Thoughts, essays, and writings on Liberty. Written by the heirs of Patrick Henry.

November 17, 2008

Atlas Starting To Shrug In Healthcare Sector

by Brad Warbiany

While I am a vociferous opponent of socialized medicine or even some of the mandated-coverage plans floated by the left-ish folks in society, you’ll not find me defending our current healthcare system in America. Why? Because it’s “our healthcare system”, and not anything approaching a free market.

Through coverage mandates, Medicare, restrictions, licensing, employer-sponsored healthcare (an outgrowth of tax-advantaged treatment for companies), tort law, and mountains of paperwork, we’ve turned healthcare in America into a nuisance. Should we surprised, then, when our doctors have grown tired of playing the game?

Primary care doctors in the United States feel overworked and nearly half plan to either cut back on how many patients they see or quit medicine entirely, according to a survey released on Tuesday.

And 60 percent of 12,000 general practice physicians found they would not recommend medicine as a career.

“The whole thing has spun out of control. I plan to retire early even though I still love seeing patients. The process has just become too burdensome,” the Physicians’ Foundation, which conducted the survey, quoted one of the doctors as saying.

Eleven percent said they plan to retire and 13 percent said they plan to seek a job that removes them from active patient care. Twenty percent said they will cut back on patients seen and 10 percent plan to move to part-time work.

Current government proposals promise to “rein in costs” but I wonder how they intend to both rein in costs and keep supply from dropping.

The only happy doctors I know of are ones who have decided to work on a cash basis, and do not take insurance. Of course, they don’t stop their customers from claiming the visits to their own insurance, but they don’t take care of all the paperwork in the office. In the pediatric practice we take my son to, the head doctor (who is somewhat famous having written several books) follows this plan. Sadly, too few doctors have this opportunity, as most Americans either don’t have the time and energy to deal with the insurance companies themselves, or don’t have the funds to carry the cost while they wait. For my son, we visit one of the other doctors in the practice because we don’t have the time or knowledge to traverse the insurance world.

Regardless of what sort of healthcare system we have in America (even if we returned to a free market), Americans will have to understand that health care is not a free lunch. What we may have now may be (like many things in America) the worst of both worlds — all the downsides of socialism without any of the efficiencies of capitalism. In such a minefield of cross purposes and inefficiencies, it’s not surprising that many providers are willing to walk away.

With the potential socialization of health care in an Obama administration, we may soon find ourselves in the same situation as Britain — importing our doctors from overseas because it becomes a job “Americans won’t do”.

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  • http://pith-n-vinegar.blogspot.com/ Quincy

    The whole problem in our health care system is “who pays for lunch”. The situation for 99% of Americans is one of two: Your doctor works for the government or your doctor works for the health insurance company who works for your employer. Only under such an idiotic system could patients be very unsatisfied while resources spent skyrocket.

    Note that our system is quite unintentionally idiotic, at least the employer-provided insurance part. It’s a vestigial tail of the FDR-era wage and price controls that we’ve never been able to shed in favor of a real free market. Now, then damned socialists are going to take what little freedom we have in getting health care by claiming the situation we’ve had for the last 65 years was a “free market”.

  • Medic

    Atlas is shrugging.

    I’m a critical care paramedic with a B.S. and a 35 MCAT. I decided to forego medical school, because I know it would mean undertaking hundreds of thousands of dollars in debt, all for a job where I would pay six figures in taxes and be required by federal law (EMTALA) to give away my labor for free.

    You cannot find ER physicians who would recommend the career to their children.

    Incentives matter. I’ll go work in the grey-market rather than suffer this looting.

  • jeremiah

    I’m a die hard civil libertarian, but once you watch a family member go into bankruptcy over medical bills DESPITE their “good” private health insurance, the free market approach to health care seems more than a bit trivial. Something needs to be done, but we have drug companies marketing poison and the medical education establishment colluding as a cartel to limit the numbers of new doctors – free market economics will not translate into a real world solution to these problems without a lot of deaths and bankruptcies along the way. In a modern society with advanced medical knowledge, an individual’s access to health care has become a inalienable privileged. I’m for a Constitutional amendment that would grant the Federal government the power to create a national insurance pool while guaranteeing an individual’s right to manage their own health care consumption.

  • http://www.duoism.org a Duoist

    When capitalism became prosperous enough in the 19C for Left-liberals to institute the inefficiencies and elitism of the welfare state, the long-term benefit to capitalism became the permanent impossibility that there will ever be a proletarian revolution in a modern, industrialized, welfare state. The welfare state co-opts the revolutionary; he’ll not blow up his monthly food stamp allowance or rent subsidy. An ugly and expensive situation to be sure, but the alternative–embittered fanatic revolutionaries without any stake in civil society–is far more expensive (see: jihadism).

