I want to comment on Dr Hochfeld’s article on health care reform, as I see some major flaws with his reasoning. I think the problem that most people have when trying to solve the high cost of health care in this country is that they have trouble stepping outside of the current paradigm. Free market health care would not work within the current system, but where is it written that the current system cannot be changed?
First of all, people do not have a right to health care. Dr Hochfeld claims that “access to basic health care is a right,” but then goes on to say that certain physician services are included in that right. There is no way that a person can have a right that infringes on the rights of other people. These are called positive rights, and are morally flawed. A person can have a negative right- the right to be free from harm by another person, but health care requires that other people provide goods and services. If I have a right to health care, the doctors, nurses, pharmacies, and drug companies will have to give me their product and service for free, which infringes on their right to be compensated for their labor. What do you want to do to people who refuse to give away their work for free? Steal money from them in fines? Put them in a cage? Once you force someone to work for free, that person has become a slave, which is prohibited by our Constitution. Claiming that people should have a right to health care is akin to saying people should have a right to food and therefore all restaurants and grocery stores must give their products and services away for free. Is the government going to pay for these things? How will they ration those dollars and determine who is deserving? Will they also throw money at another commission with a top-heavy bureaucracy? What if a physician does not want that money with all those strings attached? Is he or she free to make those decisions, or is the doctor forced to provide that service on penalty of being fined or jailed? The socialist system cannot work without threats of violence. Am I the only one who finds that troublesome?
Dr Hochfeld makes the argument that the suppliers of health care have too much control over the demand. I agree with him, and this is where the free market could take over. Why does it cost $800 for someone to come to the ER for an uncomplicated broken arm or laceration repair? Why can’t someone spend 6 months to be trained in simple procedures and make a living in his or her own private clinic? No, there is no medical degree being given, but they can let the free market determine if they are doing a good job. They have a great incentive in that they will go out of business if they do shoddy work. Before you suggest a regulatory body to oversee this industry, think about how much the costs will go up to fund the bureaucrats in this endeavor. We are trying to keep costs down, and the free market is very good at that job. I am sure these people would be happy to receive $50 for minor cuts and breaks, and they could even use dangerous drugs like: lidocaine, tetanus boosters, and cephalexin. We have a monopoly on services in this industry, and the free market cannot exist without competition. What would hospitals do to compete with this new sector? They would have to lower prices. If a person wanted a thorough physician evaluation, he or she could choose to pay more. Much in the same way you decide what to eat for dinner or what type of television to buy, cost plays a role. People make decisions about their health based on cost all the time (types of food, cigarettes, alcohol, saturated fats, etc).
Additionally, Dr Hochfeld proposes a system with a salary cap for specialists. This is akin to complete socialism without allowing market forces to determine salaries. Karl Marx’s “labor theory of value” says that value is determined by the amount of work required to produce a product, not the consumer demand. This fallacy means that a surgeon who labors for six hours and finally removes an inflamed appendix should get paid more than the adept surgeon who removes it in 30 minutes. Guess which doctor will have more consumer demand and be worth more money in the free market? When we try to fix things with central planning, we are marching down the same road that caused the downfall of the USSR. No central body can ration health care dollars because no one can predict market pressures and respond to consumer demands as rapidly or as efficiently as the free market. In order for our system to work in the free market, we would have to remove the current restrictions that allow for monopoly privilege of physician services. Dr Hochfeld claims that he is looking for a way to make physicians work harder; the answer is competition.
Pharmaceutical companies are also hampered by FDA restrictions, which make them take almost 20 years to get a new drug approved. They in turn have to charge ridiculous amounts of money for their product to recoup these costs and strategically hold off on releasing medications until they have exhausted the prior one. For those of you who will argue that this is for safety, I urge you to look at the number of drugs that came to market and were later found to be extremely harmful. What is wrong with publishing data and allowing physicians and patients to decide? Are we too stupid to make those decisions? How long would a drug company be in business if they produced a drug that harmed many people? No one would buy his or her product and the owner could be held liable in court as well. When was the last time a member of the FDA got sued for approving a drug that was harmful?
Finally, on the issue of care for those who need it and can’t afford it, I bring up the absurd notion of “charity.” We are all human beings, and most of us in this line of work have compassion. Personally, I donate a large amount of money to charities every year; charities that I feel do an excellent job. For those of you who think the government is the best charity to handle this endeavor, look at how carefully they handle your money and how efficiently they produce things like new roads and highways. Do you want more “evidence-based” medicine like blood cultures in uncomplicated pneumonia? (Hopefully the sarcasm came through in those comments). The free market would do a much better job of caring for sick people than our current socialist system. Wouldn’t it be great PR for a hospital to have an entire charity wing? I think a doctor would acquire many more patients when it became known that he or she spent even one day per month doing free care. Of course, the legal system would have to be drastically revamped in my world, but that is a topic for another time.
When the system you propose requires that you use a word of violence like Tsar, it is time to rethink that system.