Practical Anarchy Part 7 - Health Care

Yet another justification for the existence of the state is the provision or subsidization of health care. There are several compelling reasons.

1. The costs of health care can be unexpected and enormous.
2. Individuals in a severe health crisis seldom have the capacity to negotiate or haggle with their doctors.
3. Health care providers are often in a difficult situation, as they are rarely in a position to refuse a patient treatment in an emergency room whether they can pay or not.
4. People harbor a certain uneasiness about the medical service they receive, thus wish to be assured of consistent high quality.
5. Since doctors, pharmaceutical companies, and other health care providers profit from curing diseases rather than preventing them, their motivations are considered reversed.

The solution to the above problems in modern society has almost always been to expand state power into the realm of medicine. The axiom is presented that good health care is a "right" to which all citizens are entitled, and is thus a justification for the violence of the state. Even those who would prefer non-violent charity to help the sick of a nation find themselves hard-pressed to argue that hospitals should be for-profit organizations.

Everyone with any amount of sympathy feels tremendous emotion for the child with a medical handicap born to poor parents. Each of us understands that the child could easily be us. Those of us born with genetic or congenial disorders are similarly inflicted with unjust medical bills. Even something as simple as a child who's teeth grow crooked costs her parents thousands of dollars more in dental work than a child who's teeth happen to grow straight.

When a person is struck down by an unexpected medical condition - as will happen to all of us, in the case of death - it is excruciating to think that they will have to debate costs and benefits. Should a man with cancer be forced to choose between chemotherapy and food? Surely a just and compassionate society should do everything in its power to prevent such ghastly dilemmas.

Furthermore, since medical advice is often literally a matter of life and death, a compassionate society should take every step to ensure that medical practitioners go through rigorous training and evaluation. The fear associated with medical decisions should never be associated with the fear that the doctor's motives do not coincide with the desires of the patient.

THE GOAL

Anarchism, unlike every other political philosophy, recognizes that people are not naturally endowed with sainthood. Doctors can be abrupt, greedy, false, and treacherous. Patients can be difficult, obstructive, non-compliant, litigious, and hypochondriacal. They can fake injuries in order to gain benefits, and can also develop addictions to medications.

When an anarchist sees corruption, in any field, their solution tends to be the application of voluntarism and competition. When a statist sees corruption, their solution tends to be violence.

No matter what your political convictions, we should all agree that the goal of our society's medical care should be the following:

1. Focused on prevention rather than cure.
2. As cheap as possible
3. As competent as possible
4. As accessible as possible
5. Aligned with the interests of the patient

We already know that the current American system of medicine is great in some ways but quite lacking in others. Since the common solution to the problem of inaccessible health care is increased involvement by the state, let's take a look at the logical and empirical evidence associated with socialized health care and see if it accomplishes our five goals.

EXISTING HEALTH CARE SYSTEMS

A basic rule in economics is that what you subsidize increases while what you tax decreases.

In current statist health care systems, doctors do not get paid when you are healthy, but are paid when you get sick and need a cure.

In other words, doctors have no economic incentive to prevent illness, but every incentive to treat it.

In current health care systems, doctors are paid per patient visit, not per successful cure. Thus doctors do not profit from curing patients, but rather for seeing patients - thus they have every incentive to keep visits as short as possible and to outsource any expenses for treatments.

Furthermore, in current socialized health care systems, it is ILLEGAL to collect and publish any information on the quality and success rates of doctors. If I find out I have prostate cancer, I am not able to look up which doctors have the best records for treating prostate cancer. If I have a family history of prostate cancer, I am not able to find out which doctors have best prevented prostate cancer.

This is absolutely staggering. It is illegal to sell food without publishing the nutritional information and ingredients. It is illegal to run a public company without publishing its financial information. It is illegal to sell a car without publishing fuel efficiency. Heck, it's illegal to sell a T-shirt without publishing where it was manufactured. Pieces of borderline useless information that are easily found on the Internet are required by law for publication, but in situations of life and death, where finding a good doctor could mean everything, THAT information is not only not required, but if you attempt to make it available to the public, you will be put in prison.

