In my previous post, I hope I managed to express my views of the ‘system’ as an unmitigated disaster.
What makes it a disaster, is government intervention and control.
Patent laws and regulations created an environment that successfully screwed up medical research, education, knowledge exchange and public policy. Regulatory monopolies made costs escalate out of control.
Socialized medicine and heavy regulation of health insurance providers completely destroyed healthy market signals. Neither patients nor doctors have a clear idea about the actual costs of various treatments resulting in shortages and escalating costs.
Medical licensing created a shortage of doctors, an ossified and inflexible medical consensus and a body of overworked, stressed, sometimes depressed and very often bitter, jaded, burnt out or cynical doctors.
The state of health care is not healthy. The medicine it needs is freedom.
How should it work? Very simple: no state/government intervention whatsoever.
- A system where I am not only responsible for, but also fully in control of my own health and its care.
- A system where I control every single dollar that is spent on my health.
- A system where I personally pay for every medical service I receive (just as I pay my dentist or optometrist today)
- A system where doctors work for ME, not the government and the drug companies.
- A system that would incentivise health care providers to pay more attention to my needs that the needs of the system.
- A system where the government does not take my money to finance the decisions it makes on my behalf about my health.
- A system where the primary job of medical associations is helping their members to become the best they can be. NOT the advocacy of their political interests.
- A ‘system’ with no limitation on who I get that care from. No medical licensing whatsoever.
- No drug licensing either.
- A system without imposed and enforced “guidelines” for drugs, diet and medical practices.
Let’s look at some hypothetical examples:
My health insurance
- As a child of responsible parents, I had a health insurance account from an early age.
My health insurance account has two components: catastrophic event insurance and a savings account.
- The money in the savings account is MY money. It is possibly a tax-free savings account with the only limitation that money from it can only be spent on medical services. Any kind.
- How much I contribute each month and how my savings are invested is between me and my insurer. Beyond some basic fiduciary due diligence, nobody should have a say in it. My contribution is designed to make my reserves steadily increase with age. I pay for every regular service, test or drug from this account.
- The catastrophic event insurance has a deductible. When needed, I can decide whether to pay it from the savings account or out of pocket. The amount of that deductible is a decision between me and the insurance company.
- My workplace has absolutely nothing to do with my health insurance. They may provide some allowance as a benefit, but the content of my insurance is an entirely private matter.
- My insurance company also has some power over my policy. It cannot just cancel it, but it can place conditions based on the risk they face resulting from my lifestyle. They can increase the premium on the catastrophic part of the insurance if they foresee extra expenses due to my life-style from let’s say smoking or obesity. Such power to influence my behaviour is a service to me.
- If I happen to have a chronic condition, my savings requirement will go up accordingly.
- In a completely unregulated market, there will be a competition for the management rights of my health insurance savings and spending account. I can move my account at will.
- My insurance provider, or possibly another company, a medical information custodian, may provide me with a smart card (or cloud app) that keeps track of my full medical history right in my pocket. I will have full control over who can access the data. My only limitation is that I cannot delete any information and I have to authorize my information custodian to release it in case of emergency.
- I can use the same card/app to participate in medical studies if I so choose.
- I have a family doctor, who is working in a small collective that is able to provide a 24 hours service with someone always on call.
- I know that my doctor is competent and trustworthy because she has a certificate from a certification authority I trust. She shouldn’t need to have such a certificate, I may trust her on the recommendation of a relative or a friend, but I, like most people, chose a respectable company to vouch for her. I don’t need a licensed physician, just a certified one.
- The consultation fees of my doctor are clearly indicated. I may choose to take her offer and sign up with her collective with a monthly/yearly retainer to give me a little break on the price of individual visits. The options of my financial arrangements with my doctors, specialists and hospitals will only be limited by the creativity of the market, but since it is my responsibility, I will be in control of it.
- My doctor’s primary goal is to keep me healthy. I may choose a traditional interventionist doctor or another that focuses more on prevention and natural therapies. I hope to find a collective where doctors of different styles of medical philosophies work together.
- My doctor may perform some simple services such as ECGs or simple x-rays. With the advance of technology, they may even do their fully automated lab works in-house.
- When my doctor refers me to a specialist, she explains to me why, what she thinks and what I can expect from the specialist to find out. I would expect her to have some ideas about the cost.
- My relationship with the specialist will be no different from the one with my family physician: clearly defined services with equally clear prices, paid from my health savings account or insurance.
- My doctor will understand that a significant percentage of our illnesses are metabolic in origin and will not hesitate to refer me to people who can help me to heal myself with lifestyle changes. In an optimal world, she will advise me herself.
- Unregulated, hospitals will be more competitive (therefore more reasonably priced) with a greater range of service level options.
