Archive for the 'health care' Category

The Government Qwns Your Body

June 26, 2009

…at least according to The Supreme Court of Canada.

Most at the CBC seem quite happy with this decision – that a 14-year-old-girl’s rights were not violated when she was given a forcible blood transfusion against her wishes.

Read that again.

To me, this is one of the most horrifying decisions any court has ever made. The Court has said, essentially, that this girl did not own and control her body. Not even her parents owned and controlled her body.  The Manitoba Child and Family Services department did.

For the record, I abhor the idiotic, superstitious nonsense that is religion and what it does to people. But so long as no one is harmed by this choice except the person making the choice or others that consent, then, yes, one is free to believe any mythological baloney they want.

Sometimes being free means letting people make choices that are not those we would make, or even choices that are wrong, or choices that are based on idiotic beliefs.

That girl was not being beaten, not being starved or otherwise abused against her will. She made the choice knowing the probable consequences. And no one but her would pay those consequences.

Ask yourself this – would you want some fundamentalist Christian sect or Muslim sect that somehow attained power to have this same power over your children, the power to invade their physical bodies against your wishes and theirs?

“Saving lives” is the same excuse used by the Chinese government to harvest the organs of Falun Gong prisoners. After all, if it means saving a life – especially the life of a child – why shouldn’t the state be able to invade your body against your will?

It is the excuse the fetus fetishists use to try to take away a woman’s right to choose or control her body as well.

That is exactly what this decision says – given a good enough reason (decided by them, of course) the state has the right to violate the bodily integrity of someone against their will, or against the will of their parents or legal guardians.

That is horrifying.

Don’t let our natural instinct to help a child open us to giving the state the power to control our bodies. That is far worse than one 14-year-old girl making a bad or stupid choice and dying.

The Problem with Canadian Healthcare

March 13, 2009

Its not what you think, at least not from a libertarian perspective.

The biggest problem with Canadian style universal health care is that, for most people, most of the time, it works well enough. Yes, that’s right, it actually works.

But that never stops some well-meaning people from misrepresenting the Canadian system for their own ends.

For my American friends (and possibly for some Canadians as well) let me do a quick primer on what our system actually is.

The main reason that our system works as well as it does is that, despite cries of it being a “Soviet style socialized medicine”, the Canadian system is actually a hybrid system, with private, for profit delivery and public, monopoly insurance for core care. That is, doctors, diagnostics, clinics, some hospitals and insurance for things not covered by the provincial insurance plans, are all private business, usually operating for profit, based on the number of patients and obtaining fees by billing the patients insurance. The difference is, there is only one insurance company – the state.

The state, either at the provincial or municipal levels, runs hospitals and can keep some costs down because they can buy, for instance, aspirin or antibiotics or bandages or wooden crutches in bulk from private suppliers.

In short, there is just enough private and market forces at play within the system so that it works pretty well. As a Canadian who has been in the system for his entire life, let me assure American libertarians that, much to their chagrin, we get high quality care, for the most part.

Emergency rooms still see people based on priority and waits for this kind of service are not outrageous.

The quality of treatment is exceptional.

The problem is, there is also just enough state interference and manipulation of market forces to be causing the system to be unsustainable and to deteriorate.  We now hove long wait times for necessary but elective surgeries like hip and joint replacements. We have to wait months to see specialists or to get the latest in high-tech tests. People cannot even find a family doctor in Ontario anymore. And the conditions of our hospitals are worsening.

A large part of this is due to a government doctor cartel. Anyone over 30 will tell you that in the 70’s and 80’s, we did not have these problems. But around 1990, after the infamous Barer–Stoddart report, provincial governments and various provincial and national medical associations conspired to keep the numbers of doctors practicing low, so that each individual doctor (and by extension the Canadian Medical Association, the CMA, which is essentially a doctor’s union) can earn more money.

The report stated that there was a glut of doctors and that somehow this was going to cost the system millions. So provincial government, with the blessing of the medical associations, reduced the number of places in our medical schools and placed incredibly high barriers to entry for foreign trained doctors.  As a direct result of this blatant interference by the state into the market for doctors (and applauded by the medical profession itself at the time) we went from having low wait times for treatment, and the ability to change doctors at will in the 80’s and early 90’s to what we have now – long wait times, and no choice in who your doctor is. Meaning today you cannot leave an incompetent doctor because there are no doctors accepting patients.