This information is violently banned by governments for two reasons. Firstly, in any socialized health care system, this information would result in an absolute stampede of the sick to the competent doctors. Since access to doctors is no longer determined by price, the waiting list would grow exponentially, while the income for bad doctors would decrease. Voters would protest and even riot if they could not get access to good doctors. They would demand immediate change in the system. Unfortunately, the only viable way to limit access to the good doctors would be for those doctors to raise their prices, thus eliminating the socialist aspects of the system.

The second reason this information is not published is because this information is already available to certain individuals, and these individuals have a vested interest in making certain the population does not discover it.

"TWO-TIERED" HEALTH CARE

Perhaps the greatest complaint of private health care is the issue of the "two-tiers." Basically, this is the fear that if privatization is introduced into a socialized health care system, all the good doctors will flee to the private sector leaving only the bad doctors in the socialized system.

The interesting thing about this fear is that those pundits which comment on it appear blind to the "tiers" already existent in the socialized system.

There are, in fact, four tiers in socialized health care. The first is inhabited by rich and prominent people, such as politicians, celebrities, media personalities, pundits, etc. These individuals do not wait in line for MRIs or consultations with the top specialists in the field. They are never allowed to fall through the cracks, as these are the individuals who may speak out about the reality of the system. They therefore get the finest service available and speak endless praises of government medicine.

The second tier includes people close to the medical industry itself. Doctors make friends and ask for favors or information in exchange for their own favors and information. These people can thus find the best doctors and rarely have to wait for treatment.

The third tier consists of rich people without political or medical contacts able to afford overseas travel to the United States or other countries with market-driven health care.

The final tier consists of those who are not prominent, do not have power, are not rich, and who do not have any contacts with politicians or medical employees. These people must wait months for treatment, shoved aside by those who are more important or have more connections. They have no means of knowing whether their doctors are competent or not, and can do little more than hope the system will grace them with an appointment for their X-ray. They have no more "right" to health care than a sick cow in the back of the barn.

Since a doctor gets paid to see as many people as possible, he will rush through his patients, prescribing drugs or referring them to a specialist as quickly as possible (the documented average length of patient visits in Canada is 18 seconds).

There are three reasons to write a prescription. Firstly, it gets the patient out of the office as quickly as possible and places the bulk of the liability for any problems on the pharmaceutical company. Secondly, pharmaceutical companies shower doctors with gifts to promote the prescription of their medications. Thirdly, if a patient returns with the same symptoms, the doctor can simply fill out a form to refill their prescription and dismiss them.

IS THIS THE SOLUTION?

Imagine I propose this to you as a way of providing health care in a stateless society.

I think there should be one monopolistic medical insurance company. This medical insurance company will amass a gigantic stockpile of weapons, and use these weapons to drive all other insurance companies out of business. This insurance company will then turn its guns on the population and demand 20% of their income. Anyone who refuses to pay will be kidnapped or shot. With this 20% of the country's income, this medical insurance company will provide health care as it sees fit. This insurance company will also have control over how many doctors there are, how a doctor will be trained, and how much a doctor will be paid. If anyone attempts to become a doctor without following the rules of the insurance company, they will be kidnapped and/or shot. This insurance company will not pay doctors based on successful cures or prevention, but rather on how many patients visit the doctors. They will not penalize unsuccessful treatments. If anyone attempts to collect or publicize information on the effectiveness of specific doctors, they will be kidnapped and/or shot. In order to assure the citizens have a voice in their medical decisions, they will be allowed to elect an individual to the board of directors. This board member will be paid by the insurance company.


I could go on, but I think the ridiculousness of this solution is clear. If I proposed this as the ideal way to provide health care in an anarchist society, you would all no doubt fill this note with comments on how insane anarchy is and how moronic I am. Ironically, of course, countless people support state health care as the solution to our medical woes.

HOW IT DOESN'T WORK - AN ANALOGY

In socialized medicine, as in any socialized system, the consumers are not the customers.

If automobile manufacturers were paid to produce automobiles by politicians, rather than by the people who would actually be driving the automobiles, it is easy to imagine what the results would be. Consumer input would be nonexistent, and the preferences of the drivers would have no effect whatsoever on the engineering of the automobiles.

