https://www.caseyresearch.com/articles/doug-casey-health-care-laws-should-be-abolished/
By Doug Casey
How to reform the U.S. “health care” system is a continuing topic in the news. I put that phrase in quotes because it’s a misnomer. You don’t insure your health – that can’t be done. You can only insure that the costs of medical care, if your health fails, will be covered. Saying “health care” makes people think that someone else will magically assure their health, which is impossible. Collectivists like to use the phrase as part of their continuing war on what words mean, and how people think.
Health is something you do for yourself with proper diet, exercise, and lifestyle decisions. Medical care is something very different; it’s what you need for acute trauma or disease. People want good health, but all insurance can give them is hospitals, doctors, and medicines – all of which are scary.
In any event, there does seem to be universal agreement on two related matters. One, that Americans are overweight, underexercised, and overmedicated. Two, that the U.S. medical care system is “broken” and something needs to be done. I have a radical proposal, even though there’s not a chance in hell it will ever be adopted or even discussed in public.
Here it is: Not only should there be no form of national medical care, but Medicare, Medicaid, the FDA, and all laws regulating anything to do with medicine and health should be abolished. Why? Because they are the actual cause of the crisis.
These schemes and bureaucracies will, in fact, eventually disappear. But not in a controlled or planned way. They’re going to disappear for the same reason the Soviet Union did – because they’re inefficient, uneconomic, and unsustainable. Although the U.S. medical system is technologically excellent, it’s long been way too overloaded with paperwork and legalism. Obamacare made it much worse, and ensures that the collapse is going to be bigger, sooner, and with more widespread consequences.
That’s the bad news. The good news is that you don’t have to be sucked into the maelstrom with everybody else.
The national “health care” controversy isn’t about a technical issue, like how to provide medical care cheaply. It’s about basic ethics. Do you have a legal or moral obligation to pay for the consequences of some stranger’s bad habits or bad luck? I’m not, therefore, going into statistics or throwing out reams of numbers about costs. That only serves to distract from the essence of what this is all about.
It’s said to be a tragedy and a scandal that millions of Americans don’t have medical insurance. My first reaction to that is: So what? A lot of people feel they don’t need insurance because they’re young, healthy, and risk-oriented. Others don’t want it, because they can afford to self-insure. Insurance is not a necessity; it’s just a financial planning tool. Up until the 20th century, nobody on the planet had health insurance.
The whole issue of medical insurance basically arose during World War II, when the government locked the country down with strict wage and price controls. Employers couldn’t legally induce workers with cash money, so they offered benefits, prominently including medical coverage. This was an especially rich benefit during the high-tax war years, because it was tax-deductible to employers while tax-free to employees.
A perverse consequence of insurance being institutionalized was that it taught the public that someone else should, and will, be responsible for their medical expenses. The presence of insurance induced people to see doctors, and demand services, much more often than would otherwise have been the case, since these things were now “free.” This artificial demand has put a lot of upward pressure on medical costs over the years. There was once a time when a person set aside money for medical care to maintain his body much as he would to maintain his car or his house; it wasn’t considered either a critical or a potentially onerous expense. Prudent people might have a major medical policy, with a large deductible, in case lightning struck. A poorer person might have to rely on any of numerous charities and fraternal organizations; peer pressure and social opprobrium kept the moral risk from hypochondriacs under control. But that was before the government stepped in and took the place of religious, charitable, and fraternal groups.
People whine about companies denying them insurance or denying coverage for preexisting conditions. These complaints are (barring fraud) almost completely without merit. If insurers are prevented from denying coverage for preexisting conditions, then many people won’t seek coverage until they’re sure they have a problem. It subverts the entire basis of insurance, in effect trying to force a company to pay for a house fire after the dwelling has already burned down.
Do insurers owe the public coverage? No. The fact is that nobody owes you, or anybody else, anything. If you don’t qualify for a policy, that’s unfortunate. You also may not qualify for joining an athletic team. Or getting into a school. Or working for a certain employer. Or a thousand other things. I’m sorry. But tough. Your choices are to either do something to improve your circumstances or, if you can’t, find an alternative. One person’s bad luck doesn’t constitute a mortgage on another person’s life.
The Angel of Death
I would make the case that the government, directly and indirectly, is solely – not mainly, but solely – responsible for runaway medical costs and the presumed necessity of having insurance. Let me give you a few examples.
The FDA, widely promoted as a guardian of health, would better be named the Federal Death Authority. It alone is probably responsible for more deaths every year than the Defense Department in the typical decade.
How so?