Provincial health regulations also require a doctor for even the most basic medical requests – a refill of a prescription, to tell you the results of a test etc. Often these require a visit to the doctor’s office, resulting in a bill to the provincial insurance plan, even if the visit lasted 5 minutes. The reduced number of doctors becomes the bottleneck in the system.

Diagnostic clinics can open, but are not allowed to “extra bill” clients for services  and may only bill the province for service. Based on a fee structure negotiated with the province ever few years. Meaning that if a new piece of equipment comes on the market, they cannot charge what the market would bear, but what the state says. And in the end, they simply don’t buy the equipment, or find it economically viable only to run the equipment during certain hours.

In the end, thanks to this interference in the market, at the behest of doctors in order to maintain their privileged positions, we get wait times and poor client service (though the quality of treatment is still high when we finally get it).

So, although Canada’s system is not the much ballyhooed “soviet bread line medicine” it has been made out to be, its ever growing issues are still the result of interference and manipulation of the market by the state. Indeed, it is a microcosm of our entire Western, state-capitalist system – it works “just good enough” to keep most people happy and thinking that it works.  Most people miss how the very serious and growing issues are caused by the state and those they serve and favour.

That is the most nefarious part of it. It is difficult to convince people that freeing it totally from the state would make it better, when they seem to believe that more government will make it better. Trying to convince people of that is immensely harder when those who could and should be allies completely miss-charaterize how the system works. It displays an ignorance that turns people away from our message of freedom, rather than too it.

Its about being truthful and having integrity.

Two years ago I wrote a post discussing some of these issue and demonstrating how the goal of universal health care could be obtained without the state. It seems like a good time to bring it up again.

I am perfectly able to advocate for free market healthcare while recognizing both the strength and weaknesses of the Canadian system. I hope that others can now do the same.

Universal Health Care without the State

March 7, 2007

One of the things I was known for during my statist days was as an ardent defender of Canada’s Universal Health Care system. As a social democrat, I took great pride in pointing to our system as one of the things that made us ‘Canadian’. I defended it on many occasions against the forces of “privatization”.

But I have come to realize that it is possible to have universal, affordable health care without the state.

What Universal Health Care without the State is Not

Before I discuss what Health Care without the state is, I need to stipulate what it is not.

It is not the US health care model. Indeed, that very model is ridiculed quite handily in “What Hunger Insurance Could Teach us about Health Insurance” from 1993.

It is not simply privatization of the health care system as we currently have it in Canada. That would simply give corporations that benefit from state cartelization the opportunity to buy “public” property at fire sale prices while giving them oligopoly control over health care market. That is certainly not universal, nor free.

It is not a false dichotomy of choice between an American system and a Canadian system. Both of these state sponsored and supported are deeply flawed in different ways. The American system sacrifices universality for expedience while being incredibly inefficient, expensive and often resulting in what is currently called “market failure” – high costs for services that are not needed while services that are needed are unfulfilled. The Canadian system, on the other hand, resorts to rationing in order to ensure universality. The system is more efficient, to be sure, and the rationing is done via time rather than choice (that is, we wait for longer times for procedures and tests, rather than making the choice between a hip replacement and a broken leg operation, although that does happen) but the system is still expensive and unresponsive to health care consumer’s needs. Both systems have conspired to take away free choice from consumers of health care and driven up costs of these services, so that only the wealthy can get decent care, in either system.

Lastly, it is not ‘survival of the richest’ health care, where only the wealthy can afford care and the poor continue to suffer.

What Universal Health Care without the State Is

It is exactly as it says, health care without the state. Health care services offered on a free market, insured in a variety of ways, also offered in a free market, with the choice and power to make health care decisions resting with the health care consumer. This may sound Utopian, but when compared to the problems our current system and their causes, the elegant simplicity becomes clear.

