Columnist Arnold Kling writes at the Library of Economics and Liberty website:
The basic problem that the Democrats have with health care reform is that when it comes to taking our system away from free markets, there is just not that much farther we can go. We already regulate the practice of medicine and allied health services with licensing cartels. We already regulate individual health insurance practically out of existence.
In contrast, there is a lot of room to move health care in the other direction — toward free markets. The only real health care reformers are those of us on the libertarian fringe.
Libertarian candidates are even emphasizing the cash for health services issue in their campaigns. Dr. Tim Nerenz is a Libertarian Party candidate for Congress in Wisconsin. From his campaign website:
The way to fix an economic efficiency problem is to increase choice and competition; add in the component of direct payment for services, and you have a Libertarian health care alternative to government run health care – Medical Choice.
We already pay for many types of health care services directly – optometry, dentistry, chiropractic, many pharmacy products and services, routine office visits, for example. The simple act of paying the entire amount of a service, rather than a tiny co-pay portion, make consumers and providers focus on benefits and costs of health care services, just as they do any other purchase decision.
Hopefully, Libertarian Party candidates such as Dr. Nerenz can push the issue more into the mainstream of American politics. And hopefully, Republicans will be quick enough to adopt this libertarian ideal.
The completely free market alternative of cash and barter could provide a powerful counter balance to the Progressives looking for a complete government takeover.
Article comments
— go to most recent comments1 - Clavos
An interesting proposal, though perhaps not everyone is a candidate for bartering.
Welcome to Blogcritics, Eric!
2 - Glenn Contrarian
I'm a strong liberal, and my brother's a libertarian. He hasn't been able to have health care insurance for about 40 years because he simply couldn't afford it (jobs don't pay a whole lot in the MS Delta). Now he's got an infection that may well require hospitalization...but he doesn't have the money to pay for it.
My oldest son had rheumatic fever when he was 15. Now he can't get insurance at all because of his 'preexisting condition'. He's 24 now, and if he goes into the hospital for any reason, the bill will almost certainly run into the thousands...and he can't afford it, and neither can I.
ericdondero, if you want to see what your proposed system is like, go to any third-world country...and I speak from experience. In the Philippines, if you can't afford to go to the hospital, you don't go...and a lot of people die because they can't afford the treatment they need. For the ones who do get into the hospital, if the bill is more than what the family can immediately afford, then the hospital will not allow the patient to leave until the bill is paid. They essentially hold him hostage.
ericdondero, the system which you propose DOES exist, but ONLY in third-world countries. There's a REASON for that, friend. Your proposal is something that Ayn Rand might have liked...but while the libertarian ethos may make for good rhetoric (and did work in the preindustrial era), in the modern world, the real world with the whole range of human psyche to account for, libertarianism doesn't work.
There's a big difference between 'sounds good' and 'IS good'. Your proposal sounds good...but that's it.
3 - Cindy
Why not return to the traditional purely free market way of seeking and providing health care through direct payment to the doctor for services rendered?
So, how many MRIs for my brain tumor do you think I can get for a couple of Disney movies?
I would like to have been there when Alan Greenspan stood in front of congress and said something to the effect of, 'I guess I was wrong about the way things work.'
I wish you were there too. The free market is dead. Time to take down the circus tents and leave town.
Welcome to BC.
4 - Eric Dondero
Glenn, while I can't say that I go to a "third world country" for my health care needs, I can proudly say that I regularly visit a "second world country." I'm fortunate to live only 5 /12 hours away from the Mexican border (south of Houston).
I get 90% of my health care in Mexico - Matamoros, Progresso and Mexicali.
I find the service superior and the prices enormously cheaper.
For example, last year I got 5 caps on my back teeth - cost $900. Same cost through health insurance here in the States, approx. $10,000.
5 - Doug Hunter
Yes Glen, capitalism and freedom are on their death bed. Interestingly, so is America. If you guys could just put two and two together.