Although its $5.1 billion annual budget is huge and represents capital that could have been spent developing new technology, it’s trivial compared to the agency’s real costs. The FDA is why it typically takes ten years and hundreds of millions, often billions, of dollars to develop a new drug. It’s a major reason why drugs are as expensive as they are, and why relatively few are ever approved.
Does it ever keep potentially dangerous products off the market? Of course. But the desire of drug companies to survive and grow is – surprisingly, to people who are sponges for anti-capitalist agitprop – actually a much better guarantee. The argument might be made that if the FDA approved nothing, then no one would ever die of dangerous drugs.
Various laws make the sale of body parts illegal. Which means thousands die every year while waiting for a kidney or a liver. Poor people, who might have a much better life by trading a kidney for $25,000, are denied that opportunity. Or that of selling all their usable body parts upon death in exchange for a large fee payable while they are still alive.
“Consumer protection” laws encourage contingency-paid ambulance chasers to sue everybody for everything that can go wrong in a medical situation, adding many billions to medical costs every year. Medical malpractice coverage, for which many specialists pay several hundred thousand dollars a year, is only a small part of this cost. To defend against predatory litigation, doctors are forced to practice “defensive” medicine, which prescribes numerous tests, drugs, and procedures, which are useful only as legal prophylactics.
The AMA (American Medical Association), a lobbying organization and wannabe trade union, artificially restricts the number of doctors that can practice in the U.S., both through state licensing laws and limiting the number of medical schools.
In the face of these and many other government-imposed costs that make medical care hard to afford, most people now feel the necessity for insurance. Unfortunately, the cost of administering insurance is huge – both for the insurer and for the doctor. Half the employees in a typical doctor’s office do nothing but shuffle paper for private insurers, Medicare, and Medicaid.
As late as the 1950s, a doctor would make house calls, and a hospital stay cost about what a hotel stay did. Those days could reappear if the government with its laws, taxes, and regulations disappeared. The opposite is likely to happen, at least over the short to medium term, as the government takes over the remaining parts of the U.S. health care system.
In fact, in a free market, technology would be noticeably driving costs down in medicine, as it has in every other area of life. The forces agitating for “reform” carp about expensive CAT scan machines driving up costs – but they’re just the equivalent of the primitive X-ray machines of a few generations ago. In other words, providing the same quality care you would have gotten 50 years ago costs much less today, in real terms, because of technology. Insofar as some costs are higher in real terms, it’s only because the quality of the procedure is vastly higher. I defy anyone to show me an example where this isn’t true…
Practical Advice
So, what should you do, with current medical insurance rates ranging up to an unbelievable $4,000 a month for a family in some jurisdictions? (I know, you’re thinking that’s a misprint, but that’s the going rate for a top plan in some Manhattan zip codes.) My suggestions are simple; the subject doesn’t require a 1,000-page piece of legislation:
- Engage in a serious program of proper diet, exercise, and proper lifestyle. It’s inconvenient sometimes, but if you don’t, you’ll look like all those other people out there. If your body starts falling apart prematurely (they all fall apart eventually), it’s not the fault of society or your insurer. This is the ultimate solution to today’s “medical crisis.”
- For personal insurance, get absolutely the largest deductible available. It’s insane trading dollars with an insurer.
- Consider doing all your important medical and dental work abroad. Technologies and skills in the Far East and Latin America are at, or sometimes even above, the level of those in the U.S. But costs are a small fraction of those in the U.S.
- If you have a company, get a large deductible policy and allow employees to self-insure for the deductible. Your lawyer should be able to draw up a plan where the savings go into everyone’s pocket.
But enough of that. I just dropped my big bag of Oreos, and I need to figure out just the right way to swing the hammock so I can pick it up.
An After-Thought
Perhaps the bottom line of the above is that, as Hobbes observed, life can be solitary, poor, nasty, brutish, and short. But who reads Leviathan anymore? Better to refer to some of the best playwriting since Shakespeare, namely Deadwood, the HBO series. It gives, among other things, a realistic view of medical technology not so very long ago. The characters often speak in Shakespearian blank verse to boot, although not in the quote below.
“Pain or damage don’t end the world. Or despair, or f*****g beatings. The world ends when you’re dead. Until then, you got more punishment in store. Stand it like a man… and give some back.”
That’s the view of Al Swearengen, the series’ lead character. He’s a realistic, hard-bitten kind of guy. But his personality can win you over, despite his many flaws. More so because despite being a cold-blooded cutthroat, he likes to explore the philosophical implications of his actions. So, while many people today ask themselves, “What would Jesus do?” when confronted with a moral dilemma, I find it equally enlightening to ask, “What would Al Swearengen do?”
Regards,
Doug Casey
Founder, Casey Research
