Organizations and the Use of Force

What has been ignored by most people is that all professional organizations, labor unions, other advocacy groups is that all of them seek to get their way through the use of force by the government. For example, the AMA was organized in 1847. With the idea of putting restrictions upon who was to be allowed to practice medicine, who was allowed to train future physicians, and the standards to which they should be trained. Also the number of physicians should be controlled so that there would be a limited supply, which under the laws of supply and demand means they would be able to earn higher incomes. The same basic idea as was used by labor unions here later on with somewhat the same objectives of higher incomes gained through restriction of the supply of available workers. Otherwise known as the “closed shop” where everyone who wished to work there had to join the union. Not that much different from what the AMA practiced as a means of increasing the incomes of physicians.  Same basic idea.

The power of the AMA thus rested upon the power of government to provide the necessary “force” needed to make those institutions of education meet the requirements of the American Medical Association. Virtually every profession today relies in one way or another upon the use of force by the government. Doctors, lawyers, all the rest here depend upon the “guns of government” as the means to get what they want. History also shows that labor unions didn’t do very well until they too got the “guns of government” standing behind them to force employers to negotiate union contracts and closed shops. This came about during the FDR administration and the passage of the Wagner Act. The AMA got its objective of making MD’s the gate keepers to medicine through prescription laws that came with the formation of the FDA in 1938. Prior to that time we Americans had the legal right to buy non-narcotic medicines from any drugstore we wanted to use. People also before 1938 could also rely upon their pharmacist for assistance if needed. After the law was passed however, the doctor made the decisions, not the patient or the pharmacist. I should note here that there is nothing in the Constitution stating that the government actually has the legal authority to limit access to medicine to certain classes of people. It has the authority regarding safety issues under the law that established the FDA, but this only applied to the safety of medications. Narcotics could be a different matter, but again there is nothing in the Constitution granting the federal government the authority to control any sort of medication, only the safety being a part of the FDA.*

  • Note that states have authority to do things that the federal government isn’t allowed to do. Although the states also are required to follow the Bill of Rights.

As I have noted in another post, the states do have the authority to license doctors to practice medicine and prescribe medicine. However the states can also allow people who are not physicians to prescribe medication. Nurse practitioners, physician assistants, along with dentists have the right to prescribe. And in the UK pharmacists have the right to prescribe. Then different countries have different standards as to what is limited to prescription from a medical provider and what can be sold without a prescription. Interestingly there are a couple of older insulins that are sold by Walmart and can be purchased without a prescription. Mexico has over the counter medications that are prescription here in the US. Russia also has medications that are OTC there, but are prescription here in the USA. I guess those who decide these things here in the US are not as “freedom loving” as we might wish them to be. Our governments certainly don’t love freedom very much when a country like Russia allows its people freedoms that we don’t enjoy here. This is not the sort of knowledge you’ll likely learn unless you have the chance to communicate with people outside the US as to what freedoms they now enjoy that we here in the USA (once the bastion of freedom) no longer now enjoy!

One thing I think libertarians must understand is that if we are honest, we will see that freedom can only exist where the use of “force” is very carefully limited to stopping only those who wish us harm. Having a government use “force” just to benefit one group of people at the cost of economic harm to everyone else is definitely WRONG!!

So while we might still have professional groups and people organizing for their own benefit or that of others, such organizations and groups must never be allowed to use the power of the state for their own purposes, regardless of any supposed advantage to be derived from government licensing which benefits some at the expense of everyone else…

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The Basic Health Plan In Detail

Currently the US is spending $3.3 trillion dollars a year on health care. Averaged out over the current population of 320 million, this is a bit more than $10,000 per capita. Much of what is driving this is due to government interference in the health care system. We are also financing a very inefficient system of private individual health insurance policies where coverage has been decided by the federal government by the Affordable Care Act that former President Obama and the Democrats in Congress forced through Congress. With very little debate or consideration as to what was in it. As former House Speaker Nancy Pelosi said, “We have to pass it to find out what is in it.” Perhaps the “most stupid” comment made by a member of Congress for a long time! Things are simply not done this way by rational people! Personally I would have demanded a referendum by the American people on this poorly designed plan that certainly was not by any means “Affordable”! Absolutely “NOTHING” was done to reduce the cost of health care except to take money from those better off and paying taxes to provide subsidies to those who otherwise wouldn’t be able to afford it! Personally I’d be ashamed to have my name on a such badly thought out plan!