I noticed you said you're brother couldn't afford coverage. Your a hypocrite if you expect everyone else to pay for universal healthcare but you won't even chip in for your own brother. Pathetic. Typical liberal, only charitable with other people's resources then has the audacity to act like you have moral superiority.
6 - Dave Nalle
Nice to see Eric here.
As for what he proposes, one of the effects would indeed be to reduce the cost of most health care enormously. Costs are as high as they are now entirely because of the deep pockets of insurance companies and the government.
A return to a simpler pay for yourself system would inevitably lead to routine expenses coming down enormously in cost. The problem would come with long-term care, hospitalization and some of the tests done with very expensive machinery. Your local GP is not going to be able to afford an MRI machine.
The proposal is to essentially go back to an early-20th century model of health care, which provided superior care at a lower price for most people and for routine treatment, but which would fail when it comes to the more extreme lifesaving treatment we have now for the most serious conditions.
But as with any of these plans it's a trade-off. We'd be trading more deaths for the old and the very ill for better, cheaper treatment for the average patient.
Dave
7 - Doug Hunter
Interesting article, but you've got to realize that the option to barter or pay cash already exists and most don't take advantage of it. There could be some policy changes that might make it more feasible, but without some sort of catastrophic coverage or subsidies for those who can't or won't contribute at all to their own care I don't see your idea going anywhere.
I had two incidents where I had to pay out of pocket in my time. One was with a country doctor probably representative of something you'd envision. I shot a wire strung framing nail through my hand at a construction site and couldn't pull it out. I went to the local doc who did x-rays to make sure it hadn't hit a bone, did a small surgical procedure to extract the nail, and flushed and cleaned the wound. The total bill was under $200 (in the 1990's).
Now to contrast that I had a razor slice my wrist (right where one would commit suicide) in another unlikely accident. It was after hours and my hand was tingling and bleeding so I thought I'd hit the emergency room to see if anything was wrong. When I got there I waited then saw the triage nurse for probably 2-3 minutes face time. That was the first time I let off pressure and the blood had almost completely stopped and I knew everthing was fine but she suggested a doc look at it anyway as it was pretty deep. Later a doctor looked at it for a couple minutes, cleaned it, and gave me the choice of a couple stitches or a simple liquid bandage (ARV $2)
In total I had probably 2-3 minutes with a nurse and under 10 minutes with a doctor plus 2-3 pieces of gauze and $2 worth of liquid bandage. Total bill was over $2,700 which I paid in full (no doubt subsidizing the roomful of poor folks I witnessed on my way in or helping put a nice painting on the hospital owners wall)
8 - Joanne Huspek
It's not that unusual a proposition. Doctors who do cosmetic surgery or laser eye treatments are already going straight to customer, since these procedures often aren't covered by health insurance. And what about the proliferation of clinics designed strictly for those who feel under the weather and just need a prescription? Most places only charge $49. I go to a discount dentist because I have no dental insurance, $99 for a cleaning.
When you get the insurance companies in the middle, the price of everything goes up. Ditto the government.
Welcome to BC, Eric.
9 - Mark
Death to the AMA -- its control over the supply side of the equation is stifling.
10 - Andrew
Some Health Care choices as of today:
HR 3200, Sec. 59B would impose a tax penalty on "individuals without acceptable health care coverage." You won't be paying in cash without the permission of the Health Choices Commissioner.
HR 676 does not discriminate against cash, barter or or other health care choices.
HR 2629 restricts the Federal Government from requiring any individual to purchase health insurance coverage.
11 - Doug Hunter
Careful Mark, people will accuse you of wanting people to die and advocating substandard care.
Realistically, you're right though. I would be surprised if there weren't a huge savings and supply advantage to be had there. I don't have statistics on ailments and how doctor's spend their time, but I suspect alot of people know what is wrong with them when they go in and aren't neccessarily looking for a diagnosis (the only area where the years of extensive training are beneficial). If I need stitches I don't care if you have 10 years of school and know the Latin name for 10,000 viruses, I just want someone with experience. Same for broken bones and lots of other common ailments. If they'd let experienced medical professionals other than doctors take over some of the basics we'd likely have cheaper, more abundant, and overall better care. That would require doctors giving up their lucrative monopoly though.