    Is capitalism now prosperous enough to afford ‘universal’ health care? At what point does capitalism’s prosperity become obscene by the numbers of people in the system who have no health care? Can incentives to end a career in medicine be corrected to encourage careers in health care? If Left-liberals want to socialize medicine, shouldn’t the profession of tort law be socialized first? Isn’t our libertarian argument–that there has never been a ‘free market’ in health care so we should deregulate the industry–exactly mirror the socialist’s constant argument that there has never been a ‘true’ socialism, so one should be implemented as a showcase for what the ideology can really accomplish about ‘equality’?

    When do we capitalists become so wealthy that the lack of ‘universal’ health care is used to kill capitalism? Capitalism is, to paraphrase Marx, a goose “laying golden eggs.” We should argue with the Left and Right about how to spend the eggs; we should never allow our philosophy give an excuse for either the Left or Right to kill the goose.

    The welfare state is a credit to the prosperity a people obtain from capitalism; without prosperity, a welfare state is impossible and revolutions erupt constantly. Are we close yet to recognizing that it is capitalism–not ever socialism–which can design and afford quality universal health care?

  • Medic

    jeremiah is unfortunately a “libertarian-but”… a species even more reviled than normal statists.

    the drug companies marketing “poison” have made it impossibly difficult to die of polio, or scarlet fever, and CHF and a multitude of other diseases that used to kill homo sapiens fairly easily.

    “In a modern society with advanced medical knowledge, an individual’s access to health care has become a inalienable privileged.”

    It sounds so pleasant to phrase it in this socialist jargon, but just remember that SOMEONE, somewhere must ultimately hold the gun to the physicians head and demand that they give treatment…afterall, it’s your RIGHT to his labor, his time, his body, you OWN him…right? It’s your RIGHT! Although, as a self described civil libertarian it will be interesting to see how you justify this violation of private property…

  • annnort

    What we need to “socialize” in this country are the lawyers! Lawyers have made our life miserable in many ways. They make all the laws and favor themselves! Lawyers are putting doctors out of business by getting ridiculous amounts for their clients resulting in the medical profession’s having to pay exorbitant insurnace fees. That with getting partial fees for Medicare and Medicade patients put the burden on patients who have regular insurance thus increasing insurance premiums. My whole social security check goes to pay for supplemental and prescription insurance for my husband and me. With only Medicare we would not have a doctor. Too bad the lawyers in congress are trying to figure out the health insurance mess. They helped cause it!!

  • Akston

    I already hijacked another thread to suggest the inevitable consequences of assuming anything produced by other people is an inalienable privilege or right. My conclusion was much like Medic’s.

    What will you do when a physician refuses to work at rates you specify? What do you do when a mechanic refuses to fix your car at rates you specify? What about a grocer who refuses to sell you food for a price you specify? Do you find a competitor? Do you bargain? Do you organize and join voluntary consumer groups? Or do you find a man with a gun (and a badge) to force the trade? Either we’re trading voluntarily, or we’re not. If we’re not, who will be the masters and who will be the slaves? Whose effort and property belong to whom?

    Amendment 13 of the United States Constitution prohibits involuntary servitude. That works for picking cotton and practicing medicine.

    Also, when reading the responses, I find it interesting to watch for how often a writer uses the first person plural. “We” must do this. “We” have the capacity to do that. Whenever I hear that introductory word, I brace myself to be volunteered into the author’s plans. Who is “we”? Have you consulted the other members of the group you’ve defined? Do you want to be consulted before someone else disposes of your life’s efforts and property? “Society” may be a definable abstract collective concept, but “society” can’t “want” or “need” or “produce” anything. People do those things. I do. You do. And it’s not okay for me to dispose of your life’s efforts without your consent.

  • http://pith-n-vinegar.blogspot.com/ Quincy

    Medic –

    In my experience, “civil libertarians” are those who like the social liberties like free speech and privacy but couldn’t give a hoot about the things that underlie them–the rights to life and property.

    Duoist –

    Isn’t our libertarian argument–that there has never been a ‘free market’ in health care so we should deregulate the industry–exactly mirror the socialist’s constant argument that there has never been a ‘true’ socialism, so one should be implemented as a showcase for what the ideology can really accomplish about ‘equality’?

    That’s a fine line of reasoning, but it’s not quite true. We haven’t had a free market in health care since WWII. Before then, people could get health care, limited by the understanding of the day, for a reasonable price. Compensation passed directly from patient to doctor.

    The problems arose when we started placing middlemen into the equation–employers and insurance companies and the government. Each of these add little value but consume many resources. Add to that the cost imposed by the damned dirty lawyers who make the responsible practice of medicine damned near impossible, and here we are.

    We had a free market, and it worked. Libertarians want to get BACK to what worked.

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