A lot of Liberals are fond of claiming that there are many Americans who leave America and go to other countries to get health care that they can't get here and that this somehow proves that our system is messed up and needs fixing. And that there are Americans that need to stay in a hospital, that either can't get into one, or are discharged too early for their condition. That made me wonder for a long time. It contradicted all the ideas I had about America's health care. I have always thought that ours was the very best in the world. But I finally figured out that they are absolutely right on every count.  There are many instances where Americans travel to other countries for treatments not available here. Mexico is the most common destination, but there are other countries to which they travel as well. And why do they go there? They are seeking out treatments which are not approved by the FDA or other bureaucratic agencies. These are often experimental drugs or not thoroughly tested methods. Our government has very strict standards of what is and is not allowed, based upon medical evidence of the physical benefits for the patient. So some people, in a desperate attempt to cure a terminal cancer or other disease, will go to a clinic in another country, even if it is not up to our standards, to try one of these unapproved drugs or treatments.

Now, whether or not our standards should be lowered to allow these people to remain it the United States to receive their treatments is a topic for another discussion. However, for this discussion, what is relevant is what causes these people to seek treatment outside the U.S. The most obvious reason is the involvement of the United States government in deciding what treatments are to be made available to the citizens of our country. If our government were to allow these treatments here, doctors, or hospitals, or clinics, or faith-healers, or charlatans, or someone else would offer them. Whether or not the treatment works, or is wise, the patient will still have the opportunity to purchase those services he deems worthy of his money and body. And if we institute a government run health-care system, we will not make this travelling-abroad treatment less likely to occur, but actually more likely. If the problem is too much government control, based strictly on medical questions, how can more government control, including introducing cost considerations to the government’s decisions, bring about a solution to this situation? (Joe's note: Perhaps this is how Barack intends to 'reign in costs', by making people leave the nation and buy it with their own money which cannot be quantified.)

Consider also, who is it that is doing the travel to other countries? Is it the poor? The uninsured?  The homeless? No, obviously, it’s the wealthy, or at least the middle-class, people with some means. These are usually people with insurance and available treatments, but who are running from a government-controlled system that does not allow them the treatment of choice. Will this exporting of patients stop under any of the plans now before congress? Of course not! What, in fact, will be the result when the new system begins telling patients that it is not cost-efficient to treat their condition, and to offer a pain pill? (That was the solution offered by President Obama on June 25, 2009, in answer to a question by Jane Sturm.) There will be more people than ever flooding to Mexico or where ever they can find the treatment they feel they need.

And then there is the situation of hospital rooms not being available when needed, or the insurance company insisting on an early discharge or out-patient treatment. What is the most fundamental rule of economics? The one economic statement that people can quote that know nothing else about economics? “The Law of Supply and Demand.” This is not an occassional rule but a law that always works at all times, in all situations. The Soviet Union found it could not avoid it forever. They bent it, twisted it, but eventually it broke them. President Nixon’s Wage and Price controls proved that, like a rising tide, artificial restraints will be washed away in the clutches of this simple law. Just like gravity or the Borg, “Resistance is futile.”

The law shows how when the demand for a product goes up, the price goes up. As the price rises, competition enters the market as an opportunity for profit is recognized. Then supply rises and price goes down. As price goes down, there is less incentive to produce the product, so competitors pull out of the market, and supply goes down, beginning the cycle again. Only in a diverse (individual), free and open market, these shifts happen so subtly that it is usually unnoticed, until there is a sudden disruption to the market, or there is some type of limit introduced to the market.

And what has the law of supply and demand got to do with the cost of hospital rooms? Well years ago, hospitals were free to build a facility where ever they decided to build. Sometimes the motive was to make a profit . Sometimes the motive was more altruistic. However, it was up to whomever was in the hospital building business to make the choice for whatever reason seemed to be fit to them. But then in recent years, the government decided that this system of supply and demand wasn’t proper for hospitals, and they began to dictate where hospitals were to be located and how many beds were to be in them. There were targets set to limit the number of  beds in each area. The perception was an empty bed was unprofitable, so beds should be near capacity at all times.

Now the clouds begin to part, and we begin to see the connection between out-patient surgeries and basic economic law. When the number of beds went down, price went up. But the supply was artificially restricted by government mandate, and so the resulting effect was a continued rise in the price. And as the cost of a bed went up, the insurance companies had to try to control costs in the only way left to them: out-patient surgery and early discharges. So what is the cause of this symptom of a health-care system that is broken and in need of repair? Government agencies making decisions that affect the health and well-being of millions of Americans not on the basis of medical practices, but on the perceptions of a bureaucracy, on the basis of what they deem important, and arbitrarily so.  (Joe's note: the left likes to state that capitalism demeans humanity, that it reduces a person to their economic vitality. The opposite is true. It is demeaning to human life to collectivise it, to override the value of an indivdual, which is in large part economic value, to a mere return quotient society will see as a result of permitting that individual access to care, education, or their own labor. Nothing devastates the will, nature, and dignity of a man more than separating him from his natural right to have total control over his own faculties, this right of course being circumscribed by the identical rights of every other man.)