12 - Mark
I'm all for black market medicine. In any case, I think the problems in our illthcare system stem from an unhealthy relationship with the concept of longevity.
13 - Clavos
I can proudly say that I regularly visit a "second world country." I'm fortunate to live only 5 /12 hours away from the Mexican border (south of Houston).
Eric, as a Mexican citizen, I'll have to disagree with you on one point: Mexico is definitely a Third World country.
So is Miami.
14 - Clavos
But as with any of these plans it's a trade-off. We'd be trading more deaths for the old and the very ill for better, cheaper treatment for the average patient.
Sorta like Obamacare.
15 - Cindy
But as with any of these plans it's a trade-off. We'd be trading more deaths for the old and the very ill for better, cheaper treatment for the average patient.
I am glad you recognize that, Dave. So, what does that tell you?
Are we so 'advanced' beyond those who we don't consider advanced, if it all comes down to having developed the potential to understand the universe and change life and death itself--we then choose arbitrarily limit the use of our developments? In this scenario old people get to die, in that scenario poor people get to die, people who are x amount sick can die but people who are y amount sick don't have to?
One thing I never see is a scenario being supported by someone if they are a member of the group that gets to be the demised one.
16 - Clavos
Death to the AMA -- its control over the supply side of the equation is stifling.
According to my brother-in-law, who has been a physician for 35 years and never has been a member of the AMA, most physicians don't belong to it; its membership these days consists mostly of old retired farts.
If they'd let experienced medical professionals other than doctors take over some of the basics we'd likely have cheaper, more abundant, and overall better care.
They do, big time. My primary at the VA is an ARNP, and my wife is seen on the average day in the hospital by at least two PAs and an equal number of ARNPs in lieu of physicians.
They still charge the same, though.
BTW, the average annual income of primary physicians these days is between $80k and $125k, not exactly rich man's wages.
17 - Cindy
I can't think of any big problem, offhand, that doesn't in some way include an unhealthy relationship with the concept of longevity.
18 - Clavos
One thing I never see is a scenario being supported by someone if they are a member of the group that gets to be the demised one.
Which just goes to show that, despite what the politicians think, people aren't stupid.
Any health care plan we finally adopt should have the requirement that the first to sign up MUST be all the politicians, from president on down to the local county commissioner, and every single government employee.
Bet we'd wind up with a kickass plan...
19 - Mark
...ties in with the notion that growth is the greatest good.
20 - roger nowosielski
A notion, one might add, that can be subject to a serious critique.
21 - Mark
(I never know when to not crack wise; I'm waiting for a comment from zing explaining that the healthy growth of his longevity is not a big problem.)
22 - Dr Dreadful
Doctors who do cosmetic surgery or laser eye treatments are already going straight to customer, since these procedures often aren't covered by health insurance.
But these are elective procedures which are not (usually) medically necessary.
How is a stroke patient in a coma supposed to shop around for the best care?
23 - Dr Dreadful
Bet we'd wind up with a kickass plan...
Why can't we all just have the plan that Congress has now?
I mean, it must be pretty good. It's kept Robert Byrd (and, previously, Strom Thurmond) alive for several centuries.
24 - roger nowosielski
"the healthy growth of his longevity . . ."
I hope he's not referring to his own immortality, because if he does, he's off his rocker.
But then again, my reading of the BC comments has always been selective. More fun that way. You never know what kind of shit you may end up disturbing.
25 - Doug Hunter
"How is a stroke patient in a coma supposed to shop around for the best care?"
Of course, the family members would all remember the jingle from the commercial or catch the pay for two months of coma treatment get the third month free billboard on the way to the hospital.
I can't envision a scenario where catastrophic policies for things like stroke, cancer, heart disease, and major accidents wouldn't be available even if people started paying for the majority of their basic healthcare costs. The free market would demand this concept unless it is specifically outlawed or made unneccessary by the government.