Assuming we actually want to join the rest of the developed world in providing at least a basic level of health care for all our citizens, one that doesn’t have government controls written all over it, we need to decide what exactly we need and how to pay for it. I am not a friend of the monopolists. I consider the professions, the licensed occupations, labor unions as government enforced monopolies upon the rest of us! We”d be a lot better off if the government wasn’t allowed to do these “favors” to some people while at the same forcing the rest of us to pay higher prices for everything we buy, every service we have to pay an inflated price for needed services to one of these monopolists! I’ve made some estimates and it looks like we’re paying a couple extra trillion to these people just because they bought “protection” from Uncle Sam, the Monopoly Man! I’d much rather keep my share of those two trillion for myself…

Lets now look at what “de-monopolized” health care would look like. First, it’s a lot cheaper. You get to make most of the decisions for yourself. You have the legal right to purchase medicine for your own use from who you want world wide. Need medical services? Same thing. You’d also have a choice of computer software programs so for most things you could take care of them yourself. Of course you need to “educate” yourself, but there are books for that. Both paper and electronic. Plenty of web sites. Plus you will be able to ask the druggist once we change a few laws here that the AMA bribed Congress to pass so they wouldn’t have “competition”. So everyone should be able to take care of common chronic issues like high blood pressure, high cholesterol, arthritis, high blood sugar, glaucoma (eye disease), along with the prevention of heart attack and stroke. None of this is really very expensive to treat. Or to prevent which is better than trying to fix the problem later on. Still, there will be times we need to be able to pay for medical care and it can get expensive pretty fast the way it’s designed.

One reason for this is that instead of using the lowest necessary level of care, the entire thing is set up on the basis of “doing everything possible” regardless of cost. You can’t even get an idea of costs because there is no real established price except for the uninsured and then its charging about ten times what the actual cost is. There’s a term for that.  It’s called “extortion”. It’s what absolute monopolies do when they get the chance. Back in the 19th Century, the railroads did it when they didn’t have any competition. They’d charge double and triple prices because they knew they could get away with it. This is why the rest of the developed world doesn’t allow the medical profession to set prices for their services. This is also why they pay a lot less for the same service than us unfortunate Americans end up paying. When you don’t have the free market controlling prices, then you have to have government to do it for you.  Not the best way, but with professional monopolists, probably the easiest way to do it…

People always think the longer someone spent in institutions of education, the more that they know. However it doesn’t mean that they retain all they once learned. The human brain doesn’t work that way. You retain only what you use at least occasionally. Everything else just disappears. I understand that under hypnosis a person can recall everything they ever learned, but that really isn’t too practical in most cases. If you want to learn something, just “Google” it. Or “Wiki” it. That works pretty good too. In general, the specialists do pretty good at dealing with issues in their specialty. Some are better than others however. The really top notch guys really do “know their stuff”.

However, most of the time you don’t need that level of expertise, so there is little if any reason to pay for it. A lesser trained person will likely be satisfactory. Nurse practitioners and physician assistants can handle maybe 90% of what most of us require. The same is true of hospitals. You shouldn’t have to pay for what you don’t use. And this is really where we need to take a serious look at things… And only pay for what we need.  The famous VW “bug” got people where they needed to go. And it cost less than what “Detroit” was making along with an excellent level of workmanship. That’s really what we want. “An economy version of health care”. Does such a thing exist?  Yes, it does. We only need to change the way that it is financed to make it work. We also want a system that people can “buy into”, suppliment with private insurance if they so wish. I also believe we should have one basic system on which to build upon. Everyone in, no body out. A basic plan upon which you can expand to meet your needs. I call it the “M/M” plan. Medicaid/Medicare joined together into one complete plan.