Now, I’m not saying that government regulation of the medical profession or health-care system is wrong. We need government regulation of many things in our lives. The Founding Fathers knew that. That’s why they instituted the Constitution and our system of government. They knew that a government unchecked by the control of the people was tyranny, but a people without a government was anarchy. Neither was acceptable. Thus, they instituted, not a democracy, but a republic, whereby the people would be the overseers, but the Legislative and Executive Branches would manage the limited powers given to the government. But many of the Founders warned of the dangers lurking in striking that delicate balance.(Joe's note: Enforcement of contract law between patient and doctor is an area of government's duty, as with contract law between any two parties. People who agree to a contract are bound by thier word to it.)

Now we find ourselves on a precipice from which we may never recover if we take that leap of faith, trusting that our government is the best agent to decide what is available to us medically as a people. As I have shown, government control of health-care is not new, and it has shown that even with the best of intentions, it can make a bad situation worse. We have all dealt with various nameless, faceless people in government offices, in stores, on the telephone, etc. who make it plain that they are not interested in me as a customer, and would rather I just leave them alone, instead of having to do their job of helping me.

Well, if I’m in Wal-Mart, Kroger, or my local bank, and I’m not satisfied, I can walk over to Target, Marsh, or another bank to do my business. But if  I have the government providing my health insurance, where will I go if I’m not satisfied? Of course, President Obama  has assured me that if I like my insurance, I can keep it. But according to the proposal now before Congress, H.R. 3200, Section 102, (a), 1, (A.), on page 16, I can only keep what I have; if I am unsatisfied with my company and would like to switch to a different company, I cannot. My only alternative is to join the “Collective.” No other company is legally permitted to write a policy for someone who is not already a policyholder.

And finally, you may be perfectly satisfied to have your medical decisions up for review by the appointees of  President Obama, and the fact that he may make decisions on whether or not you get treatment for some disease based on whether the budget deficit is too high or if there are other diseases that are a higher priority, or whether you are a Republican or a Democrat. But what if our next president turns out to be someone like VP Cheney or Richard Nixon? Do you want to put that power in his hands? Remember, when you create a monster, that monster can turn on you and eat you as easily as he can eat your enemy.
 

On our horizon, I fear, looms a great and terrible beast, alluring in beauty to those who cannot or will not recognize the glitter of fangs or distinguish from a luxuriously brushed coat, the claws which peek out.

It has become second nature for politicians, propagandists, and aspiring demagogues to seek and secure power by appealing to the vanity of man's imperfections. This past Presidential election was no less an example. Essentially, the race was not between opposing world-views and ideologies at odds with each other. Instead, each candidate tried to out-promise the other to secure votes by effective bribery. The only distinction between typical bribery and the conduct we observed, primarily from Obama but reciprocated in McCain, is that the candidates promised taxpayer money for a vote, rather than promising a vote in return for private money. In a free society, legality does not translate to morality, although I think the case can be made that such redistributionist action can and ought to be made illegal. I suppose, in the end, the equation is different in semantics. Money changes hands as a reward for voting a particular way. Which party does what matters little.

But, the beast which may spell forever the death of individual freedom and the possibility for its recovery, is so called 'health care reform' which is simply the latest moniker and mask for the nationalization of all medicine and care. A great many others have gone into intricate detail as to exactly how any sort of health care promoted by the current crop of control-freaks is truly, at heart, a simple, if slow, takeover of the individual's right and responsibility to choose.

In an earlier post I noted that the individual is the only agent capable of properly ascribing value to his produce. If he does not feel the exchange offered for his effort is of great enough value he does not have to engage in the transaction. He is also the only agent capable of properly ascribing value to those things he desires; he does not have to purchase. So, how does this apply to health care and services?

How would an individual approach a situation of so-called 'universal' health care coverage? First, you must understand the individual. Humans are self-interested by nature. We are primarily concerned with the well being of our own bodies, and not those of other people to any extent so great. That is why it is laudable and displays uncommon valor when our military men and women gallantly sacrifice themselves to save their brothers in arms or even we Americans and our liberties. But the overwhelming average human approach remains that each person cares more for himself than he does any other person. That is not greedy. It's survival and is moral since no one must take up the slack to provide for your survival if you take care of yourself with your own able-bodied/minded effort in the first place.

So, since the individual values himself infinitely to remain alive and as physically worthless when dead, it stands to reason that he will act on that pricelessness by visiting doctors, hospitals, and clinics for every single malady or ailment, whether legitimate or perceived. He will not economize because his life is infinitely valuable to him. The only reason to economize, the true cost of procedures, he no longer has to pay.