If this government monopoly were also supported by a public sector union, thus guaranteeing payment regardless of output, can we imagine what the efficiency and productivity of the workers would be?

What if these manufacturers were paid for the number of cars produced, rather than the quality of those cars? Can we imagine what would happen as consumers attempted to drive the cars off the lot?

What if these manufacturers were also heavily subsidized by oil and gas companies, and these subsidies were directly proportional to the inefficiency of the automobile's fuel consumption? Can you imagine that they would build energy-efficient cars?

Does anyone suggest we should nationalize car production? Ha, actually, I guess in the past few months, yes, they do, but the insanity of it is obvious.

Anyway, this will not work, and it won't work any better in any other industry. Since health care is far more important than cars, I think we'd best use better sense in figuring out how best to supply it.

Any time a coercive agency steps into an industry in place of a customer, that coercive agency immediately becomes the consumer, and the needs and desires of the actual customers are absolutely ignored.

THE REAL SOLUTION FOR UNIVERSAL HEALTH CARE

Ever since Blaise Pascal discovered the laws of probability, a singular human institution has arisen to deal with unpredictable risk - INSURANCE.

Insurance is simply a means of playing the law of averages in order to create predictability. If it is determined that there is a 1/100 chance of you being randomly billed $10,000, you can spend $100 on insurance which will pay you $10,000 should the event come to pass. This is just calculating probability with no room for profit by the insurance company.

The wonderful thing about insurance is that the interests of the consumer are almost always exactly aligned with the provider. With life insurance, the insurance company continues to profit until the customer dies. With homeowner insurance, the insurance company profits until the home suffers damage.

It is always preferable to prevent illness rather than fight it, thus when designing a medical system, it would be ideal to promote the prevention of illness rather than the resolution of it. This is exactly the motivation of medical insurance. Medical insurance companies profit off of healthy people and suffer losses when people become sick.

Thus in a free society, medical insurance companies provide you two services - one which you pay for, and one which you get for free.

The service that you get for free is an objective and detailed analysis of various lifestyle choices and how they will affect your health. If you want to know how dangerous hang gliding is, you need only ask your insurance company how much your rate will go up if you desire to become a regular hang glider. You do not even have to sign up to gain this information; you need only apply. Insurance companies are invaluable resources for evaluating relative risk, since their entire existence is dependent on the analysis of relative risk.

(This argument is inevitable, so I'll address it here. Someone will doubtless draw comparisons to the current health insurance companies we have in the United States. The health care "system" we have today has very little to do with the free market, in that more than fifty cents on every health care dollar spent in the medical field today are spent by the US government, which violently protects the monopolistic doctor's union called the American Medical Association, and furthermore hyper-regulates the medical field with literally hundreds of thousands of laws, rules, directives, and requirements. The incentive for private profit, combined with the corrupt largesse of the public purse, is technically called "fascism," not the free market).

The service you pay for is the alleviation of risk, thus we can be sure that in order to maximize their profits, insurance companies will be interested in keeping you as healthy as possible. The farmer who sells cows is interested in his cattle's longevity in a way the butcher is not.

Due to this motivation private insurance companies will be extremely proactive in preventing problems from developing rather than curing them after they've occurred. They will be sure to pay doctors for prevention and successful cures rather than for simply allowing patients through their doors.

In any case where lifestyle changes can replace medication the insurance company will prefer it. It does not cost the insurance company any money if you walk or do sit ups every day. It costs them tremendously if you need insulin for the rest of your life.

In general, just as exercise is usually cheaper than medication, medication is also usually cheaper than surgery. Insurance companies will thus encourage the research and application of medication rather than dangerous, invasive surgery.

HEALTH CARE INFORMATION

Spending money on a pricey doctor will probably be the most cost-effective investment you will ever make. The most expensive doctors are usually those most efficient at curing their patients (or else they could not charge so much). Most customers of health insurance companies will likely buy life insurance from the same company, thus costing the company dearly should they encourage unwise or ineffective "cures."