Financing should be through a financial transaction tax. This is the most fair and universal system possible. We also already do have an administrative organization to run it. Instead of the inefficient complex we now have, we get the best of both worlds. A national health care system along with a far greater level of personal choice through the private health insurance industry. We also resolve the existing medical conditions problem that Obama tried to resolve through the Obamacare mandate. We also remove the “over doctored” problem where physicians seeking extra profit encourage excess use of the medical system. The plan is “individual”, not employer based. People will be encouraged to purchase added insurance through the existing private health insurance industry. Unlike existing Medicaid, people will be expected to pay an progressive income determined deductible to obtain medical services. No one gets “free care”… Health savings accounts will be encouraged to help pay for drugs and the more simple medical services. Setting a system of income based deductibles keeps prices lower and discourages over use of the system. People are encouraged to take care of their own health as far as possible. I believe we should teach basic health maintenance in the high schools. Such things as diet, the avoidance of excess carbohydrates, regular exercise so that one can maintain a healthy weight. These are all things to be considered. Hopefully there will be enough support to get things going…

 

 

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The Basic Health Care Plan

One reason US health care is the world’s most expensive is the wasteful policy of using highly trained people to do tasks that could have, and were once done, by people with considerably less training. There is little if any evidence that this policy does anything worthwhile except increase costs. For example, hospitals used to train their own nurses. This had two benefits: One, it cost less. And second, the training was more specific to the task needed. There is also the concept of “task specific” training which was extremely common during World War 2 when there was no time to waste in unnecessary training. Winning the war and defeating the enemy was far more important than teaching things found to be unnecessary when it came to bringing in untrained people to do tasks that previously were done by people now in uniform and fighting the “enemy”. As a matter of fact when my wife started working in the local hospital, they trained people using task specific training to do tasks that now require an associate degree to do. This is also the problem today where no one is willing to “train” people, but now expect the educational system to do it. I believe our “out of control” legal profession may be to blame here…

Our health care system has greatly excessive health care costs due to the administrative overhead costs of running our health care system. In effect we “waste” somewhere in the neighborhood of half a trillion dollars at least. I consider this figure “low”, but I will use it. When the UK can cover everyone as they did in 2015 for 7.7% of their GDP, while at same time Germany spent 9.8%, and the US spent 18%, you know something is seriously wrong! Nor has Obamacare (or whatever the Republicans can dream up) done anything about this. The average hospital has as many “paper shufflers” as it has patients under care. Hospitals in the rest of the developed world use far less. They also use appropriately trained people to do the patient care needed. They are “efficient” in producing the greatest value at the lowest cost. We do the opposite. While I will grant that countries like the UK don’t offer the latest “cutting edge” care, they do manage to deal quite well with the very little that they spend. Where here in the US, the cost of health care is effectively bankrupting the country with its heavy drain on our economic resources. It has been estimated that by 2024, US health care will consume 25% of our GDP! Or about $5,000,000,000,000 (five trillion) dollars a year. We seriously need to start considering what we can do to bring these costs down to more reasonable levels!

The concept of a Basic Income plan is rather well known today. However we also need to create some sort of basic health care plan so that there would be universal access to a basic level of health care. This plan would have deductibles based upon income, and would give everyone access to generic medications (no prescription laws) and would use people trained in basic health care (nurse practitioners). This would be a very “basic” plan, and those who wished to have a higher level of care would be able to purchase such through the private health insurance system out of their own pockets. Similar in principle to the Medicare Advantage plans that now exist. However there would be no requirements as exists with Obamacare to offer “infinity coverage”. No one buys “no limits” insurance for anything else! There is no reason why we should be doing it in health care. Even Medicare does “limit” coverage. There are sizable deductibles, and the hospital Part A has a limit on coverage. After which you are “on your own” or more likely “on Medicaid”. Generally if someone does reach this point, they are likely to die anyway. Realistically, all Obamacare created was a means to force people to buy very expensive insurance few would ever use. This is why we need to create something that provides some level of coverage for everyone, but is still “affordable” in the sense that it will be something people can buy into… Financing probably should be by the most economically efficient means possible. This requires additional study but lowering US health care costs to something more like what the rest of the developed world pays does seem to be “doable” given different leadership than what we’re got now. The idea is to do what is economically possible without bankrupting the country which is the course we seem to be now heading. Something around 10% of GDP. Germany does it, and their health care system is pretty good and close to comparable with our own.

