medical system. That doesn’t mean to suggest that they have supported an open market, or what we might call a free market. They have not. To be sure doctors may talk about free markets, but when it comes right down to it, that is the last thing they have wanted if history is any guide.
They have done everything they can to run the competition out of town and that includes chiropractors, osteopaths and midwives; especially midwives. They opposed advertising, and anything that let the patient know beforehand what the costs were going to be. The AMA opposed prepaid care in the late 1800s and they opposed it until recently. Pre-paid medical care was first seen in a big way amongst the immigrant fraternal organizations in the late 1800s and pre-paid care is what the HMO are all about today.
Western medicine especially as practiced in the U.S., had and continues to have a bias against alternatives of the types of medicine practiced in other parts of the world such as India and China where for a few thousand years information was collected about which solutions worked best. Those biases often became enshrined in our legal code.
Here are a number of things that we need to think about, but there certainly is more.
Midwives – midwives deliver most of the infants in our world and do so with better results than MDs. Generally speaking they have lower infant mortality rates, better birth weights, and lower rates of intervention and do so at lower costs.
Medical research – about 85% of the world medical research is paid for in the U.S., and many of these studies are questionable. The government should reduce its spending on medical studies and leave that to the private sector.
Occupational licensing we are told is there to keep the unqualified physician from working, but in reality licensing has been a tool that the established medical profession used to keep those who worked as pre-paid physicians in line. All too often the local medic al society would threaten doctors with the loss of their license if they were caught working with a pre-paid program. When Henry J. Kaiser started Kaiser healthcare during WWII that was one thing, but when Kaiser sought to expand and keep the program going after the war the local medical societies fought his doctors with everything they had just short of slander. The doctors working at Kaiser lost opportunities to consult, they were denied referrals a, they were threatened with loss of the medical license and denied acceptance to the local medical society. That last issue may have been the most damaging because the local medical societies often provided malpractice insurance at a discount. Doctors outside of the society were not able to get the insurance at a reduced price.
Paul Starr in his book The Social Transformation of Medicine mentions that if doctors offered to back up midwives they might be threatened with the loss of their medical license.
The McCarran-Ferguson Act – this law has allowed the states to regulate the insurance industry and has resulted in the balkanization of the insurance industry. The industry loves it because in many states the insurance commissioner or state board does not have the expertise to deal with the industry
The way we die – we spend much of our medical dollars in the last few month of life, but much of those dollars could be saved if all of us filled out advance directives and filed them with our doctors.
Corporate practice of medicine laws- prohibited doctors from working as employees of corporations in some states. What the status of these laws at present is up for debate. The laws were used by the AMA to slow the development of HMOs
Certificates of need – these certificates which are required in 36 states and are intended to reduce the duplication of services amongst medical care providers. Instead they reduce competition and require that those who wish to compete must spend money to prove their case. Sometimes it amount to millions of dollars in questionable spending required by the government.
State Medical Boards – the groups are a benefit for the profession rather than doing much to protect the patients.