In this way returning a customer to health not only guarantees future health care insurance payments, but also delays life insurance payouts. In this way the self-interest of the insurance company is directly in line with the self-interest of the customer, who likely would prefer not to be sick or dead. If the doctor is also paid to prevent, cure, and keep alive, then all three participants have the same motivations - the polar opposite of any statist system.

Thus whenever any customer decides on a health insurance company, every business will scramble to display verified statistics about long-term health. They will present information on the number of ailments prevented, the number of ailments identified and cured, the average life expectancy, successful pregnancies and births, and so on. These companies would be selling HEALTH to their customers, rather than inflicting repetitive treatments on them, which is the case in socialized medicine.

The proactive and dedicated partnership between insurance company and customer - designed to fit the self-service of each - would create a very positive and prevention-based health care approach. In the same way that dental insurance companies require you to get bi-annual checkups, proactive health insurance companies would require regular physicals. In this way the self-interest of the doctor, who normally gets paid for treatment, not cure, and the patient, who prefers prevention to treatment, are productively aligned.

HEALTH CARE AND THE POOR

It is a topic many wish not to discuss, but charity is a complex and dangerous thing. We certainly want to help the unfortunate, but we do not wish to enable and subsidize bad decisions. This is a complexity which the state has no capacity whatsoever to resolve.

As mentioned before, that which we subsidize increases. If society gives to the poor everything a person could possibly require to live comfortably, this would scarcely decrease the number of poor, but likely increase it considerably. On the other hand, the children of poor parents are scarcely responsible for the bad decisions their parents have made. However, if charities give money to poor people with children, more poor people will have more children, thus increasing poverty.

This balancing act is one of the most challenging problems of charity, and yet another reason why a violent government will never succeed in helping the poor in any substantial or permanent way.

When it comes to health care, there is no doubt whatsoever that the majority of people care deeply about the provision of medicine to those who cannot afford it. If this were not the case, socialized health care would never have come about in any democratic society. If you doubt peoples' passion for medicine, simply look up the numbers for donations to cancer research, AIDS research, MS research, or go to your local hospital and marvel at the thank you notes to the thousands of people who donate their time and money to health care.

Doctors as a whole will always treat someone who comes in with an immediate injury, whether they can pay or not. If we assume that health care costs for the genuinely needy poor would consume about ten percent of the general health care cost, then we can be completely certain that this amount of money will be donated by concerned individuals, either in time or money.

Thus medical needs of the poor would be entirely taken care of by charity and pro bono work. Charities would also compete to provide the most effective care for the poor, in order to gain the most donations. I would certainly rather donate to a charity which is honest and efficient than a charity with a reputation not to be.

In this way not only would the self-interest of the doctors, insurance companies, and customers be aligned, but also the self-interests of the donors, charities, and the poor they serve.

In a stateless society, the poor will be far better served by the system, as those who make it up have their self-interest directly aligned with the health of the poor.

As has been shown over and over again throughout history and across the world, benevolent self-interest, enhanced by free association and voluntary competition, is the only way to create sustainable compassion in a society.

I am aware that I have not addressed all possible objections to the question of how health care is to be provided in a free society. I am also aware that the possibility always exists that people will "fall through the cracks," or that charities can make mistakes and fund the wrong people, or not fund the right people.

The possibility for corruption and error are considered airtight arguments against anarchy, but these are in fact 100X more applicable to statism. Voluntarism and competition are the only known solutions to the inevitable errors and corruption that creep into human relations. The fact that human beings make mistakes and are susceptible to corruption is exactly WHY we cannot allow one group of people a monopoly on health care, much less violence against all other people.

When an entrepreneur, whether charitable or for-profit, makes a mistake by failing to provide value, others will rush in to provide the missing benefit. It is the constant process of challenge and competition that allows the best solutions to be consistently discovered to any problem. If you give that failing entrepreneur a gun, thus allowing him to shoot and imprison his competition, the solution-finding grinds to a halt.

Thus, once again, we find that coercion is not the solution to the problem of health care. Indeed, it is the opposite of a solution.

Thanks for reading! Have a nice day :-)