The plan would provide for public health clinics which are the most effective means of providing basic health services to the maximum number of people at the lowest cost. In effect we’d have the sort of health clinics that existed half a century ago. A means to bring basic health care to everyone, especially those whose incomes are too low or have pre-existing medical issues that make the purchase of health insurance prohibitively expensive. These clinics could also replace immediate care centers and considerably reduce the number of people going to hospital emergency rooms. By using medical practitioners with bachelor degree level of training along with access to an “electronic” doctor (doable at our present level of technology) costs can be held down to a minimum level. This is quite sufficient to deal with “chronic medical issues” such as high blood pressure, high cholesterol, arthritis, and high blood sugar (diabetes). Also sufficient for various issues of the type that were dealt with half a century ago. Like broken bones, injuries from falls, cuts, the sort of things that can be handled by people with a basic level of training in health care. Reserving the more educated MD level medical providers to issues that actually do actually  require that level of knowledge. The idea is to reduce the cost of US health care by bringing into play a level of medical services that are adequate to do with “every day” types of medical issues. These type of clinics did exist back in the 1960’s and were used by sponsoring hospitals to reduce the numbers of people without health insurance flooding into the emergency rooms where the cost was far greater for treating simple issues. Especially those who didn’t have the money to pay for regular doctor visits. Which while costs much less than doctors today, there were still a lot of people who couldn’t afford the higher cost of a doctor office visit.

Any hospital coverage should be designed to cut costs as far as possible. Large wards are the best way to hold down costs and reduce the cost of nursing care at the same time. This was BTW the way we used to do it. And the nurses were only trained to the level actually needed. RN’s supervised LPN’s who in turn watched over the aids doing most of the “shit work”. There were also student nurses who “learned on the job” how to do things. Task specific training was the standard of the time. This is why the costs back then were as low as they were. Why health care was actually “affordable” back then when few people had health insurance. Because the “money” wasn’t there to waste on stuff that most people didn’t need, the cost of running a hospital wasn’t that high. Think “skilled care nursing home” and you’dd have a pretty good idea of what an early 20th Century hospital looked like.

US health care costs back then were in the 5% of GDP. People mostly paid “out of pocket” for care. Some people belonged to organizations that would pay a doctor to provide services for its members. The AMA opposed this because doctors were forced to compete with each other for these services. The AMA has always been in opposition to a free market in health care. Again we see how the professions force up costs for their own benefit. But once libertarians start showing people how we can have “affordable” health care (like the rest of the developed world does), then perhaps we can get these costs down to more reasonable levels.

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Towards Better Government, Part 2

It is likely to be better if a country’s government represents all viewpoints, not just those held by the majority of people. This is a problem with the US style of government in that minority viewpoints get little if any recognition. We do have one “socialist” in Congress, Senator Bernie Sanders, Independent, but he is the only one. We also have Representative Justin Amash (Republican) from Michigan who also calls himself a libertarian. As does Senator Rand Paul (Republican) who seems to have some claim to the title. As did his father, former Representative Ron Paul (Republican) who also claimed with more justification the title of libertarian. It is however noteworthy that none of them seems to be anything more than just “tending” libertarian. Ron Paul did have a fixation on the Federal Reserve. However this was a rather esoteric issue that interested very few. One that interested few Americans and made him look foolish.

If we had a parliamentary system no doubt we could have proportional representation. However the number of those who might qualify to represent additional political parties is likely too small to have much effect upon the activities of the national government. So while a parliamentary system would be better than what we now have, it isn’t really enough to likely change things very much. We simply have far too many “far right” (Republicans) whose thinking more reflects that of the 19th Century than the 21st. However a bigger problem is the design of the federal government along with that of our state governments. It is extremely difficult to change the direction we are going even if it would be much better for the country if we did. The power of “special interest” groups is far greater here in the US than in the rest of the developed world.

It is this power of the “special interests” which creates most of our problems. We are effectively bankrupting the country with the increasing cost of health care which now exceeds “THREE TRILLION DOLLARS A YEAR!” On a per capita basis measured in GDP we spent twice what Germany spends. 223% of what the UK spends. Even our neighbor to the north, Canada spends only two thirds of what we do and covers everyone too! No matter what anyone thinks, we can’t continue down this road much longer. There simply isn’t enough wealth in the country to afford this along with everything else we need to do. Certainly not if we want to continue being the world’s “policeman”… We also need to seriously reduce the bloated size of our federal government and it wouldn’t hurt either if we did the same with state and local governments too.

The solution to this requires that we start looking seriously as to what our future is. We could copy what the rest of the developed world has done, but this is but one of the two possible choices we have available to us. Big government costs a lot of money, regardless of how you do things. And such systems tend to generate problems of their own. The UK encountered this problem when too little money was given to the NHS. The result was that those people who needed a higher level of care had a hard time getting it. There is of course always those in government who want to spend “less”. And raising taxes is never popular. We’re experiencing the same problem here with the VA. And the cause of the problem is the same as what the UK did. And with the same results. The problem is that governments have a lot of inertia and resolving such problems takes time. Sometimes too much time for those caught in the “pinch”!