The pharmacies and drugs
- While in a system of free health care there are no such things as prescription drugs, my pharmacist may choose to only sell certain drugs if they were ‘prescribed’ by doctors accredited to his standards and if those drugs are safe according to his knowledge. I can (and probably will) live with that or have to find another pharmacist.
- In a world of free health care, drug companies will not have much power. Their patent rights will be limited and they will have to contend with all the competition from alternative therapies and treatments that they were able to suppress when they had corrosive political power.
Drugs as a result will be cheaper and safer. Irresponsible drug companies will be sued and driven to bankruptcy, therefore out of business.
- Executives of drug companies will be criminally liable for fraudulent business practices.
Falsifying research findings, willful neglect, withholding life affecting information etc.
Medical research and literature
The favourite argument of drug companies to justify their prices is research. Without their heroic efforts there would be no new drugs, no new medical inventions. Without the generosity, diligence and benevolence of the pharmaceutical industry, we would have to revert to medieval medicine.
While it could be argued (and drug companies do argue) that the reason for high drug prices is medical research, I believe that we would have more and better research.
- In a free world, medical research is financed by individuals, philanthropies and crowd funding.
- In a free world, clinical trials are the private business and expense of pharmaceutical companies. Their aim is quality and safety control, not licensing.
- The results of such trials are open to the public, with all raw data and findings available for scrutiny.
- Medical journals and their editors should be pilloried for even the hint of conflict of interest.
It could be argued, as many do (Dr. Robert Lustig, for example), that type 2 diabetes is a ‘processed food disease’. He further argues, that for public health reasons, all agricultural subsidies for corn, wheat, soy and sugar should be eliminated.
The point here is that I cannot even dream up an ideal health care system without the need to demand an all-out libertarian world. Our health care isn’t simply screwed up by greedy corporations, it is screwed up by government policy that incentivizes greedy corporations to overproduce some crops that have a demonstrably detrimental effect on our health.
- In an ideal world, the government does NOT manipulate markets, does NOT interfere with the market, does NOT manipulate our food supply.
- In an ideal world, the government does not take sides in scientific debates.
- In an ideal world, the government’s only responsibility is to prosecute companies that cause harm or commit fraud.
- In an ideal world, whistleblowers who expose such harm and fraudulent practices are celebrated and rewarded.
Other scenarios and concerns
But WHAT IF………? What if I am an irresponsible bum? A drunk drug addict who never saved a penny for his healthcare. What I would deserve to get from society is exactly nothing. What I would get in an ideal world is a lot more. Compared to Bill Gates, I would get crappy service. Compared to my hypothetical alter ego described above, I would get adequate service. Compared to what I pay for it, I would get the best medical service there is.
- In an ideal world there would be hospitals to provide basic services to the needy.
They would be financed and maybe even built by charities. They would be staffed by doctors who care. Either pro bono or paid by people who care. Helped by volunteers.
- In an ideal world, there would be clinics run by volunteer doctors and nurses or ones paid from the voluntary donations of the well-meaning rest of us.
The services provided by a system built on charity will not be of the same quality as the services provided to those who pay, but nobody would be dying in the streets.
I do not want to derail this post into an argument about the morality of a libertarian society, I only made the above points to show that a better system can easily be imagined. A system that is less corrupt and corruptible, more rational and caring than the one we have.
What are the chances of such a system to ever becoming a reality? Slim, but not entirely hopeless.
- We can decouple ourselves from the system to some extent. I learned not to trust my doctors; something I can recommend to everybody. Don’t trust anybody. Learn as much as you can about your condition and make up your own mind. Do not trust prescription drugs. Again, learn anything about them that you can and seek out natural alternatives.
- Understand that metabolic syndrome is the foundation of a host of serious ailments, such as hypertension, Atherosclerosis and type 2 diabetes. Lifestyle changes can fix most of them. They will not be easy, but they can be done. Go through the links in my hearty bibliography for hints.
- Support initiatives aimed to change the corrupt system and spread the news.
Share this post, the whole series and any link you find credible in the long list of references I put together.
- Support this blog and all the others who fight for better health care, better science, less corruption and more personal freedom when it comes to our health.
Our lives depend on it.
…and don’t despair. Change is in the air.
I am fully aware that the ideas expressed above will be offensive to most people.
I am both willing and able to defend every one of them because I firmly believe that they wold create a better world with a health care system that is better than the one we have now. Not a perfect one, but a better one.
This post is part of a series about health care.
You can find the rest here:
A heartfelt story – the personal aspects of the story
Some heartfelt discoveries – what I learned once I looked into it
A hearty bibliography – A seemingly unending list of references to those discoveries
A heartfelt analysis – A critical exposé of the root causes of the problem
My heartfelt wishes – A libertarian answer to the problems
A heartfelt letter – A letter of frustration with a libertarian message
Healthy thoughts – Final thoughts and a the personal aspects of the story