The biggest problem in our health care system today is a shortage of doctors. This is one of the biggest reasons for our long waiting lists and the kind of rationing we see. Combine this shortage with the fact that a doctor is needed for nearly every medical decision, no matter how minor, and we see via simple supply and demand why many health care costs are so high. This is not an accident of organization, though, but a well designed strategy. Medical organizations – essentially the doctor’s union – have colluded with the state to ensure that the supply of doctors has been kept artificially low. They ensure that provincial governments keep enrollment in medical schools are low, that foreign-trained doctors find it difficult or impossible to become licensed and that doctors, as opposed to nurses, nurse-practitioners or pharmacists, must be the ones to make even obvious medical decisions. This not only reduces the supply of doctors, but all but eliminates any competition for and among them. Right now in Ontario, you cannot shop around for a doctor as you are lucky to even have one – any one – in the first place. As a result, doctors are able to negotiate high fees from the government, often making twice as much as their European counterparts. And the a person has no choice but to go to a doctor – and only a doctor – for their health care needs. A monopoly control of supply, with all the common high prices, low quality and inefficiencies that accompany all monopolies.

Without the state, the consumer would have the choice in the market. Doctor’s would no longer be the bottle neck in the system. You could choose to go to a GP or a nurse practitioner.Indeed, you could choose a witch doctor, herbalist or a homeopath if you want. If you have a recurring ailment or condition, you would merely go to the pharmacist and request the medication. You could request your own tests and diagnostics. You would be able to mitigate your risks by being informed and having health competition for these services. And the competition, combined with a lowered barrier to entry, would drive the costs of these services down. Anyone properly trained (in you opinion, not a medical association, though association membership would likely be a deciding factor) could enter the market and compete on quality and price.

Of course, the costs of many procedures, diagnostics and tests would still be out of reach of all but the richest, so there would need to be insurance. One of the other problems encountered today is with insurance companies. Because of the twin demons of “moral hazard” and “adverse selection”, especially in the US, private insurance often drives prices up, and results in those that need service being denied while others are able to get unneeded services covered. These are driven by state-implemented tax breaks and regulatory requirements as well as the profit motive of insurance companies within the system. Insurance companies exists to make money by gambling on risk. They help individuals reduce their personal risk by spreading that risk among a large group. They make money by taking individual people’s premiums, pooling them and investing these funds. The less money paid out in settlements, the more money insurance companies make. Indeed, the purpose of an insurance company is to not pay out. Now combining this clear risk-adverse profit motive with regulations requiring insurance coverage for everything, including doctor’s visits, and allowing tax deductions for businesses spending on health insurance is a virtual recipe for market distortion and inefficiency. And too look at the US, that is what they have.

Stateless health insurance would be quite different. Firstly, it need not be typical ‘insurance’ at all. Current single-payer insurance like Canada’s are more efficient than the US insurance system because they are able to spread risk without also having profit-motive driven need to drop people to avoid adverse selection. This can be emulated in the free market by consumer’s cooperatives or not-for-profit insurance, similar to he way credit unions operate in the banking sector – they would exist to provide medical services and insurance to their members. These cooperatives could offer not just insurance, but the actual service of the doctor, diagnostic technical or other health care provider. The health professionals may themselves form cooperatives or partnerships that may work with or compete with consumer coops. There would also be for-profit insurance companies competing against these agencies on price, quality of care and facilities. Again, the greater competition and elimination of barriers to entry will drive prices down for these services.

Consumers could choose to only insure for catastrophic health emergencies, like cancer and heart attack and pay for every day expenses out of pocket. They could choose to enter a consumer coop to share all expenses or sign up for a local one-stop-health shop or medical practitioner coop that offers it all as part of the monthly subscription fee. Or they could purchase it as they do now from an insurance company.

The medical practitioners, coops, clinics, hospitals and diagnostic facilities could choose accept whatever payment was appropriate. Some may accept cash, trade, barter or credit or any combination thereof. Some may do weekly volunteer work at a clinic for the poor in exchange for other kinds of labour. Some may be supported by churches, unions, coop associations (like the current Mondragon in Spain) or any other voluntary, member supported mutual aid society. In this, the poor and dispossessed will still be able to access health care, likely easier and faster than they can today.

In the end health care without the state would offer greater consumer choice and greater practitioner latitude in service and payment all at lower cost, because of greater supply and competition in the all areas. With lower costs, and higher income (because of no taxes) an more options, health care can be universal, efficient and affordable.