What we really need is a better system of representation than we can achieve even with a parliamentary system. And elections encourage corruption as the history of all electoral systems has shown. Plus the people who do get elected are by no means representative of the people who elected them in the first place. And candidates who accept donations tend to favor those who provided them with the money. Good for the “special interests”. Not so good for the rest of us who can’t donate large sums…

The “solution” is the very same one I’ve written about before. The selection of representatives by means of a lottery. This way you get a good cross section of the public. Various groups within society are represented by their percentage of the population. Minority groups are represented by their percentage. 51 percent of the representatives will be women. As for education, graduation from high school should be adequate. Of all the education I’ve had, I’ve never really needed anything that I hadn’t learned by the time I graduated from the 8th grade. This includes running my own business which I did for a number of years before I retired. My own opinion is that if you want to learn something, the public library is probably your best source for it.

One great advantage of selecting representatives by means of a lottery is that it eliminates political parties. Which in my own opinion is a good thing. We have far too many “representatives” today that parrot the party line whatever it is. These men and women may have good educations, but many times I’ve rather wondered about it! As a rule libertarians seem to be more knowledgeable, probably because the basic idea of libertarianism is something that requires more “thought” than what those who support the major political parties. There is also a wider variety of viewpoints than what is found among Democrats and Republicans. More thought as to how things should be…

 

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Towards Better Government, Part 1

Given the problems we have with the governments here in the US, is there any way that we could improve things? Fix the problems caused by too much influence by the wealthy, the professions, the corporations and the “special interests”? Along with reducing the size and scope of government so that greater personal freedom becomes possible? Currently the US is behaving more like an “empire” with military forces scattered over the entire world while we also have ongoing conflicts involving US forces in Iraq, Syria, and Afghanistan. In the last country, we’ve been fighting there now since 2002 with no apparent end in sight. Additionally, it is costing us (when everything is figured in) about a trillion dollars a year all told for “national defense”.

An interesting question is why did our “Founding Fathers” reject the example of the parliamentary form of government that was in use in England at the time? Why did we select the design of government that we did? Congress in some aspects is similar to a parliament in that there are two “Houses” of Congress. The House of Representatives and the Senate. The latter being more similar to the House of Lords there in England.

In England (the UK) the Queen is more a symbol than someone who actually rules. Whereas the President in our government has considerable power within the limits imposed by the Constitution. (The UK doesn’t have a written Constitution) We have a Supreme Court. The UK does not. There are courts in the UK, but I don’t believe they have the authority to overrule the other parts of government as is the case in the US.

Here in the US we vote for individuals instead of a political party. You can decide to vote for a Republican for President, and Democrats for Congress or even a Libertarian if there is one running. The US selects the members of Congress by popular vote, but for President we use a system of electors which number the same as the number of Senators and Representatives that the state elects. This is how Donald Trump won the electoral vote although Hillary Clinton won the popular vote. The purpose of the electoral vote is that it balances out the power between large and small states. Trump won the most states, but Clinton won the larger states with the largest populations. For balance of power considerations, we probably should keep the electoral system.

Political systems based upon elections, especially when individuals are voted for instead of political parties is that the “winner” is often the one who has spent the most money (supplied by donations in most cases). And the majority of political donations generally come from those who can donate the most money… Needless to say, these large donations comes with an “understanding” that the person running for office will if elected view the interests of those who financed the run for office with “favor”. This is nothing new. The Greeks of Classical Athens had the same problem.

The parliamentary system doesn’t have this problem to the same degree. Donations are made to the political party, not the party members that are running for office. Its a lot harder to sway an entire political party to your wishes than it is to do so with those individuals who make up the party. Some “influence” is possible, but not to the degree as is possible today in the US. Parliamentary governments thus tend to be more representative of the people as a whole than is the case where individuals within a political party can be much more easily swayed to serve the interests of a group seeking to get their own wishes put ahead of the people. This is why the US government is more representative of “special interests” than the people.

