Who should be the ultimate decision maker in health care? The doctor? The insurance company? Or should it be the patient? I think most people reading this would say that it should be the patient? After all, he or she is the one who will be the most effected by any medical decision. The doctor can give his advice, based upon his own knowledge, but the patient is the one who is the most concerned. The role of the insurance company is just to pay for the services rendered, although naturally the insurance company would like to pay as little as possible. This is why insurance companies refer to the benefits that they have to pay out as their “loss ratio”. To the insurance company, any benefit paid out is seen as a “loss”. Money that can’t be spent on wages, salaries, or dividends to stockholders. We can however replace the role of the insurance company with Health Savings Accounts filled with pre-tax dollars, create a system of long term loans to pay for needed health care. In a libertarian society health care will in any case be far less costly than what we have now… There will likely be medical insurance that kicks in only at a high level to cover those diseases where the cost of treatment will run into the tens of thousands of dollars. This type of insurance is not all that expensive, and would cost considerably less than what most people will be expected to pay under Obamacare. Obamacare itself being quite “wasteful” in that the value of the insurance is no where near the level a better design would allow. Insurance should not be used for low cost services that can be paid “out of pocket”. Of course there would be no coercion as to buying insurance as that is up to the individual.*
*The requirement of “must treat” would not exist in a libertarian society.
The right of decision making was to a great degree forcefully stripped from the patient and transferred to doctors by the passage of prescription laws by the government in 1938. Prior to that time the patient had the ultimate power as he or she did not require a prescription in order to purchase medicine for his or her own use. If they knew what medicine they needed it was a simple matter to purchase it from a local drug store. I can honestly say that the medical freedom of the patient was stripped from them by law and handed over to the doctor. The doctor became the person who controlled the patient’s access to medical drugs. Of course the doctor thought this was a wonderful thing because it gave the doctor a great deal of power over the patient and his or her health. Power that could be and is used to enhance the income of doctors over and above what it would be in a social order where they did not have this power. The so-called “shortage” of primary care doctors is due to the fact that holding the power of access to medical drugs is a good way to extort additional money from existing patients. Without these laws, there will be a much larger incentive to seek patients from the general population who now need a doctor’s services, but who are not currently served. We do have enough doctors, we just need to have them use their valuable time more efficiently. However there are a lot of things where lesser trained providers would serve just as well, which would result in savings.
Of course some will say that the patient is incompetent to make such decisions for himself or herself. This appears to be the viewpoint held by our two major political parties today. The Democratic party views these laws as necessary to keep people from harming themselves. Republicans favor these laws because they believe other wise people will drug themselves and become addicts to the drug of their choice. The truth of course is much different. For most medical drugs, there is no good reason they should be “controlled”.
Only two categories of medical drugs can be abused by addicts. These are the opiates and the antidepressants. Both are “habit forming” and both have withdrawal symptoms. The opiates are used to control pain, but the antidepressants are used in far larger numbers to control people’s moods. Children today are frequently treated with an antidepressant drug to control their behavior in school. One unpleasant consequence of using antidepressants is that they have a “rebound” factor. As the drug wears off, there is a tendency to create the opposite effect. I have myself witnessed this effect and it was rather “scary” in a way as the individual in question was behaving in a way that seemed to now hint at suppressed violence that could be released at any time. I should note here that there is some evidence that this effect caused by antidepressants may be responsible for a number of “school shootings”. The Sandy Hook shooting appears to be one. I believe if the medical records of all of these shootings could be accessed, it might be found that this family of medical drugs was indirectly responsible. They may well be “dangerous” enough that it would be wise to put stricter controls over their use. They certainly should not be made available OTC. In fact they are likely to be more “dangerous” than any of the opiate family of drugs.
The major problem appears to be the design of the US health care system which is based upon a concept where the patient has little more to say than my dog when I take her to the “vet’s”. Of course the health care establishment likes it that way because it allows a higher level of profit than what would be possible if the patient was the final “decision maker”. It is likely in such cases that the patient, being in control as the ultimate payer, would make a different decision than would the doctor or the insurance company, both of whom earn a larger profit than they could earn in a system where there was now true competition for patients. Much as in buying most consumer products you do have a wide range of choices. As for the cost of paying for basic health care services yourself, I suggest that you visit the website selfpaypatient.com, which is sponsored by WordPress. There is also a book which can be downloaded to your Kindle from the Amazon.com website.
Is it possible for patients to make such decisions? We have a great deal of available data as to the effects of different medications. Considerably more could be done in this field once patients become the decision makers. Most likely a company like Google could establish an effective program that would allow anyone who was willing to pay a fee to access a great deal of data. Somewhat similar to the offer that Amazon makes with its “Prime” system. Given this, along with a reasonable amount of study, most people would be able to make relatively intelligent decisions regarding their health care. It is also possible that learning to take care of your own health to a much greater degree than is possible today could be part of everyone’s high school education. An hour a day would be sufficient to cover the “basics”. Without prescription laws save for the two drug classes I’ve mentioned, the cost of taking care of your own health would be much less than it is today. It would certainly be more “useful” than a lot of stuff that students are taught. Knowledge that is never used once you graduate is simply a waste of time for both student and teacher. There are only a certain number of class room hours available, and they should not be wasted on low value things.