The statement of infinite value is made consistently by the left and the right. Life is too valuable to be arbitrarily tagged at a price. I agree, wholeheartedly. But all things cost money. So, what about the life of doctors, nurses, biochemists, surgeons, anesthesiologists, psychologists, pharmacologists, and mechanical engineers? No one advocates that those people be disallowed to charge for their labor and their expertise. There is a value which cannot be separated from the services and products they provide. Who is to value what they are worth, what their efforts and skills are worth? They are and their patients are. To say that someone should have no authority in setting their own worth is to declare them unworthy of basic humanity. Additionally, to say that a government bureaucrat should have a stake in what transaction a doctor and patient can agree upon or even to declare that they must engage in a transaction, is similarly debasing of individual human freedom and worth.

So, what of the patient, you ask? The patient is prime to decide his own worth as well. He will value his life infinitely, regardless of the system set in place. But no system can accept infinite value, because all medical care requires effort and all effort is limited to the time each of us has on this Earth. I advocate that people be permitted to engage in those transactions they mutually agree upon, without arbitrary force being applied to either. Once again, to try to separate a person from deciding their own worth is similar to the attitudes which enable slavery. It is simply debasing and devaluing life.

So, the doctors value their time and effort infinitely, trying to better their situation and their families' situations but at the same time patients and patient's families value themselves infinitely as well. How are these people supposed to come to grips? The media, education centers, and current political establishment will tell you that a system which assigns real-world numbers to the treatments will provide the proper care to the people who need it.

I agree with that as well. However, with players of self-professed infinite worth on either side of the transaction and neither having any responsibility to market forces, there remains only one way to settle the trade; bureaucratic force. I have little faith in people who can logically regard the benefactors of their decisions as arbitrary to their own existence. With such players calling the shots, there will be a vast amount of dissatisfaction because very few people have any real control over their situation.

Would free market forces settle trades as well? Yes, and much more efficiently since the players involved in the game are much more in control of their own situations (See note below). In the case of insurance companies, customer satisfaction is the ultimate goal because to continually disappoint the customer means to lose them to competitors, and thus continued survival of the company demands quality care. The same is true for doctors. Patients will find themselves limited by their financial circumstance but most will be able to pay for their disaster coverage on health insurance, as long as the government gets out of the way of insurance companies writing the plans their customers demand.

Finally, I'm a strong believer in private charity. I know for a fact that people are built with a degree of compassion and empathy and when successful will give in larger portions to those who truly need a hand up. The real difference between this action and what they government seeks to do is that private charity is much more carefully doled out. Abuse is not nearly the problem with private money that it is in government. Is that statement subject? Sure, but is it not also a fact we can all observe, especially with this current government which simply 'lost' several hundred BILLION dollars? You do the math. Regardless, no one is as careful with someone else's money as they are with their own (Ref. the great Dr. Milton Friedman).

I'll leave off with this statement; there is no preservation of human life in the collectivising of a population. That demands weeding out the individuals who are a thorn to the social objectives, individuals who seek their own objectives, and individuals who are unproductive to meet their rate of consumption from the public coffer. There is no way around that. Read here and make sure to take close note of Britain's QALY system which rations care based upon a person's usefulness to society. Once a society embraces doctor-assisted, government-funded suicide (as several states in America have) and nationalized health care, the difference between eugenics actions of Nationalsozialisten, slaughtering millions of people, and the 'usefulness' formulas for American health services, are a matter of who is targeted and why. The end result is the barbaric murder of the defenseless, for a social goal. No, the only moral arrangement is for individuals to operate as individuals without outside force compelling them to act in any way to which they never agreed.

Note: I feel it's necessary to acknowledge the situation of 'emergency' care. A patient may have no control over their receipt of care if the situation which demands care has incapacitated that patient. Thus, the doctor hasn't the slightest idea if the patient can pay for their services, or if the patient would desire services at all. In these cases, I think it is fair that the doctor, by Hippocratic oath, will do their level best to restore the patient to health. As far as I am aware, all hospitals have either write-off budgets for those patients who simply will not be able to pay, and for whom no funding will be received, even from government, or financial experts who will help patients set up payment plans that anyone who holds a mortgage or a car loan would die to have (pardon the pun). As it stands, the market could be made a great deal more free and it is very obvious to me that such a reduction in government invasion would be a great boost to American medicine, which is already the best in the world. To this add tort reform, a cancellation of all mandates on insurance companies, a heavy handed reduction or even closure of the FDA, and set in motion the phasing out of medicare and medicaid programs to be replaced by private charities, and nothing would stand in the way of patients, doctors, and companies for mutually benefiting each other in transactions. As it stands right now, before the beast rises, American medicine is not really all that free.