There is another consideration here. The US design of government is such that only two political parties can effectively exist. A third party (say Libertarian) would have little if any influence upon the functions of government unless it was large enough to be able to prevent either of the major parties to pass legislation without its support. Even if the third party could win the Presidency, it would not be able to accomplish very much unless it had enough members in Congress that neither of the other two political parties could pass legislation without its consent. This effectively makes it virtually impossible for a third party to actually be effective even if it can win some seats in Congress and put a President in the White House. Perhaps some sort of proportional representation would be possible, but why would the other parties agree to it? It is to their advantage to render any third party as powerless as is possible…

End of Part 1

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Government and the Use of Force

Most people probably think of the use of force as something that criminals do. However the greatest users of force are not criminals, but organized groups and businesses. They do not use “force” themselves, but instead they now use the law enforcement powers of “government” which is generally the legal user of force in modern society. They use policemen, lawyers, the courts instead of “muscle” and guns as a criminal organization would do. And governments generally have much more “power” when you get down to it than even the largest of criminal organizations.

Getting the government to use “force” in your behalf is now commonplace today. Professional organizations, labor unions, businesses, all employ the use of force by “government” to get their own way. To force everyone else to pay more for their services. The professions all employ the force of government to prevent “competition” by anyone who might be willing to provide the same services for less money. Then often today to obtain a service, you have to deal with someone who effectively has a government enforced monopoly over both services and certain materials. The doctor, backed by prescription laws that give him or her a government provided monopoly over access to medical drugs certainly earns a higher income than they would earn without these laws. So the doctor is using “force” to prevent you from legally buying medical drugs without first obtaining his or her “permission” and paying a fee of say $150 just to buy a blood pressure drug. One that you could buy at Wal Mart for $10 for a 90 day supply. The doctor relies upon the policeman’s gun to enforce his monopoly. One that allows him or her a higher income than they could enjoy without prescription laws…

Of course doctors aren’t the only ones who benefit by the force of government. Lawyers do very well too. Various licensing laws require a lawyer to do tasks that people with considerably less training and education could do just as well. As lawyers tend to be vastly over represented in Congress, it’s simple to see how they managed to get so many laws passed in their favor. Rather like hiring foxes to guard your hen house! It’s safe to say that the foxes would eat very well at your expense. The same thing holds true today with all the licensed professions and occupations. Government supplied monopoly is so common today that we hardly notice it anymore until we realize how much more money we’re paying out for their services than what we’d pay without the government licensing people so they can earn incomes well above what they’d earn without the government standing there behind them with its guns. Effectively they are using the government to “steal” from you. Overcharging you for their services just because they can. They’ve bought “protection” and you’re paying the price for it!

Next we should consider all the businesses that provide goods and/or services that also enjoy using the force of government to enjoy the benefits of a legal monopoly. On my cable bill there is a charge for a “franchise fee”. This fee, which is part of the bill, is the money that the cable company pays my local government to insure that no one else will be allowed to compete with them. A little quick math shows that the city gets about $60,000 a year off of this for effectively doing “nothing”. To the city this is “free money”. Not that much difference from the “Mafia” collecting a fee for “protection”. The only difference is that the city can do this legally, which the Mafia can’t do… Then the cable companies have attempted to get laws passed that city governments can’t compete with them in the provision of broadband services. They had to go to state governments to try to get this. The power companies don’t like cities owning power plants either. Kinda like one set of crooks going to the big “boss” to complain that another set of crooks is setting up in competition with them… The only trouble is that we the people are the ones who end up paying for all this!  A lot of these businesses are unionized and that’s another group that uses “force” to get its own way today. As these businesses can easily pass the added cost on to the consumer, they don’t care.

I’m taking a guess that all of this stuffs raises our cost of living by a couple of trillion dollars if not more. Or about $6.000 per capita. $24,00 for a family of four. No wonder we’re in debt so much. What can we do about it? That’s something I’ll leave for next time.

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Why Single Payer Proposals Fail

Two states have put forth “single payer” proposals as a means to reduce health care costs. Both have been rejected by the voters. Why? Supposedly they would have saved money by eliminating the “overhead” of private health insurance which supposedly costs more than having a government agency doing the same thing. So why did the voters reject them?

The majority of people obtain their health insurance through their employer who likely pays most of the cost leaving only co-pays and deductibles for the individual to pay. Thus, they are very likely viewing the issue considerably differently from someone who is paying the full cost of their health care insurance. Someone who is writing a check every month to the insurance company. So most people don’t understand what the true cost of health care is.

There is another issue that isn’t often considered. A US doctor probably pays more for his or her education than do doctors in the rest of the developed world. Student loans can run in the hundreds of thousand dollars. Imagine what the interest alone is on a quarter million dollar loan? The US also is the major developer of new drugs and new medical technology. Being “first” is expensive. Additionally American doctors face malpractice law suits far more often than do doctors in the rest of the developed world where filing such lawsuits is far less common. Having more lawyers per capita than any other developed country is one of the reasons for this. Another is that a bad outcome can leave a person crippled in a society where there is less of a “social safety net” than is common in the rest of the developed world. This too likely encourages lawsuits that wouldn’t be filed in other first world nations.

Back in the early 1960’s it cost me $8 to see a doctor. Today the cost is almost 20 times that. True, the value of the dollar has fallen, but only a bit less than half can be considered here. The other portion is due to “government regulation” and the greatly increased use of health insurance which considerably complicates the issue as to “who pays the bill”.  That doctor back in 1960 had an “office nurse” as an employee. Today’s doctor however will have the “office nurse” along with people to do insurance verification, billing, along with compliance with all the government regulations that exist today, but were unknown back there in 1960. Anyone who runs their own business today will be well aware of the costs involved here in dealing with all the government rules and regulations both state and federal. All of this is a part of the driving force that has driven US health care costs to the level they now are today.

So what effect would “single payer” have on this? Replacing the private insurance industry with a state or federal government agency won’t make that big a difference if any. Both Medicare and Medicaid have “fraud” problems. As does private insurance, although not to the same level as the two “government” programs do. The VA for example is an example of a health care service that is run completely by the federal government. There are “access” problems that the VA seems to have trouble resolving. The VA does have the advantage that it can negotiate drug prices (as can Medicaid) while Medicare is legally prohibited from doing this. And none of the private insurance companies are large enough to do very much about “prices” of drugs and other medical equipment. So unless the proposed “single payer system” has the authority as the VA does to negotiate prices, there won’t be much savings there. We might also consider that private insurance companies pay taxes, something that government agencies of course don’t have to do. So any comparison should take this into consideration… Looks to me like we’re comparing apples to oranges (2 different things)!

Looking at single payer systems in use in the rest of the developed world, they cut costs by paying doctors considerably less. Something they can do because the doctor’s education (in many cases) was paid by the government. (where is that cost figured in?) They also wait to purchase advanced medical technologies until the prices drop as they do after a few years. Then less equipment in total is purchased, so the cost is less although patients have to wait longer to get their MRI’s, CAT scans, etc., than their US counterparts do. This of course does “lower” the cost of health care. The popular term for doing this is called “rationing”…

There is a much simpler way to reduce US health care costs. I’ve covered this again and again in this blog. SIMPLY REDUCE THE AMOUNT OF GOVERNMENT INVOLVEMENT IN HEALTH CARE!  Repeal prescription laws. Allow people to take care of their own health (without involving a doctor) to the limits of their abilities. Hey, we used to do this! Prior to 1938, you were free to go to your local drugstore and buy the medical drug of your choice. The druggist would assist you if you needed any help. Today there is so much more available information (Internet and books) that any reasonable competent person should be able to handle health issues like high blood pressure, high cholesterol, high blood sugar, arthritis without ever seeing a doctor. That’s probably at least HALF of all visits to primary care physicians today. And the cost of dealing with these common health issues shouldn’t cost you more than $200 for a year even if you have all four of them to deal with! Even somewhat more complex issues, if they are treatable by taking a “pill” may well be within a person’s abilities to deal with. We can also expect that software companies will soon create a “doctor on a disc” program to assist you in taking charge of your own health. Even issues such as insulin dependent diabetes are not all that difficult to deal with if you’d done sufficient study to understand what the disease is and how to balance carbohydrate intake with the amount of insulin you are taking. As long as you are cautious and pay attention to what precautions you should be considering, keep up with your studies, you’ll be surprised at what you can do to take care of your own health. The more you know, the better for you! You do need to be aware of possible side effects, which affect different people in different ways.

There will of course be strong opposition to repeal. Doctors have gotten dependent upon their legal monopoly and the power over their patients that these laws give them. The AMA will doubtlessly do everything it can to prevent repeal from taking place. Remember that the US health care industry is a THREE TRILLION DOLLAR industry today. It has gotten that way because the industry relies more and more upon the government for its assured profits.

It would help if we repeal all the drug laws at the same time, but that’s another chapter in this blog and my attempts to prove how much better off we are with a far smaller government.

 

 

 

 

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